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 The Washington Post reported claims by a Chinese asylum-seeking doctor that he had taken part in organ extraction operations. Further, in 2006, there were claims of harvesting of organs from live practitioners of the persecuted spiritual movement Falun Gong, which led to a disputed report being compiled by former Canadian parliamentarian David Kilgour and human rights lawyer David Matas. The report makes 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, barring Chinese doctors from entering other countries to seek training in organ transplantation, and urging Chinese authorities to conduct a criminal investigation for possible prosecution.[5] Kilgour and Matas assessed 18 different elements of proof or disproof, all of which they say are "verifiable and in most cases incontestable."[5] One of the elements they considered was the backdrop of the current climate in China, one marked by corruption, human rights violations and a state policy of persecution against Falun Gong that includes repression, hate incitement, and massive arrests.[5]

The Chinese authorities have not denied the practice of taking organs from executed prisoners, and have taken steps to address international concerns regarding both the State's reliance on executed prisoners for organ donation and the illegal trading of these organs which in 2005 they acknowledged had occurred. They have consistently denied the allegations of removing organs from living Falun Gong practitioners. In 2007, China issued regulations banning the commercial trading of organs,[6] 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.[7] 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.[8]

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,[9] 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.[10][11]

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.[12] 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.[13] 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,[14] as it is against Chinese tradition and culture, which attach symbolic life affirming importance to the kidney and heart.[15][16] 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.[13][17] 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.[18] Development of an immunosuppressant drug, cyclosporine A, made transplants a more viable option for patients.[19]

Milestones[edit]

The first living related renal transplant was performed in China in 1972;[20] the first allogeneic bone marrow transplantation was successfully executed in an acute leukaemia patient.[21] 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.[22] Between January 2001 and October 2003, 45 patients received living donor liver transplantation (LDLT) at five different hospitals.[23] 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.[20] From October 2003 to July 2006, 52 LDLT operations were conducted at the West China Hospital, Sichuan University.[24] In October 2004, Peking University People's Hospital Liver Transplantation Center executed two cases of living related liver transplantation involving complex blood vessel anatomy.[25] 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.[26] 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.[27][28]

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.[29][30] 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."[31]

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.[20] 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,[12] and at Stockholm in 1994.[13] 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.[32] 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.[18] The WHO starting drafting an international guideline (WHA44.25) on human organ transplants in 1987[33] which resulted in the WHO Guiding Principles on Human Organ Transplantation being endorsed in 1991.[34] However, the wording did not allow the international community to draw up any laws preventing China from continuing to trade in human organs.[35]

The United States Senate Committee on Foreign Relations convened a hearing in 1995 on the trade in human body parts in China;[36] receiving evidence from various sources including statements from Amnesty International, the BBC, and Chinese government documents produced by human rights activist Harry Wu.[37]

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.[32] 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".[38] 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.[38]

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.[39] 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."[40]

By 2005 the WMA had specifically demanded that China cease using prisoners as organ donors.[41] In December of that year, 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,[42] and he promised steps to prevent abuse.[18][43] According to Time, a transplant brokerage in Japan which organised 30–50 operations annually sourced its organs from executed prisoners in China.[44] 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.[45]

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;[44] the WMA once again condemned the practice on similar grounds.[46] 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.[47]

Allegations of harvesting organs from living prisoners and execution to meet organ transplant demand[edit]

