Association for Public Policy Analysis & Management

Kidney patients undergoing dialysis treatment require kidney donations to survive.  Kidney procurement in the U.S. and throughout much of the world is based on altruistic donation.  Patients (regardless of their gender, race, and income) are registered on a national kidney registry waiting list to receive a kidney.  Data from the U.S. and Europe shows that women, the poor, and people of color have less access to kidney transplant opportunities.  The existence of disparity in receiving kidney donation among this group has been proven in previous studies.  In Switzerland and Germany, for instance, women tend to donate more kidneys but they receive less donation.   In the U.S., African-American patients are less likely to receive a kidney donation compared to their Caucasian counterparts.  Under a unique situation like that of the Islamic Republic of Iran (IRI), where kidney sale is legal and regulated, women donate less kidneys but receive significantly more kidneys.  Although the poor make up 80% of kidney sellers, they also constitute half of the buyers in the kidney market.  In this paper, we demonstrate that a regulated compensated kidney procurement model has an anti-discriminatory effect. Under free market organ trading such as that of Iran, the system seems to favor female transplant recipients over men.