Iran’s cash-for-kidney programme mired in controversy

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  Surgery tools during a kidney transplant operation at Modarres Hospital in Tehran, Iran. Ebrahim Noroozi/AP Photo

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  Handwritten advertisements for kidneys for sale, that include the sellers’ phone number and blood type, posted on a door in downtown Tehran, Iran. Ebrahim Noroozi/AP Photo

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  Iran has a unique system allows those in need of a transplant to buy a kidney. Ebrahim Noroozi/AP Photo

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  The programme has seen Iran’s waitlist for kidneys effectively drop to zero, but some ethicists worry about the system taking advantage of the poor worldwide to black-market organ sales. Ebrahim Noroozi/AP Photo

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  Sajjad Ghanbari undergoes a medical exam as part of the process of selling his kidney, in a clinic in downtown Tehran. Ebrahim Noroozi/AP Photo

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  Hassan Hamdampay uses a dialysis machine at a clinic in downtown Tehran on August 6, 2016. Ebrahim Noroozi/AP Photo

TEHRAN, IRAN // The whirling hum of a dialysis machine could have been the soundtrack to the rest of Zahra Hajikarimi’s life but for an unusual programme in Iran that allows people to buy a kidney from a living donor.

Iran’s kidney programme stands apart from other organ donation systems around the world by openly allowing payments, typically of several thousand dollars.

It has helped effectively eliminate the country’s kidney transplant waiting list since 1999, the government says, in contrast to western nations like the United States, where tens of thousands hope for an organ and thousands die waiting each year.

Critics warn the system can prey on the poor in Iran’s long-sanctioned economy, with ads promising cash for kidneys.

The World Health Organisation and other groups oppose “commercialising” organ transplants. Some argue such a paid system in the US or elsewhere could put those who cannot afford to pay at a disadvantage in securing a kidney if they need one.

But as black-market organ sales continue in countries like India, the Philippines and Pakistan and many die each year waiting for kidneys, some experts have urged America and other nations to consider adopting aspects of Iran’s system to save lives.

“Some donors have financial motivations. We can’t say they don’t. If [those donors] didn’t have financial motives, they wouldn’t ... donate a kidney,” Hashem Ghasemi, the head of the patient-run Dialysis and Transplant Patients Association of Iran (Datpa), said. “Some people just have charitable motivations.”

Those interviewed stressed the altruistic nature of the programme – even as graffiti scrawled on walls and trees near hospitals in Iran’s capital advertised people offering to sell a kidney for cash.

As far as organ donations go, kidneys are unique. While people are born with two, most can live a full, healthy life with just one filtering waste from their blood. And although a donor and recipient must have a compatible blood type, transplants from unrelated donors are as successful as those from a close relative. In addition, kidneys from a living donor have a significantly better long-term survival rate than those from a deceased donor.

Iran started kidney transplants in 1967 but surgeries slowed after the 1979 Islamic Revolution. Iran allowed patients to travel abroad through much of the 1980s for transplants – including to America. But high costs, an ever-growing waiting list of patients and Iran’s grinding eight-year war with Iraq forced the country to abandon the travel-abroad programme.

Iran created the programme in 1988. A person needing a kidney is referred to Datpa, which matches those needing a kidney with a potential healthy adult donor. The government pays for the surgeries, while the donor gets health coverage for at least a year and reduced rates on health insurance for years after that from government hospitals.

Those who broker the connection receive no payment. They help negotiate whatever financial compensation the donor receives, usually the equivalent of $4,500 (Dh12,216). They also help determine when Iranian charities or wealthy individuals cover the costs for those who cannot afford to pay for a kidney.

Today, more than 1,480 people receive a kidney transplant from a living donor in Iran each year, about 55 per cent of the total of 2,700 transplants annually, according to government figures. For Hajikarimi, a 52-year-old Iranian mother of two, a transplant cannot come soon enough. Her kidneys failed, with doctors finding higher-than-normal protein levels in her urine, and she has been on dialysis for four months.

In that time, physicians determined Hajikarimi can undergo a transplant and the nonprofit group managing her case began looking for a donor, a process that typically takes up to six months.

Iran says its system safeguards against black-market organ sales by having the nonprofit groups handle all arrangements and hold money in escrow until after the surgery. The government’s health department also must approve the surgeries, which take place in licensed and monitored hospitals.

Foreigners are now largely banned from taking part, squelching the possibility of medical tourism.

However, it is clear that some donors are motivated by the cash payout. Inflation and unemployment remain high in Iran even after last year’s nuclear deal with world powers that saw some sanctions lifted.

One man said he applied to sell one of his kidneys to pay off his debts in Iran where debtors can be imprisoned.

“I am here because if I don’t get the money my entire life will be ruined,” said the man, who spoke on condition of anonymity for fear of ruining his professional image. “My life and my public face are in danger. This has driven me to do this.”

* Associated Press