The Social Stigma of Selling Kidneys in Iran as a Barrier to Entry: A Social Determinant of Health

AuthorMohammad Mehdi Nayebpour,Naoru Koizumi
Date01 March 2018
DOIhttp://doi.org/10.1002/wmh3.255
Published date01 March 2018
The Social Stigma of Selling Kidneys in Iran as a Barrier
to Entry: A Social Determinant of Health
Mohammad Mehdi Nayebpour and Naoru Koizumi
Iran is the only country in the world currently with a legalized compensated kidney donation
system, in which kidney sellers are matched with end-stage renal disease patients through a
regulated process. From a practical point of view, this model provides an abundance of kidneys for
transplantation as opposed to the American model that relies on altruistic donation. The major
concern about adopting the Iranian model is the possibility of exploitation. A large body of literature
exists on this topic, but few have focused on its cultural aspects. This paper sheds light on the
cultural implications of the Iranian model by providing empirical evidence on the social stigmas
against kidney sale in Iran. We claim that these stigmas act as barriers to entry to the supply
market of kidneys. Due to the conditions created by social stigmas, kidney sellers are forced to
consider not only monetary rewards but also cultural factors. Thus, they tend to be more cautious
and try to avoid impulsive decisions. Such social stigmas act as unoff‌icial regulatory forces to keep
kidney sale as the last resort for the poor, to diversify the supply market by age, and to stretch the
decision-making process in the absence of a mandatory waiting period for transplantation.
KEY WORDS: kidney, Iran, transplantation
Background
Scholars and policy analysts have been passionately debating the establish-
ment of a compensated kidney donation model in the United States and other
Western countries. The proponents of this model point to the problem of kidney
shortage and claim that the only effective way to solve this problem is to establish
a regulated kidney market (de Castro, 2003; Satel, 2008). Opponents point out an
array of ethical and economic issues, concluding that the costs of such a model
are greater than its benef‌its (Roth & Leider, 2010). The present study will not
examine all issues associated with the Iranian model, but focuses on a particular
stream of critiques, that is, exploitation of the poor. Specif‌ically, we examine
cultural aspects of kidney sales in Iran and argue that social stigma against
kidney sales works against exploitation. Prior literature on the Iranian model
tends to be silent on cultural aspects of kidney sales; therefore, the role of social
World Medical & Health Policy, Vol. 10, No. 1, 2018
55
doi: 10.1002/wmh3.255
#2018 Policy Studies Organization

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