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Donor shortage slows China’s reform of organ transplants

China’s plan to phase out organ transplants from executed prisoners is hampered by a lack of donors, caused partly by traditional beliefs and by local health officials’ reluctance to join the national donor system, doctors and officials said. Despite problems in implementing a new donor system, which began on a trial basis in 2010, officials are confident of ending China’s reliance on organs from executed prisoners within five years, said Wang Haibo, director of a national transplant research centre under the Ministry of Health.

The ministry did not try to end the use of executed prisoners’ organs sooner because it worried about “unintended consequences,” Wang said during a recent government reporting trip. “We are afraid that since there is a huge demand for organ transplants, if we didn’t have a donation system people would go to buy organs,” he said.

Most of China’s transplant organs have come from executed prisoners, a controversial practice opposed by many doctors and transplant surgeons. The government insists that organs are only used with the written permission of executed prisoners. Yet a couple from Hanyuan county in the south-western province of Sichuan asked the provincial government last month to explain how the body of their son, Hao Jianchang, disappeared after his execution.

During a final prison visit on the day of his execution for murder in February 2012, Hao did not mention donating his organs, his mother, Feng Dongxiu, told the Sichuan-based Tianwang human rights website. “After our son was executed, the body and ashes were never found,” Feng said. “We suspect that our son’s organs were stolen.” Officials have admitted that some hospitals ignored legal procedures to profit from the organs of executed prisoners, for example, by persuading donors to sign documents claiming they were relatives or “emotionally connected” to wealthy recipients.

The government said its new system was designed to end abuses that favour rich patients and to prevent “transplant tourism,” where wealthy foreign patients pay for transplants in Chinese hospitals. The database for transplant recipients “doesn’t include anything about their social status, educational background or salary,” and aims to ensure “a fair allocation of organs” by prioritising those in most urgent need, database manager Jiang Wenshi told state media.

The new system has allocated just 2,100 organs from 800 donors since April 2011. Hundreds of other donated organs were distributed outside the system because the Chinese Red Cross Society clung to its former role in distributing organs to transplant hospitals, officials told the China Daily newspaper. “Without going through this system, organs may not be going to patients most in need,” Wang said.

Implementation of the new system was also slowed by a “Confucian” requirement that after a donor’s death, family members must give their consent, reflecting traditional hierarchical family structure, said Huang Jiefu, a former transplant surgeon who heads China’s organ donation committee. The health ministry said about 10,000 transplant operations take place annually in China, but it estimated the need at about 300,000 annually.

The lack of transplant organs fuelled a black market, prompting the government to ban all trading of human organs in 2007 and revise the criminal law to provide tough punishments for traffickers. About 50 per cent of China’s kidney transplants now come from living donors or donations after cardiac death, with the other half from executed prisoners, said Shi Bingyi of the Chinese Scientific Registry of Kidney Transplantation.

The percentage of kidney transplants from cardiac deaths rose from just 3 per cent in 2011 to 22 per cent in the first half of this year, Shi said. Chinese hospitals are likely to continue to use many organs from executed prisoners for several more years, even with a dwindling supply caused by a reported decline in the number of executions.

Execution statistics remain a state secret in China, but in December 2011 the US-based Dui Hua Foundation supported a Chinese lawyer’s estimate that executions had halved to around 4,000 per year since the Supreme People’s Court began reviewing all death sentences in 2007. The ruling Communist Party also has a political commitment to end hospitals’ reliance on transplants of prisoners’ organs, Huang said. “The policy is very clear that we cannot rely on executed prisoner’s organs any more,” Wang said. “On a personal level, I always think that we should not use executed prisoners’ organs because they don’t have freedom of consent,” he said.

Bill Smith, "Donor shortage slows China’s reform of organ transplants," Business recorder. 2013-07-05.
Keywords: Social sciences , Social issues , Social needs , Social values , Social activities , Social community , Social rights , Transplant research , Patients , Society-Red Cross , Hospitals , Health care , China