Organ transplants: Your part or mine?
AS MARKETS in human organs go, the one which flourishes on Tehran’s Vali Asr street, where Iran’s main transplant hospital is located, is not the cruellest—and there is no lack of people willing to discuss their transactions. Gholamreza, a 44-year-old man from northern Iran, explains what he did when his dialysis started to fail. “I put an advertisement in the paper for a kidney, and a donor came straight to me. We reached an agreement on the price quite quickly. In these cases, the recipient usually takes care of the donor afterwards. So I still visit my donor and help him out.”
Another man wandering round the district, aged around 30 and wearing torn, cheap clothing, is hoping he can find a buyer as decent as Gholamreza claims to be. He expects to get between $3,000 and $4,000 for one of his kidneys. “I need the money because I lost out in a pyramid investment scam. After the operation I won’t be able to lift heavy things, but I can still live with only one kidney.”
Iran’s Association of Kidney Patients, a non- government organisation which obviously enjoys official favour, is responsible for all legal kidney transplants: it insists that commercial deals are the exception, not the rule. For one thing, it says, the religious authorities encourage voluntary gifts: in other words, cases where a patient receives a kidney freely offered by a friend or relative. Pious Muslims may also offer up a kidney to anyone who needs it.
For surgeons, patients and medical economists alike, the shortage of kidneys seems frustrating, because no organ lends itself better to transplant. As long as they receive decent after-care, kidney donors suffer only the tiniest increase in their own risk of dying of kidney disease. And transplants make economic sense: the cost of one kidney operation and a lifetime’s supply of antirejection drugs equals that of three years’ dialysis. Kidneys donated by a living person last for a median 22 years in another body; when they are taken from a fresh corpse, the figure is 14 years.
Whatever solution they propose to the shortage of kidneys, nobody doubts that the black market, as it now works, has grotesque effects, both for donors and recipients. Rich westerners who go to South Asia or Africa in search of kidneys often receive organs that are diseased or unsuitable.
Nancy Scheper- Hughes, an American professor of medical anthropology and campaigner against organ trading, says the way poor Brazilians were induced to travel to South Africa is typical of the abuses a market in body parts, especially an international one, is bound to cause. She says donors in the Brazilian slums were given false promises about the money they would make, the care they would receive and the after-effects of the operation.
Some senior figures in the medical world draw a different conclusion: as long as some people are determined to obtain kidneys and others are desperate enough to sell them, the trade will be impossible to stop—so it makes better sense to regulate the business than drive it underground.
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