Marzieh, a widow from Northern Iran, faces the responsibility of finding money for her daughter's dowry. Bearing the burden of protecting her family's honour, the most accessible option is to sell her kidney (1). For many like Marzieh, hundreds have written their phone numbers and blood types on the streets of Tehran. Iran is the only country with a legal and government-regulated kidney market, a solution to the global organ shortage. However, such a commercialised market for human organs raises ethical concerns, including the commodification of human organs, the exploitation of the vulnerable, the possibility of financial inequality, and the tension between religious principles. This essay will therefore examine whether Iran’s kidney market represents a pioneering solution to organ scarcity or whether commodifying human organs can be justified. It will explore the ethical dilemmas of commodification while also evaluating the successes and limitations of a government-supervised system from a global perspective.

To some extent, Iran’s legal kidney market offers a structured system that ensures donor protection, reduces waiting times, and provides both financial and social support to donors and recipients. Regulated by the Ministry of Health with government support, Iran’s system offers a fixed price of $4,600 to each donor (2). This payment is made immediately after surgery and ensures that each donor receives a sufficient amount of money, thereby reducing the risk of exploitation. In agreement with this, some scholars argue that there are ‘no significant differences’ in socioeconomic background between donors and recipients (3). This demonstrates how Iran's kidney system safeguards donors by trying to minimise financial disparities. When donors and recipients come from similar backgrounds, the donor is less likely to be in a position of vulnerability. This constructively limits external pressure or influence during the discussion of organ donation.

However, it's essential to understand why one would initially consider selling a part of their body. Could economic desperation compromise one's autonomy, or is it coercion by circumstance? When recipients are unable to cover their expenses, charity organisations step in to provide support. The system also facilitates a matching process between donors and recipients, ensuring compatibility during the donation process. Such a regulated market may restrict the emergence of a black market, offering a legalised platform where one can obtain an organ. Consequently, this could prevent illegal trading with higher market prices while addressing ethical concerns. Unlike many Western countries, advocates claim that Iran has effectively eliminated waiting times. By substantially reducing this, Iran may have positioned itself compared to other countries.

According to the National Kidney Foundation of the United States, 123,000 Americans are on the waiting list for a kidney transplant (4). More than 101,000 citizens are in need, but only 17,000 people receive one each year, which is nearly ⅙ of the amount (5). This demonstrates how Iran may have practically addressed the organ shortage while also providing its citizens with more support compared to other nations. If all countries adopt Iran's commercialised system, would this solve organ shortages universally, or would it increase economic inequality worldwide?

Other countries might implement this system to tackle their growing organ shortage, as it could identify the need for intervention. As stated before, Iran’s legal kidney market hinders the development of a black market. This results in the prevention of illegal trading, characterised by higher market prices and ethical concerns. Reports suggest that 86.5% of donors reported “complete satisfaction” before discharge, with only 1.5% reporting regret (6), implying that donors are more content throughout the process. Aiding this contentment is government-funded support, including medical insurance, transplantation costs, and subsidised medicines, provided to each living donor. (7)

On the other hand, many may argue that Iran's kidney market is not a viable solution to the organ shortage. Despite its regulation, evidence around Iran’s kidney market shows a range of contrasting perspectives. Based on a careful analysis of various sources, there is a clear lack of concrete evidence regarding Iran's kidney market, as well as questionable claims. Some scholars suggest that the waiting list was eliminated by 1999 (8), while critics argue that there is insufficient evidence to support this claim. (5) So, is Iran's government transparent in its claims, or does it merely mask deeper systemic issues?

Following the lack of evidence, donor motivation is heavily impacted by economic desperation. Various reports on donor motivations have shown that 43% of donors are financially driven, and 40% are financially driven with some degree of altruism. At the same time, 75% of donors believed that their goals were not achieved by selling their kidneys. This has clear implications for the dissatisfaction of donors within this legalised system, many even prefer begging or loans rather than selling. (9) This raises the question. Are donors truly free to choose? Or can economic desperation compromise one's autonomy?

Consequently, Iran's market also raises ethical concerns regarding the commodification of human organs. Such a system may perpetuate the potential exploitation of the vulnerable, conflicting with cultural and religious values. This may fail to guarantee equitable access, as financial incentives can disadvantage low-income patients. No matter how the system is dressed up, society will always penalise the weakest.

In addition to this, the predominant religion in Iran is Islam, which teaches that the body is a sacred gift from God (10) and therefore should not be commodified. While exceptions may be made in dire circumstances to save a life, the principle remains that the body should not be treated as a means for profit. This religious perspective underscores the tension within Iran’s kidney market, where the practical need to address organ shortages conflicts with the country's deeply rooted Islamic values that emphasise the inviolability and sacredness of the human body.

In conclusion, this essay has examined both the arguments supporting and opposing Iran’s human kidney market, which is often regarded as the potential solution to the global organ shortage, while also exploring the ethical dilemmas associated with adopting this system. To some extent, Iran has fostered a regulated donor system that substantially minimises financial disparity, decreases waiting times, and supports donors. Charitable organisations support recipients who cannot afford a transplant, and no third party is involved until consent is given from both parties. However, such a regulated system is not without ethical concerns, as many individuals may be economically desperate, there is a lack of transparency in evidence, and religious values are in conflict. With Iran being the only country in the world with such a donor system, other countries could potentially implement this system under strict regulation, in comparison to unregulated black markets. Nevertheless, such a market would still exploit the vulnerable, as mentioned before, no matter how the system is dressed up, society will always penalise the weakest. Therefore, while Iran’s system may theoretically offer a practical solution, such a commercialised market cannot simply be the universal answer to the world's organ shortage.


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