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Society & Culture

Iran's Real Emerging Market: Kidneys

November 21, 2013
Sahar Bayati
8 min read
Iran's Real Emerging Market: Kidneys
Iran's Real Emerging Market: Kidneys

“Kidney For Sale. Immediate. Blood Type B+. Name the price.”

This is how somebody recently auctionied off his kidney in Iran, a sign written in magic marker taped to an electric pole before a Tehran hospital specializing in kidney transplants.

Coming across such ads on doors and walls is not an unusual sight for Iranian residents of the area, especially those who live around Labbafinejad and Martyr Hasheminejad hospitals.

National health authorities say that increasing number of kidney failures and deepening economic hardship have culminated this year to dramatically boost the market for the buying and selling of kidneys.

Labbafinejad Hospital in Tehran is the main kidney transplant facility in Iran, and Dr. Nasser Seemforoush, an expert in urology and the chief of the urology ward at the hospital, has the top record in kidney transplants in the Middle East. Iranian has one of the highest rates of kidney transplants in the Middle East, and state media often depicts this as a result of efficient transplants from brain-dead patients.

But a physician at Labbafinejad hospital, a colleague of Iran's top transplant surgeon, disputes this portrayal. “Contrary to the propaganda and claims of domestic media, we have the lowest number of transplants from brain-dead people,” he says, noting a recent case where a kidney from a brain-dead patient was transported so sloppily that it was too late for transplant and had to be thrown out. 

“The high statistics on kidney transplants in Iran arise from the gift of living people. They do it not to save another human being but to save themselves from financial difficulties,” the physician says.

Kidney transplant is the most reliable and sometimes the only way to treat patients with kidney failures. Kidney transplants in Iran have been performed successfully for many years, but patients who need transplant must sometimes wait for years, especially if they do not have sufficient funds to buy a kidney.

According to this urology specialist, the patients who can afford to buy a kidney from needy donors can be optimistic about the treatment, but many patients simply don’t have the means to buy it in the open organ market. Considering the low number of transplants from dead people, lower-income transplant needing patients end up living on dialysis for many years, waiting for the day when the body no longer responds to dialysis or when they can find a cheap kidney.

The most recent surveys of kidney patients across the country show that the majority of donors are 25 to 26 years old and that 70 percent of kidney ailments affect those between 20 and 44.

Mohammad Reza Ganji, president of Iran's Nephrology Society, on the occasion of Support Kidney Patients Week, said lat year that surgeons performed 2400 kidney transplants of which only 30 percent came from the brain dead. In previous years the rate was mere a 5 percent, he said, but it is predicted to go up to as high as 50 percent since deaths resulting from accidents is increasing.

Lives On Sale

But another specialist at the same hospital, who wished to remain anonymous while discussing such a sensitive matter, disputes this view.  “We owe the high statistics of kidney transplants to poverty in Iran,” he said an interview with IranWire.

“Right now you’ll find numerous fliers in front of Labbafinejad and Hasheminejad hospitals that advertise kidneys for sale,” he said. “And even in this situation, you’ll find middlemen trying to make money out of those transactions. This is the most painful part of our job. Instead of being happy about the increase of successful kidney transplants in Iran, we must worry about men and women who are putting their own lives on sale.”

One of phone numbers on the phone booth leads to “Nima,” who says he is 27-years old, comes from Isfahan and wants to sell a kidney. This reporter asked too many questions and made him angry. “You shouldn't sell low,” he said. “Everything is expensive. The hospital offers a payment of 9 million tomans [around $3000] but I have seen kidneys sold for up to 150 million tomans [around $50,000].” He wants to set up a business and his $50,000 dream has forced him to offer his kidney for sale.

