On July 28, Health Minister Hassan Ghazizadeh Hashemi attended the opening ceremony of a dialysis center in Tehran’s District 22. At the ceremony, he criticized the “painful” situation seen in the kidney market: “Over the past three decades, patients have bought kidneys from poor people . It is painful that some people have to sell their kidneys to cover their living expenses.”

Similarly, buyers write their numbers on the walls in hopes of finding sellers. One of the notices said, “In the name of God, a 29-year-old woman with the blood type O + needs a kidney. Donors who are willing to help her can contact the following number.”

The notices include details of sellers such as blood type, age and phone numbers. When Al-Monitor’s correspondent paid a visit, these details were expressed in sentences such as “healthy woman, 22, B + , 0927***9459” or “liver and kidney, negotiable price.”

TEHRAN, Iran — The walls of the Hasheminejad Specialist Hospital just off Tehran’s Vanak Square is covered with notices that serve as a market for an uncommon item: human kidneys.

Based on official statistics, Iran has about 9 million patients with diabetes (almost one out of every 10 Iranians), 5 million of whom struggle with kidney failure.

According to Hashemi, 28,000 patients are undergoing dialysis. Yet, he explained at the ceremony, dialysis is not a final cure for patients: “They will need a kidney transplant.”

Other than those undergoing dialysis, about 25,000 patients are officially registered and waiting to receive a kidney.

There are official and unofficial ways for buying and selling kidneys in Iran. The Kidney Foundation of Iran handles official registration of buyers and sellers. In February 2013, the foundation’s secretary-general, Darioush Arman, said in an interview with Fars News Agency that the official price for a kidney was 9 million toman ($2,650 at open market rates). Three years later, in May 2015, the health minister put the price tag at 15 million toman ($4,400 at open market rates). In the interview, Arman asked patients not to go to the unofficial market, where prices are higher: “I ask patients who need kidneys not to get ensnared with the notices on websites as well as the walls of hospitals and the foundation’s offices.”

Yet despite such pleas, it is evident that patients who are struggling to stay alive do not adhere to them. In the hemodialysis section of Hasheminejad Hospital, Mohammad Reza, a 45-year-old architect, put his wife in a wheelchair and carried her to the dialysis beds. He told Al-Monitor, “We have been waiting to receive a kidney for a year now. There is no news. Dialysis makes her suffer every day.” Reza has found a young woman who is willing to sell her kidney to his wife, Maral, but she wants more than the price of the official market, where there is a waiting list and prices are regulated: “She wants 45 million toman [just over $13,000 at open market rates]. That's a significant amount of money. I like to pay 9 million toman, but I can't wait and watch my wife die. She will hopefully undergo a kidney transplant this month.”

According to the authorities, only 2,500 official kidney transplant surgeries take place in Iran each year. Meanwhile, reports say another 1,000 surgeries — which are not reported to the Kidney Foundation of Iran — also annually take place.

Al-Monitor’s correspondent conducted phone interviews with a number of people who want to sell their kidneys. The interviews showed that, in most cases, poverty is the motive. Hossein, a 34-year-old man who lives in Varamin just outside Tehran, sold a kidney in March. He gave details to Al-Monitor on the condition of anonymity: “I sold it for 39 million toman [$11,500 at open market rates] to a furniture seller. I used the money to start a grocery store. I had nothing. I can live with one kidney, but is it possible to live without a job or any money?”

There is a large gap between the number of patients waiting for kidneys and the number of kidney transplants every year. The annual 7% increase in the number of patients with kidney failures is worsening the situation, and by extension, making the unofficial market larger.

Some reports indicate that Islamic charity institutions have also entered the kidney market. On June 30, ILNA news agency reported on the Abolfazl Healthcare Charity Institution, with 200 active offices in Esfahan province. Kidney Foundation of Iran Chairman Mostafa Ghassemi said his foundation does not have sufficient power to stop the direct and indirect activities of such institutions: “We have really tried to regulate the role of these institutions in the kidney market, but we cannot stop some of them.”

There is a high mortality rate among patients with kidney failure in Iran. In July, the head of the Health Ministry’s Transplant Department, Katayoun Najafizadeh, said 10 patients who are waiting for kidney transplants die on a daily basis. This fits with the health minister’s estimate on his personal website March 12 — World Kidney Day. Then Hashemi wrote that 3,000-4,000 patients who are on the waiting list die every year. He also noted that Iran is the only country in the world that has a legal and regulated kidney market.

Under the current circumstances, it seems that the Ministry of Health is unable and unwilling to take steps to fully regulate the trade in kidneys. Hashemi told reporters April 21, “Can we prohibit people from willingly paying for kidneys? It seems that we have to remain inactive because some patients might die.”

One practical way to stop the trade in kidneys in the long term might be to improve public attitudes toward pro bono kidney donations. Currently, the rate of organ transplants in Iran, 25 per 1 million people, is lower than the world average.

However, a nephrology expert at Hasheminejad Hospital, who wished to remain anonymous, told Al-Monitor that there is no short-term solution. He said, “Officials should not directly try to stop the market. They need to perform parallel actions. They should ask patients' relatives to donate their kidneys. Iranians need to know that they can live with only one kidney. We need to improve their attitude toward organ donation. It should be done through NGOs [nongovernmental organizations] and independent foundations. At the same time, a significant budget should be allocated to prevent diabetes and kidney failures.”

In the meantime, both buyers and sellers appear to have no option but to engage in this uncommon trade. As long as demand exists, supply, which is legal, will persist.