Heterogeneity of Market Structures in the Iranian Model of Kidney Transplantation

• Published date: 01 March 2020
• Author: Mehdi Feizi,Tannaz Moeindarbari
• Date: 01 March 2020
• DOI: http://doi.org/10.1002/wmh3.330

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doi: 10.1002/wmh3.330

© 2020 Policy Studies Organization

Heterogeneity of Market Structures in the Iranian Model

of Kidney Transplantation

Mehdi Feizi and Tannaz Moeindarbari

The Iranian model of kidney transplantation (IMKT)is an example of a legal system of compensated,

living, and unrelated renal donation. This study demonstrates its heterogeneity regarding

prerequisites, restrictions, and policies for matching donors and recipients with an emphasis on the

case of Mashhad, in which the Iranian Kidney Foundation (IKF)received criticism about the kidney

market. The IKF in Mashhad strives to prevent the poor from imprudently selling their own kidneys

by informing them about the consequences of a kidney transplant, resolving their financial needs, and

imposing several legal obstacles before a transplant is allowed. We show that the IMKT does not fully

eliminate excess demand for kidneys, although it significantly decreases demand so that Iran has the

shortest waiting list in the world. Nevertheless, the relative number of kidney transplants, especially

from deceased donors, are higher in Mashhad compared to the average of other centers in Iran, as

almost forty percent of renal patients on the active waiting list get a kidney each year.

KEY WORDS: live kidney transplant, Iranian model of Kidney Transplant, kidney market, Iranian

Kidney Foundation, compensated organ donation

Introduction

The Iranian model of kidney transplantation (IMKT hereafter)has been

relatively successful in overcoming the severe scarcity of kidneys. It is a

state‐funded system of compensated, living, renal transplant, established in 1988, in

which the government pays for all transplant‐related expenses. The legal kidney

market in Iran led not only to the alleviation of the black market but also to the

decrease of the waitlist for patients requiring a kidney transplant such that most

Iranian kidney transplant candidates, regardless of their socioeconomic class, have

access to a new kidney (Mahdavi‐Mazdeh, 2012).

In Iran, a patient can receive a kidney from either a live or deceased donor.

Once brain death is medically confirmed, organs and tissues of deceased donors are

used either with their previous consent, that is, written consent or a signed donor

card, or by the next of kin (Larijani, Zahedi, & Taheri, 2004).

1

A live donation can be

from a related donor, which is mostly noncompensated, or from a nonrelated

donor, which is almost always compensated. Kidneys donated from a deceased

donor are transplanted locally, regionally, and nationally based on the Guideline for

the Allocation of Kidneys from Deceased Donors (Transplantation Organs Unit, 2011).