The following article was written by an Iranian citizen journalist on the ground inside the country, who writes under a pseudonym to protect her identity. It was originally published in April 2015.
A short distance south of Tehran’s busy Valiasr Square, a young woman hastily attaches an advertisement to a wall. I ask the young woman posting the ad to tell her story. “My brother is suffering from thalassemia and because of his weak immune system, he has heart and kidney problems,” she says. “Thalassemia makes a kidney transplant impossible. He has dialysis every other day. The costs of the dialysis and medication are too much for my family.”
Although the street’s official name is Farhang Hosseini, it is more commonly known as “Kidney Street,” where ads for buying and selling kidneys are everywhere, displaying telephone numbers and blood group information about patients and donors.
The Kidney Foundation of Iran has its headquarters in this street. Every day, large numbers of people with kidney problems visit the area, hoping to receive some kind of help.
“I can no longer witness my brother’s agony,” says the woman hanging up the posters. “I want to play a part in his treatment. So I’ve decided to sell one of my kidneys at a high price and give the money to my family so they can pay for my brother’s medication.”
She appears very determined. I do not have the heart to look her in the eyes, so turn away toward Valiasr Street.
“There are two groups of kidney donors,” says a medical student named Sina. “The first group is made up of live donors who voluntarily donate their kidneys. They usually donate to a close member of their family because of their genetic similarity. The second group is made up of deceased people, someone who has died but whose kidneys are still healthy. The demand for kidney transplants is high. There is a long list of people who have died for various reasons, but have working kidneys that can be transplanted.”
A successful kidney transplant is dependant on how receptive the person’s body is once a kidney has been transplanted. Often, a body will reject a transplanted kidney as part of its natural defence, assuming the kidney is a threat to the body’s natural immune system.
Because of genetic, blood and tissue compatibility, the success rate of kidney transplants between brothers and sisters is high, around 95 percent. Between parents and children, it is around 85 percent. Kidney transplants from deceased donors have about an 80 percent success rate.
These figures refer to first-time transplants. If a body rejects a kidney after the first surgery, the chance of success for subsequent transplants is lower, ranging from 10 to 15 percent.
Mr. F. was a soldier during the 1980-88 Iran-Iraq war. He lost a kidney on the battlefield, and his other kidney stopped working 15 years ago, so he needed to have a transplant. For years, he and his family sought out a medically appropriate donor. He gave up trying to get coverage from the Foundation of Martyrs and Veterans Affairs because every time one of his children tried to initiate the process, they had to deal with labyrinthine bureaucracy. He had to pay all expenses himself. Eventually, Mr. F. had to give up to avoid torturing his children any further. Now, whenever the weather is cold, he gets a kidney infection. This is why he has paid 22 million tomans, or more than $8,000, to a kidney donor — and has been praying for him ever since.
According to Dr. Ganji, the president of the Iranian Society of Nephrology [kidney disease], “of the total kidney transplants performed in Iran, only 30 percent of donors were dead. Seventy percent of donors were still living.”
Numbers for the rest of the world are almost the exact opposite of those in Iran. Outside of Iran, only 15 percent of transplanted kidneys come from live donors, while 85 percent are from donors who are considered to be medically brain dead.
In some countries, including many Arab states, buying and selling kidneys is illegal, but Iran’s penal code offers no protection for those affected by the organ transplant industry. In 1994, MPs introduced a single-issue bill to parliament, referred to as the “Permission to Transplant Organs from the Deceased in Special Cases.” Out of 210 representatives present at the time, 86 voted for the bill, 112 voted against and nine abstained. The bill failed, and since then, the issue has not been discussed.
There is no general consensus within Islamic jurisprudence either - some Islamic legal experts argue that organ transplantation is permissible, while others believe it is forbidden within Islam.
This has led to an organ black market, operated by mafia groups. Websites promote the business and legal authorities do not block them. The buyer and seller both email their personal information to an address on the site, including name, telephone number, suggested cost, gender and blood type. After reviewing the emails, the buyer and seller meet in the presence of a broker. If they reach an agreement, the transplant operation takes place.
K.M. is the best known and most skilful kidney broker in Tehran. He works with a team of doctors and psychologists and pays his employees over $1,000 per month, a good salary in Iran.
Most surgeons are familiar with him and send patients desperate for kidneys to him. He has worked with many patients and donors, arranging introductions between the two parties after he gathers together extensive information concerning their medical conditions and histories. After he is sure that everything is in place and has concluded there will be no complications, he strikes a deal.
In recent years, people traveling to Iran to undergo organ transplants have driven up the demand for Iranian kidneys. According to Mostafa Ghasemi, the head of the Kidney Foundation of Iran, Health Ministry bylaws forbid Iranians from donating kidneys to foreigners, but brokers get around this by forging documents for foreign nationals, providing them with birth certificates and national ID cards that state they are Iranian. “Last year, two patients from Saudi Arabia came to Iran for kidney transplants,” he says. “Unfortunately, one of them died and the Saudi embassy is pursuing the matter. A few medical professionals working in the industry have been arrested.”
“Kidney Street” is perhaps the only public space of its kind in the world. As one approaches Farhang Hosseini, it is hard to imagine there are so many stories there, so many of them disturbing and painful. The effect of poverty manifests itself in many ways — and the organ transplant industry is one of the most bitter examples of what it is like to be poor and ill in modern-day Iran.
Dana Dadbeh, citizen journalist, Tehran