Criminal, Legal, and Ethical Kidney Donation and Transplantation: A Conceptual Framework to Enable Innovation.

Abstract

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, where surgeons operate outside regular medical centers and donors and recipients receive poor surgical care and no postoperative care. Longstanding efforts to eliminate these markets have failed, despite widespread repugnance to them, and the passage of laws criminalizing payments to donors. Iran is the only country where it is legal to pay kidney donors; transplants, nephrectomies and postoperative care are conducted in well-qualified transplant centers. While the vast majority of the world transplant community opposes payments to organ donors, Iranians emphasize the difference between criminal and legal live donor kidney transplantation. We suggest that international efforts should concentrate on increasing the availability of ethical high-quality live donor kidney transplantation. However, 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.