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Kidneys on Sale? An Ethnography of Policy, Exchange, and Uncertainty in Iran

  • Author(s): Mireshghi, Elham
  • Advisor(s): Montoya, Michael J.
  • et al.
Abstract

Since 1997, Iran has implemented the world’s only program for living paid kidney donation. The program has been developed and administered by a non-profit NGO – the Kidney Patient Foundation (KPF). Though sanctioned by Shi‘a Muslim jurists and celebrated in the West as the “Iranian Model,” the program has been rife with moral unease and uncertainty in Iran. While organ donation after death is valorized, undergoing transplantation for cash is stigmatized. Furthermore, there is little agreement among policy actors that facilitating paid organ giving is a good idea. In this dissertation, I examine kidney “selling” both at the level of the exchange – where I analyze the experiences of kidney givers and recipients – and at the level of institutional and bureaucratic process, legal and scientific reasoning, and practical and ethical negotiation, to explain how Iran came to uniquely sanction and bureaucratically routinize kidney selling. I disentangle the dense threads of moral reasoning and experience among a range of actors - from donors and recipients to doctors, policy activists, and Islamic jurists – that undergird the policy’s development and implementation. I have conducted ethnographic field research (2011-2013), including observation inside medical and Islamic institutions in Tehran and Qom, and indepth interviews of kidney givers and patients, KPF personnel, doctors and legal scholars and jurists. I have also analyzed Islamic legal texts, as well as visual and textual media.

My analysis brings together analytic approaches within the anthropology of public policy, medicine, morality, and exchange, while also contributing to a growing interest in Iranian Studies to venture beyond themes of repression and resistance. I consider Iran’s living kidney giving program within the context of Iran’s post-revolution medical modernization projects, its haphazard economic liberalization, and ongoing commitment to social welfare, alongside an examination of the role of Islamic jurists and other “experts” in policy making. I elucidate the socio-economic conditions and aspirations that motivate kidney givers, and the “medical imaginary” that facilitates their decision as well as the legal reasoning of jurists. Lastly, I offer an alternative to the “commodity paradigm” in examining exchanges involving money that can contribute to bioethical discussions of organ sales.

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