China is committed to changing its system of organ donation and to moving away from the use of executed prisoners as the main source for transplant surgery, writes CLIFFORD COONANin Beijing
WITH FOUR out of five patients dying while waiting for a suitable organ match, China has committed to overhauling its organ donation system, which provides only a handful of voluntary donations each year.
Among the initiatives being introduced are organ donation offices located near hospitals.
“My job is to go from one ICU to another, explaining to the dying or their families about the options of organ donation and how they could save lives. I also find suitable recipients,” one volunteer in the office, Chen Min, tells local media.
The Beijing government is also trying to move away from the use of executed prisoners as the chief source of organs for transplants.
“China should build as soon as possible a donation system in line with the national conditions and international ethics,” according to deputy health minister Huang Jiefu.
Huang estimates that 65 per cent of all organs donated in China come from executed prisoners, and says they are “definitely not a proper source for organ transplants”.
However, others, including the World Health Organisation (WHO), say the situation is even more extreme, that more than 90 per cent come from death-row inmates after their executions.
Part of the reason for this is cultural. There are powerful traditional taboos about transplants and organ donation. Many Chinese believe that a person’s body is part of their parents’ flesh and blood, which means few are willing to donate their organs after death, as it is seen as disrespectful.
A poll on Sohu.com, a popular Chinese news website, shows that 70 per cent of its 500 respondents would like to donate their organs. However, more than 80 per cent agree China’s transplant industry is expensive and not transparent enough.
It remains to be seen whether the new national system helps find donors. Only about 130 people have pledged to donate their organs since 2003, says Chen Zhonghua, a professor at Tongji Hospital’s Institute of Organ Transplantation in Shanghai. Last year, only 36 people donated organs – out of a population of 1.3 billion.
Last month, the Red Cross Society of China and the Ministry of Health announced the launch of an organ donation system in 10 provinces and cities in a pilot initiative to speed up organ transplants.
China has carried out more organ transplants than any other country except the US. Human rights groups have long complained about the way China makes widespread use of executed prisoners’ organs, and there has been outrage at the way some unscrupulous hospitals have turned to lucrative organ sales and transplants to raise funds.
Families have complained that the bodies of their executed relatives are not handed over.
The new donor system will link potential donors with recipients and make public a waiting list of patients to increase transparency and fairness in allocating organs. The system will be operated at both State and provincial levels. Donated organs would be allocated locally first and then nationally.
The regions covered by the pilot scheme include the provinces of Liaoning, Zhejiang, Shandong, Guangdong and Jiangxi, and cities Tianjin, Shanghai, Xiamen, Nanjing and Wuhan. These areas will start promoting donations and set up a registry system for donors and a distribution system for recipients.
The Chinese Medical Association’s deputy director for transplanting, Chen Zhonghua, says that the system as it stands is failing the needs of the population.
“The huge shortage of donors has created a significant black market for organs, which in turn has ruined public faith and willingness to donate organs,” says Chen.
“There are already signs of a backlash, with the nationwide number [of donations] falling last year to 36, from 41 the previous year, and only about 10 cases so far this year,” he says.
China does not publicly report execution figures, but Amnesty International estimates that 1,718 prisoners were put to death in 2008, the highest in the world, although it is a considerable reduction from previous years.
Beijing has said it plans to cut back on the use of the ultimate sanction by encouraging greater use of lengthy jail terms and by changing the manner in which the death penalty is imposed.
Executions in China are carried out by a bullet to the back of the head, but increasingly local authorities are using lethal injection, which is a less traumatic form of execution and helps better preserve the internal organs.
Although some 1.5 million patients in China need organ transplants each year, only 10,000 operations can be carried out because of the shortage of organ donors.
The question of transplants has a difficult cultural history in China. The prominent intellectual Liang Qichao was a major proponent of Western medicine, and a critic of traditional Chinese medicine.
Unfortunately, he had his healthy right kidney, instead of his diseased left kidney, accidentally removed by Western-trained doctors in an operation in 1926, but he still backed Western medicine until his death shortly afterwards.
Two years ago, China introduced new laws banning payment for organs and outlawing transplant tourism by rich Japanese and Korean organ seekers.
Chinese nationals are given priority in receiving organ transplants and only under special circumstances are people of other countries allowed to undergo the procedure in China.
On the black market, the cost of a kidney transplant runs to €55,000 and a liver up to €130,000. Wealthy people, including foreign patients, can get transplants more easily because they have the cash.