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Siraj MS. How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale. Philos Ethics Humanit Med 2022; 17:10. [PMID: 35897010 PMCID: PMC9331153 DOI: 10.1186/s13010-022-00122-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Advocates for a regulated system to facilitate kidney donation between unrelated donor-recipient pairs argue that monetary compensation encourages people to donate vital organs that save the lives of patients with end-stage organ failure. Scholars support compensating donors as a form of reciprocity. This study aims to assess the compensation system for the unrelated kidney donation program in the Islamic Republic of Iran, with a particular focus on the implications of Islam on organ donation and organ sales. METHODS This study reviews secondary documents for philosophical argumentation and ethical analysis of human organ donation and sale for transplantation. RESULTS AND DISCUSSION According to Islamic law, organ donation is an act of sadaqatul jariyah, and individuals are permitted to donate organs with the intention of saving lives. The commercialization of humans as organ sellers and buyers is contrary to the Islamic legal maxim eethaar, undermining donors of 'selfless' or 'altruistic' motivations. Such an act should be considered immoral, and the practice should not be introduced into other countries for the sake of protecting human dignity, integrity, solidarity, and respect. I, therefore, argue that Iran's unrelated kidney donation program not only disregards the position of the Islamic religion with respect to the provision or receipt of monetary benefits for human kidneys for transplantation but that it also misinterprets the Islamic legal proscription of the sale of human organs. I also argue that the implementation of Iran's unrelated kidney donor transplantation program is unethical and immoral in that potential donors and recipients engage in a bargaining process akin to that which sellers and buyers regularly face in regulated commodity exchange markets. Conversely, I suggest that a modest fixed monetary remuneration as a gift be provided to a donor as a reward for their altruistic organ donation, which is permissible by Islamic scholars. This may remove the need to bargain for increased or decreased values of payment in exchange for the organ, as well as the transactional nature of 'buyer and seller', ensuring the philosophy of 'donor and recipient' is maintained. CONCLUSIONS Offering a fixed modest monetary incentive to organ donors would serve to increase organ supply while protecting donors' health and reducing human suffering without legalizing the human organ trade.
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Affiliation(s)
- Md Sanwar Siraj
- Department of Government and Politics, Jahangirnagar University, Savar, Dhaka, Bangladesh.
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2
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Ambagtsheer F, Columb S, AlBugami MM, Ivanovski N. Kidneys for Sale? A Commentary on Moeindarbari’s and Feizi’s Study on the Iranian Model. Transpl Int 2022; 35:10530. [PMID: 35812157 PMCID: PMC9266991 DOI: 10.3389/ti.2022.10530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: Frederike Ambagtsheer,
| | - Sean Columb
- School of Law and Social Justice, The Liverpool Law School, University of Liverpool, Liverpool, United Kingdom
| | - Meteb M. AlBugami
- Multi-Organ Transplantation Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ninoslav Ivanovski
- Clinical Hospital Zan Mitrev, University “Sts Cyril and Methodius”, Skopje, North Macedonia
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Wirken L, van Middendorp H, Hooghof CW, Sanders JS, Dam R, van der Pant KAMI, Wierdsma J, Wellink H, Ulrichts P, Hoitsma AJ, Hilbrands LB, Evers AW. Combining transplant professional's psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation: an observational prospective multicentre study. BMJ Open 2022; 12:e045249. [PMID: 35236728 PMCID: PMC8895930 DOI: 10.1136/bmjopen-2020-045249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. The psychosocial evaluation of kidney donor candidates relies mostly on the clinical viewpoint of transplant professionals because evidence-based guidelines for psychosocial donor eligibility are currently lacking. However, the accuracy of these clinical risk judgements and the potential added value of a systematic self-reported screening procedure are as yet unknown. The current study examined the effectiveness of the psychosocial evaluation by transplant professionals and the potential value of donor self-report measures in optimising the donor evaluation. Based on the stress-vulnerability model, the predictive value of predonation, intradonation and postdonation factors to impaired longer term health-related quality of life (HRQoL) of kidney donors was studied. DESIGN An observational prospective multicentre study. SETTING Seven Dutch transplantation centres. PARTICIPANTS 588 potential donors participated, of whom 361 donated. Complete prospective data of 230 donors were available. Also, 1048 risk estimation questionnaires were completed by healthcare professionals. METHODS Transplant professionals (nephrologists, coordinating nurses, social workers and psychologists) filled in risk estimation questionnaires on kidney donor candidates. Furthermore, 230 kidney donors completed questionnaires (eg, on HRQoL) before and 6 and 12 months after donation. PRIMARY AND SECONDARY OUTCOME MEASURES HRQoL, demographic and preoperative, intraoperative and postoperative health characteristics, perceived support, donor cognitions, recipient functioning and professionals risk estimation questionnaires. RESULTS On top of other predictors, such as the transplant professionals' risk assessments, donor self-report measures significantly predicted impaired longer term HRQoL after donation, particularly by poorer predonation physical (17%-28% explained variance) and psychological functioning (23%). CONCLUSIONS The current study endorses the effectiveness of the psychosocial donor evaluation by professionals and the additional value of donor self-report measures in optimising the psychosocial evaluation. Consequently, systematic screening of donors based on the most prominent risk factors provide ground for tailored interventions for donors at risk.
