Organ transplantation in China

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Kidney transplants rose from about 3,000 in 1997 to 11,000 in 2004, falling to 6,000 in 2007. Liver transplants rose from a few hundred in 2000 to 3,500 in 2005, then dropped to 2,000 in 2007
Trend in kidney and liver transplants in the People's Republic of China (1997–2007)[1]

Organ transplantation in China has taken place since the 1960s, and is one of the largest organ transplant programmes in the world, peaking at over 13,000 transplants a year in 2004.[2] China is also involved in innovative transplant surgery such as face transplantation including bone.[3]

Involuntary organ harvesting is illegal under Chinese law; though, under a 1984 regulation, it became legal to remove organs from executed criminals with the prior consent of the criminal or permission of relatives. Growing concerns about possible ethical abuses arising from coerced consent and corruption led medical groups and human rights organizations, by the 1990s, to start condemning the practice.[4] These concerns resurfaced in 2001, when a Chinese asylum-seeking doctor testified that he had taken part in organ extraction operations.[5]

In 2006, allegations emerged that a large number of Falun Gong practitioners had been killed to supply China's organ transplant industry.[6][7] An initial investigation stated "the source of 41,500 transplants for the six year period 2000 to 2005 is unexplained" and concluded that "there has been and continues today to be large scale organ seizures from unwilling Falun Gong practitioners".[6]

The report made 17 recommendations, including that China immediately put an end to the practice. Other key recommendations include mobilizing the Canadian government and other parties to conduct their own investigations, denying or revoking the passports of people traveling to China for organ transplants, and barring Chinese doctors from entering other countries to seek training in organ transplantation.[6][8]

In December 2005, China's Deputy Health Minister acknowledged that the practice of removing organs from executed prisoners for transplants was widespread.[9] In 2007, China issued regulations banning the commercial trading of organs,[10] and the Chinese Medical Association agreed that the organs of prisoners should not be used for transplantation, except for members of the immediate family of the deceased.[11] In 2008, a liver-transplant registry system was established in Shanghai, along with a nationwide proposal to incorporate information on individual driving permits for those wishing to donate their organs.[12]

Despite these initiatives, China Daily reported in August 2009 that approximately 65% of transplanted organs still came from death row prisoners. The condemned prisoners have been described as "not a proper source for organ transplants" by Vice-Health Minister Huang Jiefu,[13] and in March 2010 he announced the trial of China's first organ donation program starting after death, jointly run by the Red Cross Society and the Ministry of Health, in 10 pilot regions. In 2013, Huang Jiefu altered his position on utilizing prisoners' organs, stating that death row prisoners should be allowed to donate organs and should be integrated into the new computer-based organ allocation system.[14][15]

Background[edit]

Globally, pioneering experimental studies in the surgical technique of human organ transplantation were made in the early 1900s by the French surgeon Alexis Carrel, and successful transplants starting spreading worldwide after the Second World War.[16] China herself began organ transplantation in the 1960s, which grew to an annual peak of over 13,000 transplants in 2004;[2] and, despite some deaths from infection and hepatitis, the transplant programme has been successful in saving many lives.[17] Though the number of transplants fell to under 11,000 annually by 2005, China still has one of the largest transplant programmes in the world.[2][4] China explores innovative surgery, such as the world's first flesh and bone face transplant, performed by Professor Guo Shuzhong.[3] Organ donation, however, has met resistance, and involuntary organ donation is illegal under Chinese law,[18] as it is against Chinese tradition and culture, which attach symbolic life affirming importance to the kidney and heart.[19][20] China is not alone in encountering donation difficulties; demand outstrips supply in most countries. The world-wide shortage has encouraged some countries—such as India—to trade in human organs.[17][21] Reports of organs being removed from executed prisoners in China for sale internationally had been circulating since the mid-1980s, when a 1984 regulation made it legal to harvest organs from convicted criminals with the consent of the family or if the body goes unclaimed.[9] Development of an immunosuppressant drug, cyclosporine A, made transplants a more viable option for patients.[22]

Milestones[edit]

The first living related renal transplant was performed in China in 1972;[23] the first allogeneic bone marrow transplantation was successfully executed in an acute leukaemia patient.[24] The first recorded clinical liver transplant from a living donor in China took place in 1995, seven years after the world's first was performed in Sao Paulo, Brazil.[25] Between January 2001 and October 2003, 45 patients received living donor liver transplantation (LDLT) at five different hospitals.[26] In 2002, doctors at Xijing Hospital of the Fourth Military Medical University described three cases of living related liver transplantation. In 2003 a landmark brain-death case involving switched off ventilation came to the attention of the public and made a big impact on medical ethics and legislation. The first successful brain-death organ donation soon followed.[23] From October 2003 to July 2006, 52 LDLT operations were conducted at the West China Hospital, Sichuan University.[27] In October 2004, Peking University People's Hospital Liver Transplantation Center executed two cases of living related liver transplantation involving complex blood vessel anatomy.[28] In 2002, the Chinese media reported surgeon Dr Zheng Wei successfully transplanted a whole ovary at the Zhejiang Medical Science University to a 34-year-old patient, Tang Fangfang, from her sister.[29] In April 2006, the Xijing military hospital in Xian carried out a face transplant operation covering the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear while protecting his sheep.[30][31]

