Both ethically and economically, organ trade has never been left to free market or even government intervention in almost all countries except for Iran. With legal and regulated kidney trade, donors receive cash payment from both the government as well as the recipient which totals to somewhere between $2000 and $4000; the government also provides a yearlong medical insurance to the donor. Also neither the transplant centre nor the transplant physicians there play any role in identifying potential donors.
In July, the head of the Health Ministry’s Transplant Department, Katayoun Najafizadeh, said 10 patients who are waiting for kidney transplants die on a daily basis. And there about a 2500 (including those from clinically brain-dead) officially reported transplants while 1000 occur in the black market where rates for a kidney go as high as &160,000. To cater to demand glut, government intervention has resulted in maximization of donors with each year at least 1400 donors giving one of their kidneys to an unknown person.
THE DONOR DILEMMA
Even though market forces had led to a stronger movement towards equilibrium, the real question is how much does this increase the purchasing power of the donor and does living with a single kidney has serious health implications or not. Generally it takes about a minimum of $1000 annually to surface above poverty; so given $3000 (on average) for a kidney donation, almost 90% of the amount will be spent on managing consumption expenditures for a couple of years. Therefore little can be saved.
STRIVING TOWARDS COMPETITIVE EQUILIBRIUM
Since a regulated market is intuitively better than having just a black market, supply might seem to be at the highest possible. This is probably the reason behind such low rates of kidney in Iran (also presumably due to a lower price floor set by the government). The market forces have incited intense competition among disproportionately poor households wherein they advertise their willingness to donate (through blood type, phone number and age) and it is in most cases not easy to find a match for them.
Another reason for such low rates is that living with a single kidney is not such a big deal. Although it does have serious repercussions against rigorous work but it is with little care that casualty can be prevented. The third reason is that both unemployment and inflation are at record high levels with the latter being at around 9.5% and the youth unemployment rate being around 25% while the overall rate being around 30% .
However all of the above reasons have left way for the leadership to set a low price floor; exacerbated by the fact that oil prices have plunged deep trimming the public revenue to a large extent. Revenues were expected to trickle down from the P5+1 nuclear deal lately but they stuck within the corrupt web weaved by the government. Also, having spent a vast amount of the public wealth on interventions in Syria, Lebanon, Iraq and Yemen, and also on terrorist organisations in the Arabian Gulf and Shiite campaigns in Africa, stagflation was imminent.
WHAT EXACTLY IS THE PROBLEM THEN?
The question that we started with was that can we operate an organs market optimally and so focussing just on the model of one such market, taking Iran’s market as the object since it stands against problems common to emerging nations, we have a couple of major difficulties:
Since the prices currently do reflect the value of a kidney – in terms of both health concerns and purchasing power – for a person, we need to first ask what exactly the problem that we seek a solution to is. There are two problems in queue – first the easy money from donation must not turn into a culture and second there is a need to increase the valuation of a kidney. And the last nascent problem will be that both the first and second problems seek counterproductive answers – if government increases the floor on donating, more people might get encouraged to donate.
The model, I believe has no specific internal solution and so will need external influence to keep itself subtle. Firstly there is a need to increases wages to incentivize people to work instead of donating but in face of rising inflation, the only way that this can be achieved is to enhance productivity and investment (also inviting foreign investment through diplomacy). Secondly a pervasive awareness drive should be deployed for enlightening people about the costs and benefits of donating a kidney. And lastly only one person from a family should be allowed to donate while the recipient market should be extended to foreigners as well. These steps can serve both objectives that we hold dear for both the health and economy of households.