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Affiliation(s)
- Lieke Wirken
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | | | - Jan-Stephan Sanders
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruth Dam
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn A M I van der Pant
- Department of Internal Medicine/Nephrology, Renal Transplant Unit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Judith Wierdsma
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hiske Wellink
- Department of Nephrology, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | - Philip Ulrichts
- Department of Internal Medicine/Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Andrea W Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
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Thomas R, Consolo H, Oniscu GC. Have we reached the limits in altruistic kidney donation? Transpl Int 2021; 34:1187-1197. [PMID: 34008872 DOI: 10.1111/tri.13921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/05/2023]
Abstract
Altruistic donation (unspecified donation) is an important aspect of living donor kidney transplantation. Although donation to a stranger is lawful and supported in many countries, it remains uncommon and not actively promoted. Herein, we ask the question if we have reached the limit in altruistic donation. In doing so, we examine important ethical questions that define the limits of unspecified donation, such as the appropriate balance between autonomous decision-making and paternalistic protection of the donor, the extent of outcome uncertainty and risk-benefit analyses that donors should be allowed to accept. We also consider the scrutiny and acceptance of donor motives, the potential for commercialization, donation to particular categories of recipients (including those encountered through social media) and the ethical boundaries of active promotion of unspecified kidney donation. We conclude that there is scope to increase the number of living donation kidney transplants further by optimizing existing practices to support and promote unspecified donation. A number of strategies including optimization of the assessment process, innovative approaches to reach potential donors together with reimbursement of expenses and a more specific recognition of unspecified donation are likely to lead to a meaningful increase in this type of donation.
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Affiliation(s)
- Rachel Thomas
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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5
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Danovitch G. Financial neutrality should replace the Iranian paid donor market. Clin Transplant 2019; 33:e13665. [PMID: 31310680 DOI: 10.1111/ctr.13665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Gabriel Danovitch
- John J. Kuiper Chair of Neprology and Renal Transplantation, University of California, Los Angeles, California.,Division of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California.,Kidney Transplant Program, University of California, Los Angeles, California
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Simforoosh N, Basiri A, Tabibi A, Nadjafi-Semnani M. Living Unrelated Kidney Transplantation: Does It Prevent Deceased-Donor Kidney Transplantation Growth? EXP CLIN TRANSPLANT 2019; 17:250-253. [PMID: 30777568 DOI: 10.6002/ect.mesot2018.p110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES It is usually assumed that an active livingdonor transplant program inhibits the growth of a deceased-donor kidney transplant program. In our 33-year experience, we found the contrary to be true. MATERIALS AND METHODS From 1984 until 2017, we performed a total of 4966 kidney transplant procedures. All cases were registered through the Collaborating Transplant Study (Heidelberg, Germany). RESULTS During the first 16 years, only living-donor kidney transplant procedures were done. Our first unrelated living-donor kidney transplant procedure was in 1986 and involved a wife to husband donation. This breakthrough in our country was the first in our unrelated living-donor kidney transplant program. In 2000, the Iranian Parliament passed the deceased-donor transplant act, and we have started deceased-donor kidney transplants since then. Despite a jam-packed living-donor kidney transplant program, our deceased-donor kidney transplant program has grown steadily since then and now comprises more than 50% of our kidney transplant procedures. When we compared the outcome of these programs, the 5-year survival from Collaborating Transplant Study report of 3527 cases of 114 living-related donor procedures was 90%. The 5-year survival rates for living unrelated-donor (n = 2689) and deceased-donor (n = 724) transplant procedures were 88% and 83%, respectively (P = .001). CONCLUSIONS Our data showed that deceased-donor kidney transplant procedures have steadily increased despite an active unrelated living-donor kidney transplant program. Wait lists for kidney transplant can be significantly reduced by following our model, both in developed and in developing countries.
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Affiliation(s)
- Nasser Simforoosh
- From the Department of Urology and Kidney Transplantation, Shahid Labbafinejad Hospital, Urology Nephrology Research Center, Shahid Beheshti Medical University, Tehran, Iran
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7
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Challenges and Future Recommendation for Kidney Transplantation in Iran: A Narrative Review. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.87026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Koplin JJ. Kidney Sales and Market Regulation: A Reply to Semrau. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017; 42:653-669. [PMID: 29149332 DOI: 10.1093/jmp/jhx023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Luke Semrau argues that the documented harms of existing organ markets do not undermine the case for establishing regulated systems of paid kidney donation. He offers two arguments in support of this conclusion. First, Semrau argues that the harms of kidney selling are straightforwardly amenable to regulatory solution. Second, Semrau argues that even in existing black markets, sellers would likely have experienced greater harm if the option of selling a kidney were not available. This commentary challenges both of Semrau's claims. I argue that there is no reason to believe that kidney sellers benefit from the current black market trade in organs, and highlight a number of potential issues regarding the effectiveness and feasibility of Semrau's proposed market regulations.
