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No. 614

March 20, 2008

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Organ Sales and Moral Travails

Lessons from the Living Kidney Vendor Program in Iran

by Benjamin E. Hippen

Executive Summary

age is well worth examining. Organ donation is

Kidney transplantation in the United States is

ubiquitous throughout the world, but Iran is the

burdened by a terrible policy failure. The cost of

only country that legally permits kidney vending,

this failure will be paid in the currency of years of

the sale of one individual's kidney to another suf-

human lives unnecessarily lost, as well as a massive

fering from kidney failure.

increase in federal expenditures over the next

After a critical examination of what can be

decade and beyond. The number of patients with

learned from the Iranian experience that will help

end-stage renal disease (ESRD) in the United

the United States solve its organ shortage, certain

States has grown, but the supply of kidneys--for

conclusions seem inevitable: The portion of the

the preferred treatment for ESRD, kidney trans-

National Organ Transplant Act of 1984 which

plantation--has not kept pace with the demand.

prohibits the sale of organs should be repealed.

Unfortunately, the issue is not simply one of sup-

The savings that will likely accrue should be spent

ply and demand: in the United States the supply

on long-term study and maintenance of the ven-

of kidneys for transplantation is kept artificially

dor system and on the creation of mechanisms to

low by a prohibition on the sale of human organs.

ensure fair trading. Finally, because so much is

If a decade's worth of reports in the trans-

still unknown regarding how organ sales would

plant literature are to be believed, only one coun-

work in the United States, individual transplant

try in the world does not suffer from an organ

centers and organ procurement organizations

shortage: Iran. Although Iran clearly does not

should be permitted to experiment with how to

serve as a model for solving most of the world's

implement a system of organ vending.

problems, its method for solving its organ short-

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Benjamin E. Hippen, MD, is a transplant nephrologist in private practice with Metrolina Nephrology Associates

and the Carolinas Medical Center in Charlotte, North Carolina. He is an at-large member of the United Network

for Organ Sharing/Organ Procurement and Transplant Network Ethics Committee and serves as an associate edi-

tor of the American Journal of Transplantation.