“What can Iran teach us about good governance?” is not a question often posed in Washington. But according to Benjamin Hippen, a transplant nephrologist in North Carolina, the Iranians have managed to do something American policy makers have long thought impossible: They’ve found kidneys for every single citizen in need.
As Hippen explains in a March report for the Cato Institute, the Iranian government has been paying kidney donors since 1988. To avoid potential conflicts of interest, donors and recipients work through an independent organization known as the Dialysis and Transplant Patient Association. Donors approach the association on their own; they cannot be recruited by physicians or referred by brokers with financial incentives. They receive $1,200 and limited health coverage from the government, in addition to direct remuneration from the recipient—or, if the recipient is impoverished, from one of several charitable organizations. The combination of charitable and governmental payments ensures that poor recipients are treated as well as wealthy ones.
Critics of organ markets often claim that where payments are permitted, altruistic donation will drop off. Hippen found this is not the case in Iran. The country’s deceased donor program, started in 2000, has grown steadily alongside paid donation. (Posthumous donations are not remunerated.) During the last eight years, deceased donations have increased tenfold.
Data on the long-term health of Iranian kidney doors is mixed and inconclusive, so Hippen recommends that any U.S. system closely track donors and provide them with lifelong health care. Since many potential kidney recipients are currently surviving on vastly more expensive dialysis treatment (paid for by Medicare), providing donors with long-term health care is probably more cost-effective than the status quo.
American critics continue to lament that Iran failed to adopt the U.S. policy of banning payment for organs in the mid-1980s. “Carrying this reasoning to its conclusion,” writes Hippen, “would entail admitting that in so doing, Iran would have also incurred our current shortage of organs, our waiting list mortality, and our consequent moral complicity in generating a state of affairs that sustains an international market in illegal organ trafficking.” No other country has managed to eliminate its kidney waiting list; the U.S. has a list 73,000 patients long. Who should be advising whom?