The whirling hum of a dialysis machine could have been the soundtrack to the rest of Zahra Hajikarimi’s life but for an unusual program in Iran that allows people to buy a kidney from a living donor.

Iran’s kidney program stands apart from other organ donation systems around the world by openly allowing payments, typically of several thousand dollars. It has helped effectively eliminate the country’s kidney transplant waiting list since 1999, the government says, in contrast to Western nations like the United States, where tens of thousands hope for an organ and thousands die waiting each year.

Critics warn the system can prey on the poor in Iran’s long-sanctioned economy, with ads promising cash for kidneys. The World Health Organization and other groups oppose “commercializing” organ transplants. Some argue such a paid system in the US or elsewhere could put those who cannot afford to pay at a disadvantage in securing a kidney if they need one.

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