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.