In 2006, claims of harvesting of organs from live practitioners of the Falun Gong spiritual movement at a research hospital led to an investigative report being compiled by former Canadian politician, David Kilgour, and human rights lawyer David Matas.[48] The findings of their investigation were controversial as the conclusions were based on circumstantial evidence,[49][50][51] The report outlines extraordinarily short wait times for organs in China—one to two weeks for a liver compared with 32.5 months in Canada (median wait for 2003) as an incriminating factor. Kilgour and Matas also present self-accusatory material from Chinese transplant centre Web sites that advertise the immediate availability of large numbers of organs from living donors. Organ price lists were available on Chinese hospital Web sites.[52][53] Investigations, including by dissident Harry Wu, and the U.S. State Department, failed to find evidence to support the allegations,[43][54][55][56][57] though Kirk C. Allison, Associate Director of the Program in Human Rights and Medicine in the University of Minnesota, (2006) and Tom Treasure of Guy's Hospital, London (2007), considered the report "plausible from a medical standpoint" based on the numerical gap in the number of transplants and the short waiting times in China compared with other countries.[58][59][60] In May 2008 two United Nations Special Rapporteurs reiterated their previous request for the Chinese authorities to adequately respond to the allegations,[61] and to explain the source of organs which would account for the sudden increase in organ transplants in China since 2000. China has repeatedly denied the organ harvesting allegations in the report.[62]

No straight answers have been produced by the Chinese regime over the allegations of state-sanctioned organ harvesting of Falun Gong practitioners, said Manfred Nowak, the United Nations Special Rapporteur on Torture. "The Chinese government has yet to come clean and be transparent," said Nowak in an interview with The Epoch Times. "It remains to be seen how it could be possible that organ transplant surgeries in Chinese hospitals have risen massively since 1999, while there are never that many voluntary donors available."[52] Nowak has submitted two reports to the U.N. Human Rights Council formally requesting the Chinese regime respond to the allegations. The report states, in part, that, "The Falun Gong practitioners were given injections to induce heart failure, and therefore were killed in the course of the organ harvesting operations or immediately thereafter." “Nothing seems to have changed for the better," said Nowak. The majority of the inmates in the forced labor camps were Falun Gong members. And that is so frightening, because none of these people were ever given the benefit of a trial. They were never charged", he said.[52]

On 12 September 2012, the United States House Committee on Foreign Affairs heard the testimonies of experts about organ harvesting in China. Ethan Gutmann, an investigative journalist, referred to the body of witness testimony, much of which he has wrangled, from former surgeons and nurses who have direct knowledge of organ harvesting from prisoners of conscience. He has also interviewed imprisoned Falun Gong practitioners who have been tested for their blood type, which is needed for their organs to be harvested. He lamented the lack of interest in the West in the evidence that he and others have worked to accumulate, and urged the committee to invite the witnesses to be cross-examined.[63] Dr. Gabriel Danovitch, a professor of medicine at UCLA, noted the efforts that international medical organizations have made to change abusive Chinese organ sourcing practices. Dr. Damon Noto, the spokesman with the medical society Doctors Against Forced Organ Harvesting, presented a careful historical analysis of the beginnings of organ harvesting by the ruling Chinese Communist Party (CCP), and ran through a narrative that led to the ultimate conclusion that the Party has harvested the organs of up to 60,000 Falun Gong prisoners of conscience. The CCP's military apparatus began with death row prisoners in the 1990s and after 1999 moved on to the newly persecuted Falun Gong population. There was an "exponential increase in transplantations" from 2000 onward, Noto said.[63]

Arthur Caplan, a Professor of Medical Ethics and the Director of the Langone Medical Center and School of Medicine of New York University, said that the release of any information on forced organ removal is the first step in stopping the practice. "Having this release of information is very important. I am very pleased that these Congressmen have called for this release and I hope that the state department responds quickly", he said. He also said the evidence that this is happening in China should not be in question.[64] Dr. Caplan also called on the American scientific and medical community to actively boycott transplant information and research coming from China.[64]

Developments since 2006[edit]

In March 2006, the Ministry of Health issued the Interim Provisions on Clinical Application and Management of Human Organ Transplantation, which stipulated that medical centres must meet new requirements for transplant services; the provinces were made responsible for plans for clinical applications. Establishments performing transplantation were thereby obliged to incorporate considerations for ethics, medical and surgical expertise, and intensive care. In April 2006, the Committee of Clinical Application of Human Organ Transplantation Technologies was created to standardise clinical practice; a national summit on clinical management took place in November 2006 which issued a declaration outlining regulatory steps.[2] Professor Guo Shuzhong conducted a series of face transplant experiments in Xijing hospital, leading in April 2006 to the world's first face transplant that included bone.[3][65] The donor had been declared brain-dead before the operation.[66]

