Abstract

Organ transplantation services, particularly kidney transplants, have been provided in a fairly large number and good quality in the Islamic Republic of Iran since the 1990, and there are currently more than 25 kidney transplant centers that provide transplant operations. From the ethical and religious point of view, Iran has provided a flexible and relatively regulated environment for organ transplantation, especially regarding the possibility of unrelated living organ donation. This flexibility is mainly related to the role of ijtihad in Shi’a Islam where new rulings can be extracted by Shi’a jurists to facilitate the use of technologies that ordinarily might have been banned by traditional Islamic rulings. The possibility of monetary compensation for unrelated kidney donors in Shi’a Iran has helped expand the supply of donated organs, especially of kidneys, to a number almost equal to the demand. The Supreme Leaders in Iran have issued a series of fatwas that played a major role in legitimization of compensated organ transplantation from unrelated living donors. The main ethical issue is the large number of donors whose primary motivation is to gain monetary compensation to deal with their financial needs, and the inability of the ethical and legal system to fully regulate the market, to maintain fairness, and enhance altruism as a motivation for organ donation. This issue is also influenced by the economic hardship affecting most people in Iran, and is not merely a consequence of medical legislation to facilitate organ transplantation.