In Iran, unique system allows payments for kidney donors

2016-08-25 20:05
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Tehran - 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 doctors and other 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 said. "And some people just have charitable motivations."

Altruistic

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.

In 1988, Iran created the programme it has today. A person needing a kidney is referred to the Dialysis and Transplant Patients Association, 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. 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% of the total of 2 700 transplants annually, according to government figures. About 25 000 people undergo dialysis each year, but most don't seek transplants because they suffer other major health problems or are too old.

About 8- to 10% of those who do apply are rejected due to poor health and other concerns. The average survival rate of those receiving a new kidney is between seven to 10 years, though some live longer, according to Iranian reports.

Medical tourism

Iran says its system safeguards against black-market organ sales by having the non-profit 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. But Iranians who are dual nationals can benefit from the programme.

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