In May 2007 the Regulation on Human Organ Transplantation came into force, banning organ trading and the removal of a person's organs without their prior written consent,[67] and this has been favourably received by the World Health Organization and The Transplantation Society.[2][4] To curb illegal transplants, doctors involved in commercial trade of organs will face fines and suspensions; only a few hospitals will be certified to perform organ transplants.[68] As a result of a systematic overhaul, the number of institutions approved for transplants has been reduced from more than 600 in 2007 to 87 as at October 2008; another 77 have received provisional approval from the Ministry of Health.[2]

To further combat transplant tourism, the Health Ministry issued a notice in July 2007 in line with the Istanbul Declaration, giving Chinese citizens priority as organ recipients.[2] In October 2007, after several years of discussions with the WHO, the Chinese Medical Association agreed to cease commercial organ collection from condemned prisoners, who would only be able to donate to their immediate relatives.[7][69] Other safeguards implemented under the legislation include documentation of consent for organ removal from the donor, and review of all death sentences by the Supreme People's Court. Transplant professionals are not involved until death is declared. A symposium among legal and medical professionals was held in April 2008 to discuss the diagnostic criteria for brain death for donors of transplant organs.[2]

A liver-transplant registry system was established in Shanghai, in 2008, which allows the monitoring of the after-care of liver recipients; at the same time a nationwide proposal was announced that would allow people to note on their driving licence that they wish to donate their organs.[8] Despite these initiatives the China Daily newspaper reported in August 2009 that approximately 65% of transplanted organs still came from death row prisoners,[9] which has been described as "not a proper source for organ transplants" by Vice-Health Minister Huang Jiefu.[6] China's first posthumous organ donation system was jointly launched in March 2010 by the Red Cross and the Ministry of Health.[2] Huang Jiefu announced that the scheme, which will allow people to express their wishes on their driver's licences, would be trialled in 10 pilot regions including the cities of Tianjin, Wuhan and Shenzhen.[6] Funds will be made available for the families of people who voluntarily donate their organs. Chinese authorities say they hope the pilot program's success will reduce the need to take organs from death row prisoners and stem the tide of black market organs.[9] In 2012 China officials stated they plan to phase out organ harvesting of death-row inmates.[70]

In September 2012, the report "Organ Harvesting of Religious and Political Dissidents by the Chinese Communist Party" presented to the members of a US Congress Subcommittee by Damon Noto, the spokesperson for the organization Doctors Against Forced Organ Harvesting, opined: "Medical doctors outside China have confirmed that their patients have gone to China and received organs from Falun Gong practitioners".[71]

The Hangzhou resolution was promulgated in front of the 2013 China National Transplantation Congress on 31 October 2013 and was presented on 2 November 2013. The resolution vows for the cessation of the harvesting of organs from executed prisoners. While not all transplantation facilities have adopted the resolution, a campaign to eradicate inmate organ harvesting is underway.[72]

Wait times[edit]

The wait times for organ transplants for organ recipients in China are much lower than elsewhere in the world,[73] and there is evidence that the execution of prisoners for their organs is "timed for the convenience of the waiting recipient."[74] Organ tourists to China report receiving kidney transplants within days of arriving in China.[75] A report produced by David Matas and David Kilgour cites the China International Transplantation Assistant Centre website as saying "it may take only one week to find out the suitable (kidney) donor, the maximum time being one month..."[53]

By way of comparison, the median waiting time for an organ transplantation in Australia is 6 months to 4 years,[76] in Canada, it is 6 years as of 2011.[77] In UK it is 3 years.[78]

See also[edit]

References[edit]

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