Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran

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Kidney transplantation in the United States isburdened by a terrible policy failure. The cost ofthis failure will be paid in the currency of years ofhuman lives unnecessarily lost, as well as a massiveincrease in federal expenditures over the nextdecade and beyond. The number of patients withend-stage renal disease (ESRD) in the UnitedStates has grown, but the supply of kidneys—forthe preferred treatment for ESRD, kidney transplantation—has not kept pace with the demand.Unfortunately, the issue is not simply one of supplyand demand: in the United States the supplyof kidneys for transplantation is kept artificiallylow by a prohibition on the sale of human organs.

If a decade's worth of reports in the transplantliterature are to be believed, only one countryin the world does not suffer from an organshortage: Iran. Although Iran clearly does notserve as a model for solving most of the world'sproblems, its method for solving its organ shortageis well worth examining. Organ donation isubiquitous throughout the world, but Iran is theonly country that legally permits kidney vending,the sale of one individual's kidney to another sufferingfrom kidney failure.

After a critical examination of what can belearned from the Iranian experience that will helpthe United States solve its organ shortage, certainconclusions seem inevitable: The portion of theNational Organ Transplant Act of 1984 whichprohibits the sale of organs should be repealed.The savings that will likely accrue should be spenton long-term study and maintenance of the vendorsystem and on the creation of mechanisms toensure fair trading. Finally, because so much isstill unknown regarding how organ sales wouldwork in the United States, individual transplantcenters and organ procurement organizationsshould be permitted to experiment with how toimplement a system of organ vending.

Benjamin E. Hippen

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 editor of the American Journal of Transplantation.