by Peter Laird, MD
In the ongoing debate over payment for organ donation, I recently came across a 2002 article on the Iran experience and retrospective interviews of 300 kidney vendors (paid donors). Contrary to the many glowing and positive statements on the Iranian system, the actual donors in this country do not view their own post donation experiences in a positive manner:
In a country where brain-stem death is not recognised by law, the system has virtually eliminated recipient waiting lists. Members of the CFSD have claimed that the regulated system is a "new chapter in the world's transplantation history," a "development in donor-recipient relationships" and "an innovation in the Islamic Republic." However, two studies done by Javaad Zargooshi from the Department of Urology at Kermanshah University of Medical Sciences, Iran (The Journal of Urology, Vols. 165 and 166), show otherwise.
Zargooshi interviewed 300 kidney vendors six to 132 months after the transplant operation. His findings offer a frightening insight into what a regulated kidney trade in India might look like.There are reports that 70% of the donors suffered from post-operative depression and 60% from anxiety. Several donors said they had attempted suicide and spoke of donors who had killed themselves.278 70% of donors said that they felt worthless after the operation and 85% stated that if given the chance to go back in time, they would not donate their kidney and would also advise others against donating or selling their kidneys or any other organs whilst still alive. A large number of sellers spoke of not being socially accepted and demonstrated increased marital conflict following the kidney sale.
I would caution all commentators and promoters of a legal, payed renal donation system from using Iran as a positive model for the rest of the world. Not only do the actual vendors voice a negative experience with payed donation in Iran, but Iran also discriminates against woman as recipients and those over the age of 50. The Iranian model so widely cheered is a very flawed and biased model.
The negative experience of the donors leads us to once again remember the physician's dictum to first do no harm. There remains many troubling issues with the concept of a payed legal donation system.