Today, Readers Unbound welcomes guest blogger  Sigrid Fry-Revere, whose book The Kidney Sellers will launch March 1st. Dr. Fry-Revere is the ethics consultant for the Washington Regional Transplant Community’s Organ and Tissue Advisory Committee and project director of the Center for Ethical Solution’s SOS (Solving the Organ Shortage) project. She has written hundreds of articles for publications such as The New York Times, The Los Angeles Times, The Wall Street Journal, The Cambridge Quarterly of Healthcare Ethics, The Journal of Clinical Ethics, and Pediatric Nursing. She is also the author of one book (The Accountability of Bioethics Committees and Consultants) and has edited another (Ethics & Answers in Home Health Care). Fry-Revere holds a Ph.D. in philosophy and a law degree, both from Georgetown University.

Creative non-fiction books that aren’t biographies or memoirs are rare for a reason. They are rare because mere factual stories may lack the narrative excitement found in novels. But sometimes there are stories where the novelty of the truth itself is what makes the book exciting. Consider books like Rebecca Skloot’s The Immortal Life of Henrietta Lacks, where, as in my book, the author uses her own journey of discovery as a theme that ties disparate stories together.

Steve Lessin: Fry-Revere’s American friend to whom she dedicated the book.

The Kidney Sellers is my story of going to Iran to try to find answers to solving the U.S. organ shortage. When I returned from Iran, I realized my adventure had so much more to offer than what might go into an academic monograph. The story itself ranged from my son having kidney cancer at age 10 months, to my friends who were dying on dialysis, to the wonderfully sad and moving stories I heard from kidney sellers in Iran. The truth of what happened is plenty exciting in and of itself —the cultural insights and ethical and moral questions raised by what I saw are significant.

There’s a reason so few Americans go to Iran — The State Department warnings talk about floggings and kidnappings, and in most cases it is illegal to do business with Iran. But I went because Iran is the only country in the world to have solved its kidney shortage. Kidneys make up 90% of the organ shortage. Twenty to 30 Americans die every day waiting for a kidney transplant. The Iranian medical community claimed it didn’t have a waiting list for people who needed kidney transplants — as a matter of fact, they said, there often are waiting lists for people who want to donate. How is this possible? Is it even true? So I went to see for myself. My book is about my adventure from getting to Iran to making it home safely.

One of the stories I tell is about a young man who had been in a moped accident, with his wife riding behind him. When they crashed, she fell and hit her head so hard, she lost her vision. Her only hope of recovery was to go to Germany, where an expert team might be able to help. Her husband didn’t want to sell his successful spice shop to pay for the trip, so he was selling his kidney.

Ms. Shahnaz Abdulwahaz, Afghan dialysis patient. In Iran, only Iranian citizens can get transplants at government expense.

I could not change what my interviewees said or what they meant by quoting them out of context in order to shape my research, but I could add my feelings, fears, beliefs, and stories from my own past to be more creative in how they were presented. In other words, I wouldn’t be constrained to an actual transcript in presenting my own thoughts as I was when I quoted my interviewees, or reported the facts of the stories they told me. The following is how I presented the story of the husband who sold his kidney to pay for his wife’s eye operation:

     Hamed was 28 but looked more the age of my own boys who are in their early 20s. His tight, dark-brown curls and large doe eyes with thick lashes projected an innocence that defied the severity of his grief. He never smiled; he kept repeating that he had to do right by his wife.

    Two months earlier, Hamed’s wife had lost her sight in an accident while riding on the back of his motorcycle. I thought of the many couples I’d seen weaving in and out of traffic on their mopeds and motorcycles, often with a child wedged between them and none of them wearing helmets. Once I saw a man driving with an infant on his lap, holding the baby in place with one hand and steering with the other. An involuntary shudder shook my frame.

   “Dr. Bastani, was anyone else hurt? There wasn’t a child, was there?”

   “No,” was the reply, and I let out a sigh of relief.

    To try to repair his wife’s vision, Hamed had already spent eight million tomans beyond what his insurance would cover. His wife’s doctors suggested that taking her to Germany was their only hope.

    “So now you would like to donate. How much do you think you can get from the sale of your kidney?

     “Well, I don’t really know, but the more I can get the better. I’ve three million in loans, but I’m still about nine million short.”

     Dr. Bastani pointed out that the going rate for a kidney is only five million tomans.

    “Well, then I will still need to think of a way to get the remaining four million.”

    Dr. Bastani inquired what Hamed would do if selling kidneys were illegal in Iran as it is in other countries. Hamed’s face went ashen, and in a soft, defeated tone he said, “Well . . . I don’t know. I would have to sell my successful spice shop, which is my only source of income. There would be no other way.”  

Ms. Soghra Dargahi, organ recipient, Imam Reza Hospital, Kermanshah

Another literary device I mentioned earlier is illustrated in the following passage. After an unpleasant encounter with a cab driver who let me carry my own luggage and acted as if I weren’t there, I muse about how as I child I had my first lesson about discrimination against women.

    My parents and I were walking down the street in Istanbul on our way to the Hagia Sophia when the entourage in front of us stopped abruptly, causing a traffic jam on the sidewalk. Three women in line behind a man all came to a halt, and we watched as the man turned, put out his foot, and pulled up his trouser leg. The last woman came forward, knelt with one knee to the ground, tied his shoe, got up without looking up, and returned to her place in line.

     I glanced at my mother in bewilderment.

     She winked at me and said, “Not so bad if you’re wife number one.”

     My father shot her a glare as if to say, Are you sure she’s old enough for a joke like that?

     My mother ignored him and continued, “When your father and I were in Morocco after the War, we saw men walking with their wives and the order was reversed: woman, woman, woman,” she paused for emphasis, “horse, and then the man.”

    “Why?”

    Without looking at me, she answered, “Land mines.”

In both these passages I use stories, the one about the young man with a blind wife and my own personal story about Turkey to illustrate how in every culture there are people who treat women both well and badly, but the ultimate question is whether law and society sanction such behavior. 

Eventually, with plenty of persistence and repeated rewritings, I found a publisher, Carolina Academic Press, for my book. And now, the true story of what kidney selling is like in Iran is ready to be told in the form I intended – a nonfiction story that could change how we look at what it means to solve the organ shortage.