Solving the Organ Shortage

In the United States, 18 people die every day waiting for an organ donation that never comes. In 2007 alone, 9,600 patients died or became too ill to undergo surgery while waiting.

The sad fact is, this is how 1 out of every 5 people is removed from the 99,000-person U.S. Transplant Waiting List. Almost 90% of these people were in need of organs that could have been donated by living donors with relative safety. The overwhelming majority were waiting for kidney transplants — the modern surgical procedure for which involves an average hospital stay of 3-days for the living donor.

Of course, this is not just an American tragedy. The organ shortage is a global crisis, with just one nation claiming to have solved its organ shortage problem: Iran.

This may come as a surprise, but keep in mind: Iran was the birthplace of modern medicine. The Persian philosopher, Ibn Sina’s, Canon of Medicine was the premiere text studied by western medical students for nearly 700 years. Today, however, Iran’s reported successes in kidney procurement have gone largely unstudied, despite the fact that reports from inside Iran indicate an average wait of zero to four-months for patients in need of a donor kidney — some 56 to 60-months shorter than the average wait in the United States.

For those patients in the U.S. who are able to hold on through the 5-years that it normally takes to receive a donor kidney, the chance to lead a productive life is interrupted three times a week by 3-4 hour long dialysis treatments. Their lives go on, but their quality-of-life suffers, all because of a problem that could be solved by willing, living donors; as is reported to be the case in Iran.

With so many lives at stake, an in-depth study & analysis of the Iranian system is imperative. However, to date, there have only been two major papers discussing this system published by American researchers; both are currently involved in this project. Dr. Benjamin Hippen, who serves on the project’s advisory board, published an analysis based on what Iranians have reported in American journals. Dr. Diane Tebor performed a pilot study in one hospital while in Iran to study family planning.

No debate over solving the organ shortage in this country can be fully-informed without a clear understanding of the Iranian experience. To this end, the Center for Ethical Solutions intends to send a team of researchers to Iran, to study its kidney procurement system – the only system in the world in which compensation to the donor is permitted by law. We believe this study will provide the basis for an accurate account of the benefits and pitfalls of the Iranian system, and serve to fill a vital information gap in the debate over how to best solve the U.S. organ shortage crisis.

Project Details

The Center for Ethical Solutions is commencing the “Solving the Organ Shortage” project in order to scrutinize the Iranian kidney procurement system, with a view to informing the debate over solutions in the United States. By sending a team of researchers to Iran, we will be able to produce a more comprehensive and objective analysis than has been produced in the past.

Analyzing the Iranian system is difficult at best, without collecting data first-hand from several regions in the country. There is no standardized or centralized form of data collection in Iran, and it is likely that Iranian accounts of their own system differ because they rely on information from different sources. Almost all of the data we have on the Iranian system comes from Iranian doctors, and often reflects region-specific data. These accounts vary from one to the next, and lack any analysis as to what causes these variations. This project will try to mitigate these inconsistencies, which are reflected in the existing studies, by using identical methods for collecting data in at least six regions of Iran, and in the United States.

Though it is true that Iran is the only country in which compensation to organ donors is legal, it is certainly not the only place in which such compensation occurs. Our researchers will also be taking a close look at the world’s “Black Market” for human organs, both here in the United States, and, tentatively, through a first-hand look at such systems in India and/or the Philippines.

More-specific details will be available here as the project moves forward.

The Research Team

Sigrid Fry-Revere, J.D., Ph.D., is the lead investigator and project coordinator. Dr. Fry-Revere has a Ph.D. in philosophy with a concentration in bioethics. She has studied and followed the U.S. kidney crisis for years and in the past two years concentrated on learning about Iran. She commissioned and edited Dr. Hippen’s Policy Analysis “Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran” and just recently sponsored a debate at the Cato Institute entitled “Human Organs for Sale?” where Drs. Arthur Matas, Francis Delmonico, Benjamin Hippen and Samuel Crowe from the President’s Council on Bioethics debated the merits of allowing compensation for live kidney donation. Dr. Fry-Revere will be speaking at the Middle East Society for Organ Transplantation annual conference, Nov. 2008, to be held in Shiraz, Iran.

Bahar Bastani, M.D., is co-lead investigator, and lead medical data analyst for the project. Dr. Bastani is Professor of Internal Medicine – Nephrology at Saint Louis University, School of Medicine, Saint Louis, Missouri. Dr. Bastani is a Transplant Physician and is the Medical Director of the Kidney and Kidney-Pancreas Transplant Program at Saint Louis University, School of Medicine. Dr. Bastani is an Iranian American fluent in Modern Persian. He is well respected in the transplant community and has professional ties with all Medical Schools and transplant centers in Iran. Dr. Bastani will be speaking at the Middle East Society for Organ Transplantation annual conference, Nov. 2008, to be held in Shiraz, Iran.

Richard Ray, Professor at the University of California, Santa Barbara (March 2009), is serving as co-lead investigator both in the United States and Iran. His extensive experience interviewing native populations and conducting cultural research in over a dozen middle and far-eastern countries, including Syria, Jordan, Burma, Cambodia, and Lebanon, makes him an invaluable resource to our study in Iran. Ray has lectured on his experiences in these and other countries at the University of Wisconsin, Madison; SUNY Fredonia; Lewis and Clark St. College; the University of Utah; and the University of Colorado.

Shane Steinfeld is tasked with producing and promoting an online research center, to collect narrative testimony from organ donors and recipients – both those who have gone through the existing legal channels, as well as those who have turned to the black-market. The website will also be used to allow participants to fill out our structured interview questionnaire online, for inclusion with the data collected by our investigators in the United States and Iran. Once complete, the site will be available at http://solvingTheOrganShortage.com, in both English and in Farsi.

Project Advisors

Benjamin Hippen, M.D. is a transplant nephrologist in private practice with Metrolina Nephrology Associates and the Carolinas Medical Center in Charlotte, North Carolina. He is an at-large member of the United Network for Organ Sharing/Organ Procurement and Transplant Network Ethics Committee and serves as an associate editor of the American Journal of Transplantation. He is the author of “Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran.” Cato Institute Policy Analysis, March 20, 2008.

David J. Undis is the founder and Executive Director of LifeSharers, a national non-profit network of organ donors. LifeSharers members promise to donate upon their death, and they give fellow members first access to their organs. By creating a pool of organs that are available first to registered organ donors, LifeSharers has created an incentive for non-donors to become donors. Membership is free and open to all at www.lifesharers.org