The Iranian model of living renal transplantation

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http://www.nature.com/ki/journal/v82/n6/abs/ki2012219a.html

The Iranian model of living renal transplantation
Mitra Mahdavi-Mazdeh
Kidney International (2012) 82, 627–634; doi:10.1038/ki.2012.219

Abstract
Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the ‘Achilles heel of the model’.

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http://onlinelibrary.wiley.com/store/10.1111/ajt.12675/asset/ajt12675.pdf?v=1&t=hx9ighx4&s=4fac669dc34d08ca067f65314200624e3b6d9a4f

Letter to the Editor
Perfect Is the Enemy of Good: The Iranian System of Paid Donation
S. M. Khatami1 and M. Mahdavi-Mazdeh2,

American Journal of Transplantation 2014; 14: 1222–1223
doi: 10.1111/ajt.12675

To the Editor:
We read the article and editorial titled ‘‘Comparison of
health status and quality of life of related versus paid
unrelated living kidney donors’’ and ‘‘Where there is smoke
there is fire: The Iranian system of paid donation.’’ They
tried to shed light on the darker side of living-unrelated
donation (1,2). As there is no concrete solution for organ
shortage, it is the responsibility of experts to discuss
different aspects of every possible system to clarify its
weaknesses and strengths. We fully agree with the authors
that the lack of long-term donor follow-up and the direct
method of payment by the recipient in the Iranian model are
major weak points (3).

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