Another kidney vendor, “Massoumeh,” says she has no dreams other than securing the release of her husband from prison. She is 31-years old and wants to sell her kidney to pay the blood compensation for which her husband is liable. “Of course I am frightened. My unlucky husband was involved in an accident and now he is a captive in the prison,” she said.  “What can I do with two kids? I have to pay the poor guy’s blood money. The victim's situation is not good either; somebody worse off than us. He was the breadwinner of the family, God rest his soul.”

Among the vendors there are also professionals like “Shayan,” 32, a senior electrical expert and graduate of Tehran Science & Industry University. He says that he has gone bankrupt and his only asset is his kidney: “People have my checks. If I can sell it for 60 million [about $20,000], at least I won't go to prison.”

The two specialized hospitals, one in eastern Tehran and the other to the north, are thronged by kidney patients day and night. The hospitals have expert physicians and high-tech equipment so that hospitals in other cities send them patients in need of more specialized treatments and tools. But are these two super-specialized centers enough to sustain the kidney patients of the whole country? And why is kidney disease on the rise anyway?

Ganji, the president of the Iranian Nephrology Society, said last year that efforts to prevent kidney disease have not been successful. The stark increase in the number of kidney patients, along with shortages of drugs, dialysis equipment and hospital beds, has alarmed health officials.

Experts say that 70 percent of the cost of treating kidney diseases is born by the patients themselves. The drugs are perhaps subsidized, but the cost of tests are very high. Patients pay 80 percent of the cost and insurance the remaining 20 percent, while the simplest test for kidney patients costs the equivalent of $20, very high for the average income.

Diabetes and high blood pressure are on the rise amongst Iranians, Ganji told Iranian media, and doctors and public health officials have failed to stem the increase. Kidney failures is more widespread that diabetes and kidney malfunction, while not immediately dangerous, increases the risk of cardiovascular diseases and strokes, he has said.

The Top Complaints

The rising costs of drugs and the shortages of dialysis machines rank high among the complaints of patients and specialists. According to Abdolreza Azizi, chairman of the parliamentary Commission of Social Affairs, drugs for kidney patients were supposed to be given free after the government dropped its subsidies program.

But Ganji says that patients with kidney illness whose kidneys are only 30 percent effective must be considered special cases, so that the they receive a certificate to prevent insurance-booklet changes and the high costs of the treatment that complicates their situation even more. A regular insurance booklet has 25 pages and each drug sometimes requires 5 prescriptions.

If the government helps patients with chronic kidney malfunction and subsidizes kidney transplants, Ganji asks, “why does it not increase the insurance? These patients must pay for blood-flow syringes themselves. Perhaps the drugs are always available but the distribution is problematic and the patient must try to buy drugs every month.”

One of the kidney treatment drugs cost 1200 tomans before the introduction of subsidies, but the cost has increased to 1570 tomans since insurance began covering the expense.

According to statistics published by the Nephrology Society, the ratio of people suffering from kidney ailments in the country is 75 per million. But there are not enough specialists in dialysis wards. Ganji believes that nephrology and kidney specialists must be deployed to small towns, where hospitals face myriad problems.  “Kidney specialists are the most deprived group in the Ministry of Health because they are not like other surgeons and have no way to make money,” he says.

The kidney surgeon at the Labbafinejad Hospital adds that “unfortunately the increase in the number of kidney patients and the increasing costs of treatment have forced people to stay away from private clinics because they can only afford treatment at government health centers. More patients come to the two specialized hospitals in Tehran than go to the health facilities in other provinces and cities. The sheer number of patients prevents us from setting aside even one bed for an emergency.”

Currency fluctuations have adversely affected the health sector in Iran, to the point that officials of the Health Ministry claim that these fluctuations have made effective management impossible.

Minister of Health Hassan Hashemi recently told the media, “I feel fine but my ministry is in a critical condition.”

Whether the government intervenes to staunch the disturbing rise in kidney sales remains to be seen. But what is clear is that costs of economic hardship combined with poor management of the health sector and currency fluctuations are being born by ordinary Iranians, who have nothing left to sell but their own insides. 

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