Coercion, dissatisfaction, and social stigma: an ethnographic study of compensated living kidney donation in Iran

  • Sigrid Fry-RevereEmail author
  • Deborah Chen
  • Bahar Bastani
  • Simin Golestani
  • Rachana Agarwal
  • Howsikan Kugathasan
  • Melissa Le
Nephrology - Original Paper


This article updates the qualitative research on Iran reported in the 2012 article by Tong et al. “The experiences of commercial kidney donors: thematic synthesis of qualitative research” (Tong et al. in Transpl Int 25:1138–1149, 2012). The basic approach used in the Tong et al. article is applied to a more recent and more comprehensive study of Iranian living organ donors, providing a clearer picture of what compensated organ donation is like in Iran since the national government began regulating compensated donation. Iran is the only country in the world where kidney selling is legal, regulated, and subsidized by the national government. This article focuses on three themes: (1) coercion and other pressures to donate, (2) donor satisfaction with their donation experience, and (3) whether donors fear social stigma. We found no evidence of coercion, but 68% of the paid living organ donors interviewed felt pressure to donate due to extreme poverty or other family pressures. Even though 27% of the living kidney donors interviewed said they were satisfied with their donation experience, 74% had complaints about the donation process or its results, including some of the donors who said they were satisfied. In addition, 84% of donors indicated they feared experiencing social stigma because of their kidney donation.


Living kidney donation Ethics Paid organ donation Law Iran Ethnographic study Human rights Social justice Transplantation Bioethics Exploitation Donor satisfaction Poverty Medical ethics Transplant ethics Living organ donation 


Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest.

Human and animal rights

No animals were used in the study.

Ethical approval

An IRB letter that indicates that IRB approval is not needed for this qualitative ethnographic study is attached.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.American Living Organ Donor NetworkLovettsvilleUSA
  2. 2.Center for Ethical SolutionsMadisonUSA
  3. 3.Saint Louis University School of MedicineSaint LouisUSA
  4. 4.University of TexasAustinUSA
  5. 5.Harvard UniversityBostonUSA
  6. 6.Fisk UniversityNashvilleUSA
  7. 7.University of VirginiaCharlottesvilleUSA

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