Iran's organ market: Look, he has no kidneys to sell

 　　 In Tehran, the capital of Iran, there is a long street called Farhang Hosseiny, which the locals call "Kidney Street". The walls on both sides of the streets and alleys are covered with "patches" all year round, and latecomers can only fill the walls to find vacant spaces, and paste the advertisements printed in advance.

　　 Entering this long street, life is disassembled into specific parts. Kidneys, livers, bone marrow, corneas, and plasma matched to various blood types can be peddled generously. Just like electronic parts, the relationship between supply and demand is the irrefutable truth.

　　 In the only legal organ trading country in the world, selling one's own organs is not so much a transaction as a well-documented folk custom. There are two paths above and below the ground, one is legal but the price is conservative, and the other is risky but flexible.

　　 In the past few years, the demand for organ sales has become more and more urgent. The registration hall is bustling like a vegetable market, and the paper on the walls of the alleyway has also turned into graffiti. They have rough lines and bright colors, because only this is enough to stand out.

　　 When the phone rings, the "chosen" people have no time to panic and be suspicious. Because no matter what method is used, it seems that only when the organs are taken out and the wound is stitched up, can the broken life be healed. 　　 The reception of the Tehran branch of the

　　"Fate's Bounty" Iranian Association of Kidney Patients, one of Iran's institutions set up to promote trade in organs, was packed. 　　 The corridor at the reception desk is long and cramped. People line up to fill out forms and answer questions before undergoing examinations or X-ray scans. Only healthy people are released to surgery. 　　 After completing the registration form, everyone posted their own photo on the information card. After intense and chaotic bargaining, some people reached an agreement, while others left the meeting angrily. 　　 Everyone has two kidneys, so even if there is only one kidney left, it will basically not affect life. For the only legal trading market in the world, this is like a "reward of fate", and it is also the most common trading category. Compared with "organ sales", local people prefer to use the term "paid donation" to describe their behavior.

　　 According to incomplete statistics, in the few years after this transaction was legalized, an average of more than 1,400 people sold one of their kidneys to strangers every year. The change was inspired by a crisis. After the Iranian revolution in 1979, Iranian assets abroad were confiscated, and the eight-year Iran-Iraq war overdrawn the treasury. Funds for dialysis have bottomed out, and kidney resources are extremely scarce. People who have lost kidney function have two options: go abroad for a transplant or die in Iran.

　　 Entering the 1980s, the population of end-stage renal failure in Iran continued to grow, and the supply pressure of dialysis resources was increasing. The government began to pay for living-related transplants abroad. When the cost of transplantation increased year by year, Iran began to establish its own small kidney transplantation team. From 1985 to 1987, nearly 100 transplants were performed each year, but this was a drop in the bucket for more than 25,000 patients with end-stage renal disease.

　　 Finally, in 1988, Iran legalized non-related living donor kidney donation and established a transplant system for this purpose, where patients can find suitable kidney sources among people other than relatives. This government-organized system regulates and finances the transplant process and compensates organ donors. In addition, the government also established a third-party association to connect donors and recipients, and this institution has been in operation to this day.

　　 In most countries, selling human organs is considered an inhumane thing, but Iran has broken through this layer of moral concerns. Shia jurists have found a reasonable explanation for this blood and flesh trade-according to the "Quran", "Saving one person's life is equivalent to saving the lives of all people."

　　 In 1997, under the impetus of Ali Khamenei, Iran's highest-ranking jurist, the "Compensatory Donation Act" was passed, and a relatively complete set of organ trading rules was officially introduced. The government takes the lead, and both the donor and the recipient register and complete the inspection. After the match is successful, the operation can be performed.

　　 In this process, the government covers part of the cost, compensates the donor, provides the hospital with a year of medical insurance, and sometimes gets an additional payment from the recipient. Immediately, donors flocked in, and the kidney source was abundant and the price was low, only between US$2,000 and US$4,000, which was negotiable.

　　 In the eyes of some donor candidates, they only want almost free organs, and selling their own organs is as cheap as selling meat. But even so, donors are still coming in an endless stream.

　　 A statistical survey shows that 70% of donors come from the bottom of society. Iranian authorities have publicly stated that their system provides a relatively safe way of earning money for the poor, saves lives, keeps surgery costs low and reduces wait times for transplants. By 1999, the transplant waiting list in Iran was empty.

