Transplant Medicine in China: Need for Transparency and International Scrutiny Remains

Abstract

Previous publications have described unethical organ procurement procedures in the People's Republic of China. International awareness and condemnation contributed to the announcement abolishing the procurement of organs from executed prisoners starting from January 2015. Eighteen months after the announcement, and aligned with the upcoming International Congress of the Transplantation Society in Hong Kong, this paper revisits the topic and discusses whether the declared reform has indeed been implemented. China has neither addressed nor included in the reform a pledge to end the procurement of organs from prisoners of conscience, nor has the government initiated any legislative amendments. Recent reports have discussed an implausible discrepancy of officially reported steady annual transplant numbers and a steep expansion of the transplant infrastructure in China. This paper expresses the viewpoint that, in the current context, it is not possible to verify the veracity of the announced changes, and it thus remains premature to include China as an ethical partner in the international transplant community. Until we have independent and objective evidence of a complete cessation of unethical organ procurement from prisoners, the medical community has a professional responsibility to maintain the academic embargo on Chinese transplant professionals.

Uncontrolled donation programs after out-of-hospital cardiac arrest. An estimation of potential donors

“…As the number of brain death donors decreases, other ways have to be found so that the number of transplants does not decrease. The two ways currently being used are: live donor transplantation and uDCD [5,6]. The number of uDCD programs in Spain has increased and many provinces without such programs are considering establishing them.…”

Why are there so many liver transplants from living donors in Asia and so few in Europe and the US?

“…(Figure 1) China is the only country in Asia where the majority of LT are performed from deceased donor organs. (Figure 1) China's practices of organ procurement and transplantation have been a matter of international medical and ethical attention for several decades resulting in intense debates on human-rights violation and organ trafficking [1,2,[13][14][15] . This was due to the presence of close ties between the judicial system and organ procurement agencies, resulting in the use of non-voluntary organ donation mainly from executed political prisoners.…”

Determination of Death in Execution by Lethal Injection in China

“…13 Therefore, the implementation of the announcement is at least questionable. 14,15,16,17,18,19 Since March 2014, China has openly announced a plan to integrate prisoner organs donated with "consent" into the citizen-based national organ donation system 20 in order to count these prisoner organs as "voluntary donations from citizens." 21 In 2015, Chinese transplant officials have repeatedly insisted that death-row prisoners have "the right" to donate organs and "if death-row prisoners are willing to atone for their crime by donating organs, they should be encouraged."…”