Inside the World’s Only Legal Kidney Market: An Ethical Discussion of Iran’s Regulated Organ Trade
Vilson Ashvin
Introduction
For people with end stage renal failure, kidney transplantation is often the treatment of choice. Kidney transplantation involves donation of a kidney from a donor who can be either living or deceased. However, shortages of kidney donors around the world mean that many people must instead undergo dialysis, a process which mimics to a lesser extent the functions of a healthy kidney or, in some cases, turn towards illegal markets.
Amidst these issues, Iran seems to have adopted a unique solution - a regulated system by which kidney donation can be compensated.
This article examines this Iranian model, scrutinising the socioeconomic and ethical implications of this system and comparing it to the the rest of the world which, for the most part, prohibits organ sales.
Why are kidney transplants so important?
End-stage renal disease (ESRD) is a serious condition in which the kidney can fail, no longer being able to properly perform its role in filtering and removing waste and fluid from the blood.
For patients with ESRD, transplantation or dialysis are often the only options available [1].
Dialysis - Artificial filtering of blood to remove waste and excess fluid.
Transplantation - The transfer of a healthy kidney from a donor to a recipient.
Of these, the World Health Organization notes, transplantation is associated with better survival, quality of life and cost-effectiveness outcomes as well as. In some conditions, kidney transplant may even be the only option [2].
However, the global supply of kidneys continues to fall short of the demand. As of January 2026 there are over 90,000 patients awaiting transplant in the United States [3].
How is the rest of the world dealing with this?
Most countries prohibit compensation for organ donation. This means that most organ donation comes from altruistic or deceased donors. However as of the moment this not enough to match the demand for organs. Currently these countries are combating this shortage by looking into methods of raising public awareness and researching alternatives like bioengineered materials or animal products [2,4].
How is Iran combating the kidney shortage?
In 1988 Iran approved the funded LURD (Living UnRelated Donor) program in an attempt to combat long waiting lists for kidney transplantation.
Today, any patient that chooses to unrelated kidney transplantation is referred to the Iranian Patients’ Kidney Foundation and undergoes routine medical tests and imaging
Informed consent is then obtained from both parties and the donor and recipient are introduced to each other.
A nephrologist will then do further checks, including evaluation for coercion. The donor and recipient can then negotiate for extra compensation for the donor [5].
Arguments for and against the Iranian model
Autonomy and Saving of Lives
One argument for the Iranian model is respect for self-autonomy. Supporters argue that a person who has the ability to decide whether they can work a dangerous job like coal mining, should be entitled to the decision of what to do with their bodies.
Another argument supporting organ sale is the claim that it will save lives by supplying the shortage of kidneys. The basis of this claim is that the financial incentive might drive more people to donate their kidneys [6].
Critics argue that regardless of whether informed consent is received and lives are saved, the financial incentive leads to an unfair market where poverty is fuel for organ donation. They reason that a healthcare system that brings with it the inequalities of society cannot be seen as capable of producing truly autonomous decisions and that any such system would be nothing less than exploitation.
Illegal Organ Markets
A third argument in favour of organ sale is that moves people away from seeking organs through illegal markets. These illegal markets are much riskier and cannot be held responsible in the case of
any problems. As such those who advocate for regulated organ sale postulate that any regulated healthcare system would be safer, regardless of financial incentive.
Altruism and Commodification
Yet another argument condemns organ sale by pointing at the risks to altruism. If organ sale was permitted, it may lessen the number of altruistic deeds in the world.[6] Furthermore, commodifying organs implies that even health should depend on your social class. The World Health Organisation raises concern at this notion, arguing that health should be respected as a basic human right and that no opportunity to receive treatment should be based on recipient’s gender, race, religion, or economic condition [7].
Conclusion
Ultimately, the Iranian transplantation policy represents a call to action for the rest of the world in finding an end to this kidney shortage. It draws attention to the balance between protecting the vulnerable while ensuring those who need treatment are able to get it. The kidney shortage is a very real issue and action is needed. But is it worth doing so if we risk exploiting poverty?
1. World Health Organization. Kidney disease [Internet]. Geneva: World Health Organization; 2026 Apr 20 [cited 2026 Jul 1]. Available from:
2. World Health Organization. Transplantation [Internet]. Geneva: World Health Organization; [cited 2026 Jul 1]. Available from: https://www.who.int/health-topics/transplantation
3. 3. United Network for Organ Sharing. U.S. surpasses 49,000 organ transplants while deceased organ donations dip [Internet]. Richmond (VA): UNOS; 2026 Jan 28 [cited 2026 Jul 1]. Available from:
https://unos.org/media-resources/releases/u-s-surpasses-49000-organ-transplants-while-deceas ed-organ-donations-dip/
4. World Health Assembly. Increasing availability, ethical access and oversight of transplantation of human cells, tissues and organs: WHA77.4 [Internet]. Geneva: World Health Organization; 2024 Jun 1 [cited 2026 Jul 1]. Available from:
5. Mahdavi-Mazdeh M. The Iranian model of living renal transplantation. Kidney Int. 2012;82(6):627-634. doi:10.1038/ki.2012.219. Available from:
6. Wilkinson S. The sale of human organs. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy. Fall 2020 ed. Stanford (CA): Metaphysics Research Lab, Stanford University; 2020 [cited 2026 Jul 1]. Available from:
7. The Transplantation Society. WHO guiding principles on human cell, tissue and organ transplantation [Internet]. Montreal: The Transplantation Society; [cited 2026 Jul 1]. Available from:
https://tts.org/108-tts/about/tts-and-the-who/604-who-guiding-principles-on-human-cell-tissue -and-organ-transplantation
8. Pospelov V. Hemodialysis machine INNOVA.jpg [image on Internet]. Wikimedia Commons; 2008 Aug 22 [cited 2026 Jul 1]. Available from:
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