International Health Care Systems

Kidney Transplants in Iran

Almost ten years ago, I wrote a post on Iran’s policy of paying organ donors.  It looks like the New York Times has finally caught on.   An excerpt is below:

But [Iran’s organ donation program’s] chief advantage is this: People who need kidneys get them rapidly, rather than die on the waiting list.

In the vast majority of cases, donors know in advance what they will be paid and receive appropriate screening and good medical care before and during the operation. And by getting patients new kidneys instead of keeping them on dialysis, the society saves a lot of money and avoids much misery.

The Iranian model suffers from insufficient funding, lack of follow-up for donors and other problems. But as waiting lists for kidneys grow around the world, Iran offers an important lesson: With good design and regulation, a system that pays donors need not be exploitative or immoral. In Iran, the legal kidney market has prevented the development of the abusive black markets and kidney tourism seen in other countries. As the kidney crisis intensifies, governments should look closely at what Iran has achieved.

Health economics is the application of economic principles to inform medical decisionmaking. It is clear that Iran–not the US–has been able to apply economic principles to its organ donation program to create a more humane, efficient system.


  1. It does not surprise me that so many economists think a market for kidneys just must be the best thing to do, but it does disappoint and frustrate me.

    A market for organs would result in a redistribution of health from those who need money (i.e. the poor, who also tend to be the least healthy) to those who can afford to pay for a kidney (i.e. the not poor, who also tend to be healthier). A market for organs therefore has the potential to be grossly inefficient if one seeks to maximise health (<a href="; title="see my blog post on the topic").

    I'm not saying that paying kidney 'donors' couldn't be a good thing, but economists need to check their biases before extolling the virtues of organ markets.

  2. @Chris: presumably renal failure/kidney disease strikes the poor as much as it does the not poor (this is just my prior… if you have data that suggest otherwise, please post a link), so if you think that only the poor would sell their kidney (an extreme claim), then health is just as likely to be distributed from the poor to the poor as from the poor to the rich. If you are concerned that the poor wouldn’t be able to afford to pay for a kidney, you could just advocate that the cost of the kidney should be covered by the government. Given that the government already provides the coverage for kidney transplants (through Medicare’s ESRD program), having the government include the cost of the kidney with all the other costs it covers doesn’t seem so outrageous.

    I would also guess that currently the not poor are donating their kidneys at a higher rate than the poor. This is probably due to the poor facing a higher opportunity cost for donating (I’m guessing the poor hold jobs that are not conducive to taking leave, whereas the not poor may have jobs that are more conducive… the not poor also have the resources to take off work whereas the poor probably don’t). Again, this is just my prior, if you have data saying otherwise, post it in the comments. For live donations, the organs will generally come from a family member or friend (either directly or through a transplant chain). If socioeconomic status is correlated among relatives and friends (which it is) and If the poor donate less (as it would not be unreasonable to assume), then those who are getting organs are the not poor and those left on the waiting list are the poor. So if there was some compensation for kidneys, the poor would probably benefit more than the not poor.

    If you are still concerned with exploitation, you could advocate compensation for organs from deceased donors. With this policy, no one is exploited (unless you think that you are coercing someone who views the body as sacred into donating the organs of their deceased loved one… a not implausible claim but one that would probably be in the minority of cases), and the relatives of the deceased would be better off.

    Regarding your claim that economists should “check their biases”: most economists I know (myself included) who promote a market in organs do so, not because of some reflex to recommend markets in everything, but because it will lead to vastly less suffering than the current way of doing things (if you haven’t spent much time with someone on dialysis, I recommend it… you will then get a sense of the suffering wait-listed patients go through). What is interesting is that it is the bias against a market in organs that leads to the current suffering of millions around the world. I would recommend that should be the bias to be fought.

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