The Price of Life: Inside Iran’s Legal Kidney Trade
Organ trafficking is a dark, secretive business in most of the world—but not in Iran. While other countries struggle with illegal organ markets and desperate patients, Iran has taken a radically different approach: a government-regulated kidney trade where selling your kidney is entirely legal. Initially, it sounds shocking. Paying donors? No shady middlemen? A system that works? But how does it function? And could this be a solution? Or does it come with its ethical nightmares? In this post, we’ll break down Iran’s unique kidney market, how it compares to the global black market, and whether this controversial model could ever work elsewhere.
Iran performed the Middle East’s first kidney transplant in 1967, but these surgeries only became common in the 1980s. Iran allows kidney donations from both deceased donors and living donors who are paid for their organs. Before 2000, almost all transplants used kidneys from paid donors. Now, about 13% come from deceased donors. Some groups, like the Cato Institute, say Iran’s paid donor system helped eliminate its transplant waiting list by 1999. But the truth is more complicated. Many people with kidney failure in Iran are never diagnosed or treated, so they never make it onto the waiting list. As Dr. Ahad Ghods from Hashemi Nejad Kidney Hospital explains, this is likely the real reason the waiting list disappeared so quickly.
Iran’s kidney transplant system is run by nonprofit organisations, with costs covered by the recipients and the government. Charities step in to help those who cannot afford to pay. Two main groups, the Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD), manage the process under government supervision. They match donors with recipients and arrange medical tests to ensure compatibility. To prevent unfairness, doctors and transplant centres cannot choose donors. Donors in Iran typically receive US$2,000 to 4,000 for a kidney—far less than the US$160,000 or more that a kidney can cost on the global black market. The standard payment is around US$1,200 (as of 2001), given right after surgery, but donors can sometimes negotiate extra money or benefits from the recipient.
Figure 1: The percentage of kidney and liver transplant from living donors compared to brain-dead donors in Iran from 1999 to 2023.
Government officials are well aware of why people sell their kidneys: they need the money. Iran’s legal but controversial organ trade has created alarming social consequences, particularly for the poor. When a crisis hits, people may run out of money to cover living expenses, support children or cover debt, hence opting to trade in their kidney for some extra cash out of desperation. Some families may over-reproduce to sell their children’s organs in the future—a practice that worsens overpopulation and drastically lowers living standards, especially for women forced into repeated pregnancies without adequate recovery in a country with limited healthcare. Meanwhile, Iran’s severe economic crisis has driven a surge in teenagers selling their organs, as young donors’ healthy kidneys, livers, corneas, and even bone marrow fetch high prices for desperate buyers. The trade isn’t just limited to Iran; brokers facilitate organ sales abroad, with impoverished Iranians travelling to Iraq, the UAE, and Turkey to sell kidneys and other body parts.
While Iran’s legal market demonstrates the immediate demand for organs, it also exposes the systemic exploitation and long-term harm caused by commodifying the human body. Without proper safeguards, legalisation risks institutionalising inequality rather than solving it. Currently, there has yet to be a legal organ market that effectively safeguards the interests and well-being of all parties involved. Therefore, organ trade should not be legalised until policymakers can address such a system's ethical and practical challenges. In the meantime, institutions should encourage organ donation through incentives, such as granting donors priority if they later need an organ or offering additional healthcare benefits.
Sources:
20 Years Iranian Experience of Organ Donation: Shifting From Compensated Living Unrelated Kidney Transplantation, Haghighi, Ali Nobakht et al. Kidney International Reports, Volume 10, Issue 4, 979 - 982
https://en.wikipedia.org/wiki/Kidney_trade_in_Iran#:~:text=Iran%20currently%20is%20the%20only,a%20shortage%20of%20available%20organs.
https://link.springer.com/chapter/10.1007/978-3-642-30913-7_19
https://www.ramapo.edu/scholarsday/wp-content/uploads/sites/26/2023/04/Mardini-HGS-2023.pdf
