Iran is one of the few countries in the world that has eliminated kidney failure. A useful new paper looks at how donors,
First some background:
Adoption of a regulated market approach to kidney procurement in Iran began in 1988 without adequate postmortem donations (Ghods and Savage, 2006). This facility allows living unrelated Iranians to donate kidneys to Iranian patients with end stage renal disease (ESRD) for financial gain. This program has been successful in eliminating the waiting list for kidney transplants within ten years of its inception (Mahdavi-Mazdeh, 2012). In addition, the Organ Transplant Act legalized brain stem death donations in 2000. Both ESRD patients and potential kidney donors are referred and registered with The Association for Supporting Renal Patients, a non-profit organization (NGO) that conducts basic medical screening. and facilitates market exchange. After successful completion of the screening, formal approval is obtained and the potential donor and recipient are introduced to each other. At this stage the patient and donor are referred to a psychiatrist for further examination, contrast, and angiography. If the patient-donor pair is compatible, in the next step the pair negotiate the terms and conditions of the exchange. All policies within the limited amount have been verified and implemented by the NGO. The price-cap is usually adjusted for inflation and during our study it was set at 180 million Iranian Rial (US$4700 in August 2017). However, the negotiation is confidential and the two can agree on any terms they wish. The donor also receives a “sacrifice gift” and one year’s insurance from the government through the Charity Foundation for Special Diseases. Transplant surgeries are performed free of charge in public university hospitals. Iran’s Ministry of Health and Medical Education introduced additional process changes in July 2019. In particular, they established an organ transplant and procurement center in the ministry that acts as a single center and provides full oversight and control of the process.
Are donors naive, risk-averse, impatient? No, they are ordinary people who take advantage of limited opportunities sometimes:
The overall picture is of people who were in financial need, often unemployed but with a family to support and where other means of obtaining financial assistance were difficult. However, regardless of their financial status, these people were patient and risk-averse. They were less intelligent than average, but those who eventually completed the program may be seen as more intelligent than those who did not….Overall our findings show that even in cases of extreme poverty we should not assume low levels of intelligence. it will be full.
Given that donation saves lives and that kidney donation is not particularly dangerous (much less dangerous than driving a motorcycle, for example) the trade-off seems good and within normal limits.
Turning to the US, here’s Sally Satel on the proposed kidney donation tax credit:
What if we could solve the organ donor shortage with a simple tax credit? That is the vision of the End Kidney Deaths Act (EKDA) (HR 9275).
The bill, developed by the Coalition to Modify NOTA (NOTA stands for the National Organ Transplant Act passed in 1984) would provide a $50,000 refundable tax credit—$10,000 a year for five years—to any living donor who donates a kidney to the next person. on the waiting list. The tax credit would be a 10-year pilot program.
The credit will save 10,000 maybe as many as 100,000 lives within ten years.
FYI, I am a supporter of Modify NOTA (along with Al Roth, Steve Levitt, and Mario Macis, to name just a few economists, combined with surgeons, nephrologists and others).
Hat tip: Kevin Lewis.
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