Cato study finds Iran a surprising model for kidney markets

Iran's compensation program completely eliminates kidney shortage

March 20, 2008

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WASHINGTON — The United States suffers from an acute shortage of kidneys for transplant, with 73,000 people waiting for deceased donors to make organs available.  Allowing compensation for donors, an idea that has allowed Iran to completely eliminate its waiting lists, would help solve this problem, reports a new study by the Cato Institute.

In “Organ Sales and Moral Travails,” Benjamin E. Hippen, MD, transplant nephrologist, shows that Iran’s system of compensated donation has effectively provided the organs needed for transplant. “Iran is the only country that legally permits kidney vending,” he writes. “The waiting list for kidneys was eliminated in 1999, 11 years after the legalization of organ vending, and for the past 8 years, Iran has had no waiting list for kidneys.”

Concerns about the negative impacts of offering financial incentives for kidney donation naturally arise. Hippen reports that Iran has addressed this problem by putting a non-profit intermediary between potential kidney vendors and patients in need. “Separating the role of identifying vendors from the role of evaluating their medical, surgical, and psychological suitability permits transplant professionals to avoid confusing judgment on a vendor’s candidacy with various financial and professional incentives to perform more transplants,” Hippen writes.

Though the Iranian system is not perfect, it offers lessons that would be of value to American policy makers seeking to reduce the United States’ tragic organ shortage by setting up markets. “A review of 20 years of experience with a living organ vendor system in Iran reveals successes, deficiencies, and ambiguities,” Hippen concludes. “If the discussion of kidney markets in this country can progress beyond preconceptions as to what can and cannot work, in Iran or elsewhere, to an examination of the example of the Iran based on the evidence, that will be a significant step in the right direction.”