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


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.

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    Note that “buying power” is a different concept than “exchange rate”. A detailed explanation of why “buying power” is a better measure for understanding what living organ donors are paid in Iran is provided in The Kidney Sellers (p. 212) [7].

  2. 2.

    All the quotes and details about donors are about men unless the donor is specifically identified as a woman.


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Correspondence to Sigrid Fry-Revere.

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No animals were used in the study.

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

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Authors are listed in the order in which they joined the project. The affiliations listed are the relevant affiliations the authors had while working on this article.

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Fry-Revere, S., Chen, D., Bastani, B. et al. Coercion, dissatisfaction, and social stigma: an ethnographic study of compensated living kidney donation in Iran. Int Urol Nephrol 52, 2403–2414 (2020).

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  • 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