Wednesday, March 28, 2018

An anthropologist (Dr. Elham Mireshghi) looks at the market for kidneys in Iran

Elham Mireshghi completed her Ph.D. in Anthropology at UC Irvine in 2016. Her dissertation is
Kidneys on Sale? An Ethnography of Policy, Exchange, and Uncertainty in Iran

Here's the abstract:
"Since 1997, Iran has implemented the world’s only program for living paid kidney donation. The program has been developed and administered by a non-profit NGO – the Kidney Patient Foundation (KPF). Though sanctioned by Shi‘a Muslim jurists and celebrated in the West as the “Iranian Model,” the program has been rife with moral unease and uncertainty in Iran. While organ donation after death is valorized, undergoing transplantation for cash is stigmatized. Furthermore, there is little agreement among policy actors that facilitating paid organ giving is a good idea. In this dissertation, I examine kidney “selling” both at the level of the exchange – where I analyze the experiences of kidney givers and recipients – and at the level of institutional and bureaucratic process, legal and scientific reasoning, and practical and ethical negotiation, to explain how Iran came to uniquely sanction and bureaucratically routinize kidney selling. I disentangle the dense threads of moral reasoning and experience among a range of actors - from donors and recipients to doctors, policy activists, and Islamic jurists – that undergird the policy’s development and implementation. I have conducted ethnographic field research (2011-2013), including observation inside medical and Islamic institutions in Tehran and Qom, and indepth interviews of kidney givers and patients, KPF personnel, doctors and legal scholars and jurists. I have also analyzed Islamic legal texts, as well as visual and textual media.

"My analysis brings together analytic approaches within the anthropology of public policy, medicine, morality, and exchange, while also contributing to a growing interest in Iranian Studies to venture beyond themes of repression and resistance. I consider Iran’s living kidney giving program within the context of Iran’s post-revolution medical modernization projects, its haphazard economic liberalization, and ongoing commitment to social welfare, alongside an examination of the role of Islamic jurists and other “experts” in policy making. I elucidate the socio-economic conditions and aspirations that motivate kidney givers, and the “medical imaginary” that facilitates their decision as well as the legal reasoning of jurists. Lastly, I offer an alternative to the “commodity paradigm” in examining exchanges involving money that can contribute to bioethical discussions of organ sales."

Here's a paragraph describing the reduction in waiting time for a kidney transplant resulting from the market:

"The culmination of these regulations has resulted in a much shorter wait for kidney transplants in Iran than is the case in, for example, the United States, where paid donation is prohibited and most organs from unrelated donors come from cadavers and brain-dead individuals. This has often been touted as one of the most important outcomes of permitting kidney sales. In the US, if one does not find a donor among family or friends or an “altruist” living stranger, then the wait can take nearly four if not more years. In Iran, the wait can be a little over a year, if not less; though celebratory reports on what is now called the “Iranian Model” often claim that there is no waiting list at all .... If a patient chooses non-living donation, then much like the US the wait can take much longer than a year. "

Much of her interaction was with a social worker who was reluctant to enroll kidney sellers:
"Management was not unaware of Ms. xxx’s principled opposition to kidney selling and her attempts at talking people out of it. Ms. xxx explained to me once that she framed her activities as a benefit for the organization in the form of counseling for sellers. It would garner legitimacy for a program that had frequently come under domestic and international scrutiny, she argued. So management and Ms. xxx shared an interest in counseling prospective donors while assuring that a certain number made it to the list. For management, the interest had to do with protecting the organization’s credibility while also assisting in the treatment of suffering kidney patients. For Ms. xxx, it had to do with ensuring that fewer young men and women fell into what she called the “sick cycle of disease and poverty” (what she deemed to be the likely result of kidney selling) while also maintaining her employment."

One aspect of her work concerns the religious rulings that permit the Iranian kidney market.

Here's a quote from Ayatollah Makarem Shirazi  about what can be sold:
“The severing of an organ from a living person and the transplantation of that to someone whose kidneys have both decayed (fasid) is permissible on the condition that the owner (sahib) of the organ consents, and his life (jan) is not put into danger; and caution requires that if money is received in exchange, that it be in exchange for the permission to proceed with the taking (giriftan) of the organ, and not the organ itself.

 I blogged about this part of Dr. Mireshghi's work earlier here:

Friday, June 5, 2015

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