A recent working paper from Warwick reports an experiment and survey study whose participants are compensated kidney donors (and prospective donors) in the legal Iranian monetary market for kidneys.
Kelishomi, Ali Moghaddasi, and Daniel Sgroi. A Field Study of Donor Behavior in the Iranian Kidney Market. No. 1381. University of Warwick, Department of Economics, October 2021.
Abstract: Iran has the world’s only government-regulated kidney market, in which around 1000 individuals go through live kidney-removal surgery annually. We report the results of the first field study of donor behavior in this unique and controversial market. Those who enter the market have low income, typically entering to raise funds. They have lower risk tolerance and higher patience levels than the Iranian average. There is no difference in rationality from population averages. There is evidence of altruism among participants. This might shed light on the sort of people likely to participate if other nations were to operate suchmarkets.
From the introduction:
"There is no doubt that the notion of paying for a kidney raises ethical concerns and some see this form of market transaction as incompatible with the “sacred value” of human life (Elias et al., 2015). However, given the apparent success of the Iranian kidney market and the existence of long waiting lists, patient suffering and significant loss of life elsewhere, there has also been something of a re-evaluation of the potential for regulated organ markets in the developed world
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"Given the nature of the debate it seems important to consider the characteristics of those likely to come forward as donors if a market is established and to ask what special features they may possess. Since there is only one existent regulated market, this must involve a controlled examination of participants in the Iranian kidney market. Our paper reports the outcome of an unprecedented first study of patient behavior in the Iranian kidney market in which we obtained direct access to donors before and after surgery. We provided full incentives where appropriate during our experimental treatments, providing incentive payments of around $50 (in terms of purchasing power parity) on top of a show-up fee of roughly $15.2 We also collected data that is similar to existing generic data on the Iranian population. This allows us to not only provide comparisons within our sample but also between our sample and Iranian averages where data is available.
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" The study started in August 2017 (shortly after the end of sanctions between the UK and Iran) and live sessions continued until May 2019,with further telephone interviews and follow-up sessions continuing until February 2021. 78 subjects were first interviewed post-donation while the remaining 137 were interviewed pre-donation. Of the pre-donation group 91 were contacted a second time to confirm their final status in February 2021. 35 had donated by this point with the remaining 56 dropping out of the market (30 for medical reasons and 26 through choice). Following this process we were able to measure behavioral variables such as risk aversion, time preference (patience), altruism, rationality (consistency with GARP, the generalized axiom of revealed preference), and a wide variety of demographic and socioeconomic data. Where feasible we incentivized answers and used the most prominent measures available. We also examined why these patients enter the market and what alternatives might have been available to them. We are able to compare our patient data with available data for typical Iranians to provide a benchmark (Falk et al., 2018)
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"While the typical donor is in considerable financial difficulty, they are significantly more patient and exhibit lower tolerance for risk than an average Iranian (though conditional on entering the market those with lower patience are more likely to have donated during our study). Those who go through with the process exhibit higher levels of altruism than those who drop out. We find no difference in rationality between participants in the market and the subjects in a leading study of rationality from which we take our core measure (Choi et al., 2014). We would argue that alternative options for those in financial difficulty such as approaching a loan shark might be more appealing to the risk-loving (and perhaps more impatient) since this offers an immediate solution but replaces it with a serious and risky long-term liability, while the organ market is a difficult short-term prospect but does not result in higher levels of debt in the long run. Our findings on altruism are consistent with the idea that, while donors are being paid, they are nevertheless taking part in a difficult process that has the potential of saving a life, and this may also be important when considering alternatives."
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