The market for kidneys in Iran

The Iranian economist Farshad Fatemi at the Sharif University of Technology sent me this link to his very interesting working paper The Regulated Market for Kidneys in Iran.

Among other things, it is full of institutional detail and comparisons. Here are a few things that caught my eye.

Comparing total (live plus deceased) kidney donation across countries, per million population, the most recent figures (from 2007) are Iran 27.1%; UK 33.5%; Spain 49.5%; US 54.7%. (His source is the Barcelona-based Transplant Procurement Management Organization, whose international database I have yet to fully explore.)

His description of the market for kidneys in Iran includes the following

"After the donor passes the initial tests, the administrators contact the first patient in the same waiting list as the donor’s blood type [and other components of a match]...
If the patient who is on the top of the waiting list at the moment is not ready for the transplant ..., the next patient will be called... until a ready patient will be found. Then a meeting between the two parties is arranged (they are provided with a private area within the foundation building if they want to reach a private agreement) and they will be sent for tissue tests. If the tissue test gives the favourable result, a contract between the patient and the donor will be signed and they will be provided with a list of the transplant centres and doctors who perform surgery.
When the patient and the donor are referred to transplant centre, a cheque from the patient will be kept at the centre to be paid to the donor after the transplant takes place. The guide price has been 25m Rials (≈ $2660) until March 2007 for 3 years and at this time18 it has been raised to 30m Rials (≈ $3190). This decision has been made because the foundation was worried of a decreasing trend in number of donors.

"In some cases, the recipient will agree to make an additional payment to the donor outside the system; it is not certain how common this practice is, but according to the foundation staff the amount of this payment is not usually big and is thought to be about 5m to 10m Rials (≈ $530 to $1060). The recipient also pays for the cost of tests, two operations, after surgery cares, and other associated costs (like accommodation and travel costs if the patient travels from another city). Insurance companies cover the medical costs of the transplant and the operations are also performed free of charge in state-owned hospitals.
"In addition, the government pays a monetary gift to the donor for appreciation of her altruism (currently, 10m Rials), as well as automatic provision of one year free health insurance, and the opportunity to attend the annual appreciation event dedicated to donors...
"The minimum monthly legal wage for 2007 was Rials 1,830k (later raised to 2,200k for 2008). The minimum payment of Rials 45m is around 2 years of minimum wage. "
...
"[T]o prevent international kidney trade, the donor and recipient are required to have the same nationality. That means an Afghan patient, who is referred to the foundation, should wait until an Afghan donor with appropriate characteristics turns up. This is to avoid transplant tourism. "
...
"the donors are mostly men (Table 7). This can be because of the two facts. Firstly, the ages between 22 and 35; when the donation is accepted; is the fertility age; and women are less likely to be considered as potential donors. Secondly, as we mentioned before since men are supposed as the main breadwinner of the family, it is more likely that they sell their kidneys in order to overcome financial difficulties. Female donors count for around 18% of traded kidneys in our data; it is in contrary with the Indian case where 71% of the sold kidneys were from female donors (Goyal et al. 2002)."

In his sample of 598 transplants (Table 6), 539 were "traded kidneys," 10 "non-traded" and 49 "Cadaver", i.e. the vast majority of kidney transplants were live donor transplants with compensation to the donor.