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10
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Piccoli GB, Sacchetti L, Verzè L, Cavallo F. Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney? Philos Ethics Humanit Med 2015; 10:13. [PMID: 26684455 PMCID: PMC4683780 DOI: 10.1186/s13010-015-0033-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/05/2015] [Indexed: 05/08/2023] Open
Abstract
Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of "reverse" informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties.
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Affiliation(s)
- Giorgina Barbara Piccoli
- SS Nephrology, Department of Clinical and Biological Sciences University of Torino, Torino, Italy.
- AOU san Luigi Gonzaga, Regione Gonzole 10, Orbassano, Torino, Italy.
| | - Laura Sacchetti
- EBM Course, Torino Medical School, University of Torino, Torino, Italy.
| | - Laura Verzè
- EBM Course, Torino Medical School, University of Torino, Torino, Italy.
| | - Franco Cavallo
- EBM Course, Torino Medical School, University of Torino, Torino, Italy
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11
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Bruzzone P. Paid Organ Donation: An Italian Perspective. Transplant Proc 2015; 47:2109-12. [PMID: 26361655 DOI: 10.1016/j.transproceed.2015.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/11/2015] [Accepted: 01/28/2015] [Indexed: 11/30/2022]
Abstract
The only countries that have allowed financial incentives for organ donation are Iran since 1988, and later on, Singapore and Saudi Arabia. In Europe, and of course in Italy, financial incentives for donors are prohibited. The author has completed extensive research via the Internet (PubMed) of worldwide scientific literature on paid organ donation, also researching studies concerning public opinion on organ commercialism and "regulated markets". Italian transplant laws also have been reported and analyzed.
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Affiliation(s)
- P Bruzzone
- Department of General Surgery, Surgical Sciences and Transplantation "Paride Stefanini", Università di Roma "La Sapienza", Rome, Italy.
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12
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Koplin JJ. The ambiguous lessons of the Iranian model of paid living kidney donation : Fry-Revere, S. (2014). The kidney sellers: a journey of discovery in Iran. (Durham: Carolina Academic Press). Monash Bioeth Rev 2015; 32:284-90. [PMID: 25743055 DOI: 10.1007/s40592-015-0023-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julian J Koplin
- Centre for Human Bioethics, Monash University, Ringwood, VIC, Australia,
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13
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Delmonico FL, Martin D, Domínguez-Gil B, Muller E, Jha V, Levin A, Danovitch GM, Capron AM. Living and deceased organ donation should be financially neutral acts. Am J Transplant 2015; 15:1187-91. [PMID: 25833381 DOI: 10.1111/ajt.13232] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 01/25/2023]
Abstract
The supply of organs—particularly kidneys—donated by living and deceased donors falls short of the number of patients added annually to transplant waiting lists in the United States. To remedy this problem, a number of prominent physicians, ethicists, economists and others have mounted a campaign to suspend the prohibitions in the National Organ Transplant Act of 1984 (NOTA) on the buying and selling of organs. The argument that providing financial benefits would incentivize enough people to part with a kidney (or a portion of a liver) to clear the waiting lists is flawed. This commentary marshals arguments against the claim that the shortage of donor organs would best be overcome by providing financial incentives for donation. We can increase the number of organs available for transplantation by removing all financial disincentives that deter unpaid living or deceased kidney donation. These disincentives include a range of burdens, such as the costs of travel and lodging for medical evaluation and surgery, lost wages, and the expense of dependent care during the period of organ removal and recuperation. Organ donation should remain an act that is financially neutral for donors, neither imposing financial burdens nor enriching them monetarily.
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14
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Quality and Quantity of Health Evaluation and the Follow-up of Iranian Living Donors. Transplant Proc 2015; 47:1092-5. [DOI: 10.1016/j.transproceed.2014.11.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/19/2014] [Indexed: 01/13/2023]
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Tong A, Chapman JR, Wong G, Craig JC. Perspectives of Transplant Physicians and Surgeons on Reimbursement, Compensation, and Incentives for Living Kidney Donors. Am J Kidney Dis 2014; 64:622-32. [DOI: 10.1053/j.ajkd.2014.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/20/2014] [Indexed: 12/19/2022]
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16
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Gordon EJ, Gill JS. Reply (invited response to 2 letters re Iran editorial). Am J Transplant 2014; 14:1226. [PMID: 24707777 DOI: 10.1111/ajt.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Institute for Public Health and Medicine, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Medical Humanities and Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Khatami SM, Mahdavi-Mazdeh M. Perfect is the enemy of good: the Iranian system of paid donation. Am J Transplant 2014; 14:1222-3. [PMID: 24618409 DOI: 10.1111/ajt.12675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- S M Khatami
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Koplin J. Response to open peer commentaries on "Assessing the likely harms to kidney vendors in regulated organ markets". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:W1-W3. [PMID: 25229598 DOI: 10.1080/15265161.2014.955329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Gordon EJ, Gill JS. Where there is smoke there is fire: the Iranian system of paid donation. Am J Transplant 2013; 13:3063-4. [PMID: 24224692 DOI: 10.1111/ajt.12486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 01/25/2023]
Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Institute for Public Health and Medicine, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Medical Humanities & Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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