The first successful penis transplant procedure was performed in September 2006, at a military hospital in Guangzhou. The patient, a 44-year-old male, had sustained the loss of most of his penis in an accident. The transplanted penis came from a brain-dead 22-year-old male. Although successful, the patient and his wife suffered psychological trauma as a result of the procedure, and had the surgery reversed fifteen days later.[32][33] Following this, Jean-Michel Dubernard, famous for performing the world's first face transplant, wrote that the case "raises many questions and has some critics". He alluded to a double standard writing, "I cannot imagine what would have been the reactions of the medical profession, ethics specialists, and the media if a European surgical team had performed the same operation."[34]

International concerns[edit]

Organs sourced from prisoners sentenced to death[edit]

Transplantation first began in the early 1970s China, when organs were sourced from executed prisoners. Although other sources, such as brain-dead donors, had been tried, the lack of legal framework hampered efforts. Dr Klaus Chen said in 2007 that this was still the dominant pool.[23] Concerns that some poorer countries were answering donor shortages by selling organs to richer countries led the World Medical Association (WMA) to condemn the purchase and sale of human organs for transplantation at Brussels in 1985,[16] in 1987 and at Stockholm in 1994.[17]

In Madrid in 1987, the World Health Organization (WHO) condemned the practice of extracting organs from executed prisoners due to the difficulty of knowing if they had given consent.[35] Growing concern led other professional societies and human rights organisations to condemn the practice in the 1990s,[4] and to question the way in which the organs were obtained.[9] The WHO starting drafting an international guideline (WHA44.25) on human organ transplants in 1987[36] which resulted in the WHO Guiding Principles on Human Organ Transplantation being endorsed in 1991.[37] However, the wording did not allow the international community to draw up any laws preventing China from continuing to trade in human organs.[38]

The United States Senate Committee on Foreign Relations convened a hearing in 1995 on the trade in human body parts in China;[39] receiving evidence from various sources including statements from Amnesty International, the BBC, and Chinese government documents produced by human rights activist Harry Wu.[40]

The World Medical Association, the Korean Medical Association, and the Chinese Medical Association reached an agreement in 1998 that these practices were undesirable and that they would jointly investigate them with a view to stopping them; however, in 2000, the Chinese withdrew their cooperation.[35] Amnesty International claimed to have strong evidence that the police, courts and hospitals were complicit in the organ trade, facilitated by the use of mobile execution chambers, or "death vans".[41] Amnesty speculated that this profitable trade might explain China's refusal to consider abolishing the death penalty, which is used on between 1,770 (official figure) and 8,000 (Amnesty estimates) prisoners annually. Corpses are typically cremated before relatives or independent witnesses can view them, fuelling suspicions about the fate of internal organs.[41]

In June 2001, Wang Guoqi, a Chinese doctor applying for political asylum, made contact with Harry Wu and his Laogai Research Foundation, who assisted Wang in testifying to the US Congress in writing that he had removed skin and corneas from more than 100 executed prisoners for the transplant market at the Tianjin Paramilitary Police General Brigade Hospital, and that during at least one such operation the prisoner was still breathing.[18] Wang, a 'burns specialist', said that he had also seen other doctors remove vital organs from executed prisoners; and the hospital where he worked sold those organs to foreigners. Harry Wu said that he had gone to "great lengths" to verify Wang's identity and that both the foundation and congressional staff members found the doctor's statements "highly credible."[42]

In December 2005, China's Deputy Health Minister acknowledged that the practice of removing organs from executed prisoners for transplant was widespread – as many as 95% of all organ transplants in China derived from executions,[43] and he promised steps to prevent abuse.[9][44] In 2006, the WMA demanded that China cease using prisoners as organ donors.[45] According to Time, a transplant brokerage in Japan which organised 30–50 operations annually sourced its organs from executed prisoners in China.[46] Edward McMillan-Scott, vice president of the European Parliament, said he believed that nearly 400 hospitals in China had been involved in the transplant organ trade, with websites advertising kidney transplants for $60,000.[47]

On the eve of a state visit to the United States by President Hu Jintao, the 800-member British Transplantation Society also criticised China's use of death-row prisoners' organs in transplants, on the grounds that as it is impossible to verify that organs are indeed from prisoners who have given consent;[46] the WMA once again condemned the practice on similar grounds.[48] A BBC news report by Rupert Wingfield-Hayes in September 2006 showed negotiations with doctors in No 1 Central Hospital in Tianjin for a liver transplant.[49]

Allegations of Organ harvesting from Falun Gong practitioners[edit]

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