And a poor person with one kidney less but extra health checkups can probably get better health outcomes than a poor person with two kidneys but extra health checkups. (This assumes that the kidney sale comes with some mandatory regular health checkups. Just like kidney donations do.)

In Iran, there is no tracking of donors and most donors don't want to be associated with the donation long-term, as it's connected to their poverty and the shame of their poverty. In the limited surveys that have been done many also noted that they haven't been properly informed about the risks of a donation.