A Forum discussing:
Kidneys for Sale: Empirical Evidence From Iran by Moeindarbari T and Feizi M (2022). Transpl Int 35:10178. doi: https://doi.org/10.3389/ti.2022.10178

Criminal, legal, and ethical actions are three very different issues: this applies to all human activities, including living kidney donation and transplantation. Criminal live donor kidney transplantation happens in countries with illegal black markets for organ transplantation.

In these countries, surgeons perform the procedure outside regular medical centers, where donors and recipients receive poor surgical care and no postoperative care. Therefore, patients return to traditional medical institutions with no documentation and often with severe and life-threatening opportunistic infections (1). So far, longstanding efforts to eliminate these markets have failed, despite widespread repugnance to them, and the passage of laws criminalizing payments to donors (2). Moeindarbari and Feizi (3) discuss the kidney market in Mashad. In Iran, it is legal to pay kidney donors. Transplants and nephrectomies are conducted in well-qualified transplant centers, which are also responsible for postoperative care of donors and recipients. The vast majority of the world transplant community opposes payments to organ donors, whether legal or illegal. Iranians emphasize the difference between criminal and legal live donor kidney transplantation. Many members of the international transplant community have witnessed that the legal live donor kidney transplantation in Iran is conducted with the highest medical and surgical standards.

We strongly believe that international efforts should concentrate on increasing the availability of ethical high-quality live donor kidney transplantation options in all countries. This is not the same as accepting legalized organ markets, as in Iran. But the present state of the discussion, and its legitimate concern with black markets, has become so dysfunctional that caught in the crossfire of these counterproductive discussions have been other ways of increasing the availability of legal, ethical and safe transplantation and donation. Vigorously opposing criminal black markets should not be conflated with opposing all innovations in living kidney donation that draw closer to the line of valuable consideration. Many recent innovations, such as various forms of kidney exchange, remain inappropriately associated with illegal black markets, when in fact they are opportunities to reduce the demand for illegal black markets.

Kimberly D. Krawiec et al., Criminal, Legal, and Ethical Kidney Donation and Transplantation: A Conceptual Framework to Enable Innovation, 35 Transplant International 22–24 (2022).