　　 However, due to the low return rate of the official transplant system and the long waiting time, it takes an average of more than 5 months from registration to transplantation. Gradually, the legal trade led by the government gradually loses its allure. The black market is the light of the poor.

　　Underground black market, light for the poor?

　　 Wearing a pair of half-rim glasses and a suit shirt, Rezai looked like a white-collar worker. He comes from the local middle class, and once earned enough money to support his family, a career change made his situation take a turn for the worse.

　　 Iran at the time launched a campaign to build affordable housing for low-income families. He is responsible for the air-conditioning supply of some of the project's housing units. However, many apartments could not be sold due to poor quality, some developers fled Iran, subcontractors were not paid, and Rezai was also implicated.

　　 He owed the bank nearly $7,000 and was jailed for attempting to bounce checks. After borrowing money to bail three months ago, he was arrested again for failing to repay the loan, this time with his brother-in-law mortgaging his apartment to cover his bail costs.

　　 "If you don't pay back the money, my brother-in-law's house will be confiscated, and I will go back to prison. What about the child?"

　　 Rezai was desperate. He wrote down his appeal in a large piece of white paper with a blue pen, and then put it It was posted on a brick wall outside a medical supply company - "kidney for urgent sale, price is negotiable, blood type AB positive", with his phone number under the white paper.

　　 Rezai bid $9,000 for his kidney, but the official price of the kidney is only $3,000. It’s just that in the black market, the price is artificially controllable, so Rezai is waiting for a call from an intermediary, and his kidney may be smuggled to a private clinic in the Kurdish region of Iraq. Maybe he can also directly connect with the buyer, pretending to be the other party's relatives and friends, and complete the operation as soon as possible.

　　 "If selling my kidney can help me get out of my debt crisis, so can my liver," Rezai said.

　　 However, the inexperienced Rezai is obviously insensitive to the market. There is an unwritten rule in the local black market: the closer the age is to 35, the organ will be considered too damaged, and the price will be lower. Most of the sellers are in their twenties. The 42-year-old Rezai obviously does not have much bargaining power.

　　 In the end, Rezai's ad was still plastered on the wall after the repayment date set by the bank passed. When the Los Angeles Times called his number again, no one answered the phone.

　　 On the walls of Tehran's alleyways, struggles can be seen everywhere. These low-level people have no time to wait, and can only compete to sell their organs at the cheapest price. Donors who are unlucky will also encounter black intermediaries, which will make their already poor life worse.

　　 Sarah, a 35-year-old divorced woman, also turned to the black market for help. She guaranteed a $6,000 bank loan for a friend, who defaulted, and couldn't make up the shortfall with her monthly salary of just $420, so she joined the street advertising army. Two agents contacted her, but disappeared after asking for a deposit of several hundred dollars.

　　 Sarah decides to go back to legal channels. But six months after registration, the buyer has still not been heard from.

　　"Fatal Combination" Rolling Opposite Tehran

　　 's Hashimi Nejad Kidney Center, new advertisements are posted on the wall near the hospital almost every day. Between 1993 and 2017, doctors at the hospital performed more than 30,000 kidney transplants.

　　 It is a harsh fact that in a country with abundant organ donors, many sick people still cannot afford organ transplants. As the economic situation deteriorates, fewer poor Iranians are able to receive transplants.

　　 The Iranian boy Jafar is a uremia patient. In recent years, due to illness, he terminated his studies. After making hundreds of phone calls, he found 72 blood donors, but all of them were dismissed due to mismatched types. Just when the whole family was desperate, a donor named Nalin appeared, and they finally reached a deal for $4,300.

　　 Nalin's asking price is not expensive in private kidney transactions. But Jiafar's family was from an ordinary family. In order to pay for the transplant, his parents sold all the land in the family. His father said: "I have to make a choice between my family's livelihood and saving my son.

　　 " The total volume has plummeted from 2.5 million barrels per day at its peak to 200,000 barrels per day, with a daily loss of about US$100 million.

　　 For the Iranian economy, the move is tantamount to a chokehold. However, when the domestic economy was hit, prices were soaring, and people's livelihood could not be guaranteed, the Iranian government decided to double the domestic oil price to ease the financial crisis. In the two years since 2017, poor Iranians, who could hardly bear the pressure, took to the streets to protest many times.

