The recent Becker-Elias article, about which I blogged about
my thoughts here, has drawn some letters to the editor, which the WSJ published under the headline
Is a Market in Kidneys the Right Answer to Shortage? It is a tragedy when people die while waiting for a lifesaving transplant, but paying for organs isn't the answer.
One of them, by Sigrid Fry-Revere, doesn't fit the sub-headline. She advocates adopting something like the market approach in Iran. Her unedited letter, which she shared by email, is below:
Letter
to the Editor of WSJ
Edited
version ran Sat. Jan 2014
The
Rest of the Story
I
read with great interest Gary S. Becker and Julio Elias article “Cash for
Kidneys: The Case for a Market for Organs” in Saturday’s WSJ. Like so
many others who have written on this subject, their article misrepresents the
Iranian system of compensated donation.
Usually
not much is said about Iran, because not much is known, but I went to Iran and
spent nearly two months interviewing paid kidney donors for a documentary film
I was planning. I visited six different regions and returned with over 200
transplant stories. There are too many misconceptions about what is going
on in Iran to explain in one letter, but the most important thing I would like
to point out is that paid kidney donors are people, not commodities, and no
matter what the economics of the situation, there is a human element that can’t
be ignored.
You
might think I’m going to say we should not pay kidney donors, or that I’m going
to rage about how exploitive kidney selling is. Not so. I learned many things
on my trip to Iran, but the most important was sometimes money is what makes
helping others possible.
The
issue isn’t how much a kidney is worth, but how to make helping economically
feasible and how best to show appreciation. I disagree with economists who say
you can put value on someone giving up part of their body to save another
person’s life. A conscious, informed decision, to risk oneself for another is
an invaluable gift both to the person and to society.
Iran
is the only country in the world that has solved its kidney shortage, and it
has done so by legalizing and regulating compensated donation. In the
rest of the world there are two options: Altruistic donation and the
black market. The third option only exists in Iran where the rule of law
protects donors and recipients alike. Paid donors are not treated like
criminals, as is the case when the underprivileged are exploited for their
kidneys on the black market.
The
Iranian system has developed over 30 years and continues to improve.
Today, paid donors are secure in their knowledge that the system works to
protect their rights as much as the rights of recipients. Their money is put in
escrow, the middlemen who arrange kidney matches are NGO volunteers, not black
market profiteers, and they are treated on the same medical wards and in the
same post-operative clinics as kidney recipients.
How
much are Iranian kidney donors paid for their service to humanity? Much more
than the thank you, travel expenses, and occasional lost wages, paid altruistic
donors in the United States. Iranian kidney donors receive the equivalent to
six month’s salary for a registered nurse in Iran, or approximately $32,000 in the
United States. But in addition to monetary compensation, they receive many
goods and services that are hard to quantify in dollars. All receive at
least one year of health insurance, not just care related to their nephrectomy,
as is the case in the United States. They also receive automatic exemption from
Iran’s two-year mandatory military service.
Furthermore,
Kidney donors often receive extra health insurance, sometimes for their whole
family and often under terms where it can be renewed annually. They receive
dental care at the NGO dental clinics that serve diabetes patients and kidney
recipients. They receive job services, small business loans, and household
goods. I estimate the total average package paid donors receive in Iran
is close to $45,000 in value.
Most
importantly, these paid donors know the government supports them for having
done something honorable, like a paid firefighter or a paid emergency medical
professional. They have saved a life -- and their contribution to society is
invaluable. Mohaghegh Damad, the ethicist for the Iranian Academy of
Medical Sciences told me no payment could ever be enough. But, the payment
Iranian kidney donors get, makes doing the right thing easier.
In
the United States 20-30 people die every day because they can’t get a kidney.
Iran is the only country in the world where almost everyone who medically
qualifies to get a kidney gets one, and in many regions of the country there is
a waiting list for people who want to donate. Maybe its time we learn
something from their experience.
Sigrid
Fry-Revere, J.D., PhD, is a bioethicist and founder and president of the
non-profit organization Stop Organ Trafficking Now and author of The Kidney
Sellers (Carolina Academic Press, 2014).