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The Shocking World of Iran's Legal Kidney Trade
How people are cashing in and saving lives with a spare organ.
I recently finished a book by two economists (Jason Brennan & Peter Jaworski) Called “Markets Without Limits” and with a title like that I like “Oh here we go again”, gonna read some wacky libertarians saying about how child labor is not-so-bad or something like that, and even though the book has flaws it gives a much more nuanced view, and I would say even say a moderate approach to how market structures could be used to solve many problems, in more difficult scenarios.
But a couple of the topics that are touched upon in the book I personally believe could be better tackled by a well regulated market, and I put the emphasis in well regulated because oh my god this book touches upon many topics that could be abused without proper checks and balances, and one of them is a human organ marketplace, specifically kidneys.
The organ transplant problem
Unless you’re a nerd who likes to read up on stuff like this, most of you, just like me, have never had to face this sort of decisions and it is pretty complicated problem. Currently, the WHO estimates that over 660.000 people in the world are in need of any type of transplant from those about 80% are needing a kidney transplant. But around 90% of the people who are in need of a new kidney transplant are left out to die, or live a life with lower standards of quality, and a lot of suffering. And this is due to a shortage of available and compatible kidneys in practically any country in the world and the endless waiting lists. This shortage is in part due to the low willingness of healthy people to donate a kidney unless it is for close family members that are in vital risk.
And this unwillingness can happen because of many reasons, fear of the surgery is the largest disincentive for people to donate. Even though donors go on to live happy healthy lives afterwards with no complications (this because the remaining kidney grows in size and takes over the job of it’s missing buddy becoming a strong and healthy BIG KIDNEY)
But still this leaves a huge number of people without access to a kidney, So why would a marketplace solve this issue?
Well in a very simplified manner, markets are places where people exchange goods and services using money as a means of exchange. In this case what people want are kidneys so now we just need to find out how much money are people willing to receive to push their decision into donating a kidney and then regulate the marketplace to avoid abuses from happening, and start saving peoples lives.
And that’s somewhat what Iran did starting in the 1980s with kidney transplant from recently deceased people, and then expanding in living donations and codifying it into law in the year 2000. Some officials claim that this system has eliminated organ waiting lists, and with it possibly saved thousands of lives, and increased the quality of live of thousands more. This is a marketplace where donors are payed by the government between $2000 and $4000 USD for a kidney, then after some time has passed and an evaluation is complete the payment is processed to the donor. This in part to avoid people who are desperate to pay off an emergency debt could donate their kidney for some quick cash.
I wouldn’t donate my kidney for your subscription. But it would be very valuable and helpful.
In some cases people can get payed immediately after the surgery, but the amount is reduced heavily (a maximum of $1200 USD) the recipient of the organ can arrange for extra benefits given to the donor. This system is handled by different charity organizations under the Health ministry and from the outside it seems like it is a viable solution creating and aligning economic incentives with peoples desires to give a kidney and help their fellow humans. (there’s a lot more literature on behavioral economics and incentives so if you’d like to read more on that please do)
And let’s not forget a legal marketplace such as this cuts through the black market of organ harvesting and ilegal organ trade which can elevate the price of a kidney from $160.000 . Also reducing the number of transplant tourism where wealthy people in need of an organ travel to poorer or less controlled countries such as China and purchase from illegal dealers organs that might have been extracted without the consent of their previous owners.( I might write an article about the Falun Gong and the organ harvest trade in China in the future, but we shall see.)
Are there better solutions than this?
Well, as a matter of fact yes! there are, on one hand we can have synthetic or artificial organs. This mean the development of artificial or “robotic” organs that could be implanted on people, and there have been some development in organs such an artificial heart that pump blood without a pulse. This is great because depending on the complexity and capacity of artificial organs they could be even better than biological organs in the future and have a better performance than the organs we currently have inside of us.
Then we can have xenotransplantation, which is using organs from other species such as pigs (animals that we already slaughter by the millions just to feed humans with animal protein why not save human lives as well?) In this case some methods is using the structure of the pig’s organ as the scaffolding which is latter on filled with human cells from the person needing the organ, to prevent rejection of the organ and any other complications and then is implanted into the recipient.
Finally we have 3D printed organs where a person would donate painlessly some cells from their body and then these cells would be used in a 3D printer to create and manufacture a human organ. Companies such as Organovo have made progress in this field and the results are promising. Because with this there is no risk of rejection of the donated organ, no animal had to killed to get the organ to a person and there is the possibility of just like designs for pieces using plastic 3D printers technologies such as this could open up the creation of new and better biological organs in the future( but that’s a bit of a stretch for this time)
Not everything is as simple as that.
Sadly, even though I love all of these 3 pathways, most of these solutions are still in need of more time and capital until it’s the R+D is enough and they become readily available or affordable so that they can be distributed to all over the world.
That is why implementing markets is way easier and faster than waiting for these technological advances to develop. The technology to do a kidney transplant has been known since the 1960s and is practically available in most major hospital in the planet. We just need the market to be legal and regulated and have serious nations start implementing it and then we can get the wave rolling.
Just imagine how many people could be saved from a life of suffering or even worse a premature death because of a shortage of organs. And most of this is caused by letting emotions and a subjective perception on how we should control what other people do with their bodies and let them freely decide if they want to help others why not receive a small economic incentive to push them further into that altruistic decision.
Now of course this is an open ended issue, Iran has been the only country where this has happened, it’s difficult to extrapolate from a data pool as small as this.Also let’s be honest, from what we’ve seen in the past year or so we know that Iran is not the best example with regards to the rule of law, democracy, and an effort from those in power for the wellbeing of its people.
So let’s take the learned experiences from this and push for life changing policy in more and better countries, hundreds of thousands of human lives could be saved and an almost endless amount of human suffering could be eliminated(not counting a great blow to illegal human trafficking organizations) if we just implement these sort of market structures and adjust accordingly to avoid exploitation and harm to come to those who are willing to participate in this market.
So what are your thoughts? Would you donate an organ to a total stranger for money? or Would you be willing to pay someone to donate you their Kidney?