　　 In September 2019, the National Council of Resistance of Iran (NCRI) reported on the recovery of trade in human organs that in this country, in addition to selling kidneys, a traditional transplant, the list of transactions gradually included livers, lungs, bone marrow, corneas and blood plasma.

　　 In the second year, Iranian President Hassan Rouhani pointed out that the economic losses caused by the sanctions to Iran were as high as 50 billion U.S. dollars, equivalent to twice the 2019 budget. At the same time, the new crown pneumonia epidemic has pushed Iran's inflation levels to historical peaks. Prices are soaring, and legal currency is depreciating. In the worst case, 1 US dollar can be exchanged for 250,000 rials.

　　 At the height of the crisis, Rouhani encouraged people to invest in stocks to boost the national economy. Member of Parliament Musen Alizad said bluntly: "People empty their pockets, sell houses, cars, and wives' jewelry, and then end up with nothing."

　　 A study by the Iranian Institute of Advanced Studies shows that between 2017 and 2020, The number of people living below the poverty line has doubled. As early as 2014, Iran introduced a bill that prohibits foreigners from receiving organ transplants in Iran under the guise of traveling. As a result, fewer people were being donated, and the line waiting for organ donation became longer and longer.

　　 After Nalin sold the kidney to Jafar, she and her husband paid the rent with the money from the kidney sale. They planned to maintain this for a while, and wait for the oil price to stabilize before going to the talent market. But just a month after the transplant, Narin received a call that Jafar had passed away due to rejection.

　　 At his funeral that day, people gathered around the young man's grave, and Narin's kidney was buried with him in the cemetery. During this time, Nalin was ill, and her remaining kidney was aching. "The doctor told me to go on a diet and drink more water. But I have to stop the medicine and go to the hospital."

　　 "As long as there is poverty, transplant commercialism will always exist." Behruz Bu, a nephrologist at the Iranian Organ Transplant Association Luman said, "Iran's experience is that after a transplant, the poor are still poor, but with one less kidney."

　　 However, dry pockets and scarce jobs are forcing more and more Iranian citizens to join the army of organ donation. In desperation, many Iranians followed the black market brokers alone to the black market in neighboring Iraq to get a good price for their kidneys.

　　 "Most sellers want to use the money to buy a car as a driver, or to rent an apartment. In short, the higher the price, the better, and it can solve more problems." An official from the Kidney Disease Support Association told " Iran International said.

　　 Given the generally poor economic conditions of Iranian donors, Kevin Longino, CEO of the National Kidney Foundation, said, "Trading organs and using them as a business model is a slippery slope that exploits the poor and the poor." Vulnerable groups.”

　　 However, this concern was refuted by Larry Zad, chairman of the Ahvaz Kidney Transplant Association in Iran: “One kidney is enough.” The

　　 UAB Institute for Human Rights pointed out that compared with pure exploitation, the official Iranian government Part of the supplementary benefits can alleviate the damage caused by transplant surgery to the donor to a certain extent. "When a financially hopeless person donates an organ, usually health declines and the financial situation becomes more precarious. However, in the Iranian model, donors get health insurance after surgery to tide them over."

　　 Facts Is that so? The Royal Annals of Surgeons noted that for most donors, selling a kidney did not bring about the life transformation they dreamed of. Many are slipping back into debt, not physically able to carry out strenuous work.

　　 The 23-year-old Mehdad was heavily in debt due to unemployment. He sold his kidney to pay off the debt, and even bought a car to start a new life as a taxi driver. But not long after the good times passed, he was involved in another accident and the car was scrapped. When he was out of work again and life continued to be impoverished, he began to think hard about everything that had happened to him.

　　 He opened a letter written to him by the recipient before the operation, in which he was called the "angel of salvation". The recipient said: "I will protect this gift of yours for the rest of my life, and feel that you will always be by my side."

　　But Mehdad still has lingering fears when he thinks of the kidney removal operation. He once dreamed a similar scene, and there was his deepest fear: in the dream, lying on the operating table, he heard the doctors cut up his stomach and said, "Look! He has no kidneys to sell!"