Tuesday, May 29, 2012

Why Iran's Kidney Market Should Not Be Emulated


Iran currently is the only country where the buying and selling of kidneys is legal. Pro-market advocates (who generally know nothing about the reality of living kidney donation) and those whose main concern is increasing kidneys for would-be recipients (usually those who benefit from such an arrangement: surgeons, recipients themselves, etc) praise Iran for their novel problem-solving.
Except that all evidence indicates the system is hella bad for the people giving up the kidney.

One of the chief objections to a kidney market is that possible exploitation of the poor or vulnerable. What's this article's title?
"Kidneys for sale: poor Iranians compete to sell their organs"
Within the article:
"..the number of ads [kidneys for sale]  has made the streets of Tehran into a sort of kidney eBay"

I don't think the author's use of Ebay in this sentence was accidental. After all, what did Ebay build their brand on? Getting something of value for the lowest price possible.

the majority of people selling kidneys are aged 20-30
Smack dab during a woman's child-bearing years when pregnancy is stressful for the kidneys, and when we have evidence that living kidney donors under the age of 35 are at the highest risk of long-term adverse effects (kidney stones, hypertension, diabetes, cardiac disease and death, and kidney disease and death)

Despite the state control, bureaucracy and time-consuming procedures have left the door open for non-official direct negotiations, making the Iranian system more like a kidney market.
This is what all those pro-market advocates in the US must realize. The US govt will, in no way, be able to monitor, oversee or control a kidney market once it is implemented. Hell, these are the same people that haven't ensured proper protections and research for living donors in nearly 60 years, and who were told about Rosenbaum's organ trafficking ring a decade before they finally did something about it.

"The majority of those selling kidneys in Iran are disproportionately poor, and information about the long-term outcomes for sellers is quite limited." 
Exactly.

In the US, more than 100,000 people were estimated to be on the waiting list for kidney transplants in 2010 – waiting lists were eliminated in Iran in 1999.
Aaaand - bullshit. 1/3 of the US kidney wait list is 'inactive', so they couldn't have a transplant if a kidney were available. Sure, Iran eliminated their wait list but at what cost?
- What was their wait list before implementing this system?
- What is their population in comparison to the US?
- What is the average age of someone in Iran who needs a kidney transplant versus someone in the US? (In the US it's 64.4 yrs; are folks in the US simply living longer and therefore age is catching up with our kidneys?)
- What are the underlying diagnosis requiring a kidney transplant in Iran? (In the US, it's diabetes, most of which is preventable or treatable, meaning that many transplants might be avoided with the right early healthcare and lifestyle changes)
- What is the average lifestyle in Iran vs the US? Do they have the same rates of obesity, the same overall unhealthy diet?

If one is only concerned about would-be recipients, or one benefits from organ transplants, then a kidney market is something to consider. But if one believes that all people deserve equal consideration, then harvesting a major organ from a living person in return for money or other incentives is not acceptable. Pragmatically, there is simply no way to control for abuses and manipulations. Even Iran admits "...that there are many different systems, rather than a single unified system in Iran."
But more so, as I hope my queries above indicate, Iran is not the United States. Supply side economics in this case Will Not Work. The only way to address the so-called kidney shortage is to decrease the demand. Focus on prevention and treatment. Ensure high quality matches. Encourage deceased donation. But under no circumstances, and certainly not the ones that exist in the US in regards to LDs lack of standards and/or data, should the public's needed body parts be on the auction block. Such a thing completely negates human dignity, despite the libertarians simplistic protestations.



Full article available here.