Kidneys for sale: Iran’s trade in organs

[Clark]

http://www.theguardian.com/society/2015/may/10/kidneys-for-sale-organ-donation-iran


Kidneys for sale: Iran’s trade in organs
Francesco Alesi and Luca Muzi

Iran is the only country in the world where it is legal to sell a kidney. Donors get money from the buyer and from the state, a system which eradicated waiting lists but, detractors say, exploits the poor and vulnerable. Here, we follow one terrible story


A strong hot wind blows from the desert and, around the Iranian city of Ahvaz, flames from the chimneys of the oil refineries all bend in the direction of the Persian Gulf. On the road, a festive crowd advances though the dust raised by the wind, to the sound of drums. Shiites are celebrating Ashura. Ghaffar goes to his window to watch: he would like to be with them, but he is in a hospital waiting for a kidney transplant.

In the female transplants unit, the rhythm of the drums drowns out the cheerful chatter of three young patients. Tandis and Chaman are showing Narin the scars on their chest – they have received kidneys and are currently recovering. Narin will have a similar scar soon: she has sold one of her kidneys to Ghaffar.
Iran is the only country in the world where it is legal to sell a kidney. The “Rewarded Gifting” act was approved by the Iranian Board of Ministers in 1997; two years later the waiting list for kidney transplants had almost disappeared. The state guarantees a cash reward of the equivalent of about £300 to each donor, and one year of medical insurance. But most of the “gifting” is done in private transactions.
Written in marker pen on the walls outside hospitals where transplant operations are performed are thousands of adverts like these: “A+ 25 years, I sell my kidney”, or “B neg sells kidney, 33, a bargain”. The essential information is blood type, phone number and age. The closer you get to 35, the maximum age to donate a kidney in Iran, the lower the price.
“I wanted to become a teacher, but I had to stop studying because of the disease,” says Ghaffar. “In these years I had only one purpose – to find a donor.” Ghaffar has called hundreds of numbers and has found 72 possible donors with his own blood type. They were all rejected by the doctors due to incompatibilities, or because of their poor health. “One year ago I found a donor, Ashkan, he passed all compatibility tests, but he took the money three days before the operation and disappeared. I was desperate.
“A few months later, I saw Narin’s notice. I called her, she wanted 20 million Toman, I could offer her only 13. In the end we agreed to 15 million [£3,600]”.
Ghaffar’s experience is unusual in Iran. Only the wealthy can normally afford to buy a kidney, and Narin’s asking price was the equivalent of two years’ salary for a state employee. “We sold all the family lands to pay for the transplant,” Ghaffar’s father Gholamreza tells me. “We had to choose between the sustenance of the family, or to save a son, we preferred Ghaffar. But how will we live now?”
Narin too comes from a poor family. She has just got married. She and her husband are both unemployed and live with her parents. They are among the many young Iranians out of work because of the collapse of oil prices and the economic crisis. Narin refuses to talk about why she’s selling a kidney. “It is an act of altruism,” is all she will say.
But Ghaffar knows more. “I hosted Narin and her husband at home for a few days before the surgery,” he says, “and we got the chance to know each other better. In Iran it is shameful for a married couple to still live with their parents. By selling her kidney, Narin and her husband will be able to rent a house and settle down, at least for a while. They hope that the price of the oil will rise, so that there will be more job opportunities.”
The World Health Organisation believes kidney sales should be banned. “Transplant commercialism targets impoverished and otherwise vulnerable donors,” says their Istanbul Declaration. “It leads inexorably to inequity and injustice and should be prohibited.” Ana Manzano, researcher at the Centre for Health, Technologies & Social Practice at the University of Leeds, calls it “a form of exploitation of the poor”. And the risks can be high. According to Manzano “there are no long-term studies on the health of Iranian donors. The poorer the donor, the higher the possibility that he or she loses the functionality of the remaining kidney because of demanding work or inadequate health care.” The president of Ahvaz’s Kidney Transplant Association, Lari Zadeh, counters that “one kidney can be enough. The kidneys are organs used to coping with high workloads increasing their volume and capacity.”
The morning of the transplant Ghaffar is nervous and doesn’t speak. The surgeon won’t let us attend the operation – “you should not even be inside the hospital” – and we wait outside the door of the operating room. Narin goes in first, then Ghaffar. After four hours, the operation ends successfully. Ghaffar will remain under observation for three weeks, Narin will be back home in three days. When he wakes up from anaesthesia, Ghaffar starts to think about the future. “Thanks to Narin I will finally become a teacher,” he tells me. I leave Iran a week after the operation. It sounds like a story with a happy ending.
A month later I get a call. Ghaffar’s body rejected the kidney, and he hasn’t survived the crisis. At his funeral a group of people walk around his freshly dug grave in the village of Benshoar. Narin’s kidney is buried with him in the graveyard.

Narin is ill and still has pain in her remaining kidney. “The doctor said that I must diet and drink much more. But I have stopped taking the pills and going to hospital.” She is troubled by Ghaffar’s death. “I thought that Ghaffar would have had a better life after transplantation, but my donation was useless. I think that God didn’t accept my donation to Ghaffar. God is not satisfied with me.”
She tells me that Ghaffar’s father went to the hospital to complain. “They told him that the kidney was too big for Ghaffar – they said that they warned him about this. But they are telling lies. They did lots of tests before the operation. The doctors have killed Ghaffar because of their negligence.”