Over­haul­ing China’s or­gan trans­plant sys­tem could take some time

China Daily (Canada) - - FRONT PAGE -

Ev­ery year in China there are about 300,000 pa­tients who need an or­gan trans­plant but only about 10,000 surg­eries are per­formed. That ac­cord­ing to Huang Jiefu, for­mer vicem­i­nis­ter of health.

There are a num­ber of rea­sons for the short­fall. The main one is that Chi­nese peo­ple are much less will­ing than other pop­u­la­tions to do­nate their or­gans after death. Huang es­ti­mates that six out of 10,000,000 peo­ple in China do­nate, where as in a coun­try like Spain the fig­ure is 370.

In most coun­tries, de­mand for trans­planted or­gans heav­ily out­strips sup­ply. But China also faces other bar­ri­ers. As the cur­rent is­sue of the Lancet re­ports, “Cul­tur­ally, the con­cept of or­gan do­na­tion con­tra­dicts the tra­di­tional Con­fu­cian view that one is born with a com­plete body, which should end the same way be­cause the body, hair, and skin are gifts from par­ents.”

In 1984 it be­came le­gal in China to har­vest or­gans from ex­e­cuted pris­on­ers with their fam­i­lies’ con­sent, a prac­tice that was im­me­di­ately con­demned by in­ter­na­tional hu­man rights and med­i­cal groups. Eth­i­cal con­cerns cen­tered on the pos­si­bil­ity of co­er­cion or cor­rup­tion in the al­lo­ca­tion process. A black mar­ket de­vel­oped.

By 2011, Huang re­ported that 65 per­cent of the trans­plants in China used or­gans from de­ceased donors and 90 per­cent of those were ex­e­cuted pris­on­ers.

That same year, Arthur L. Ca­plan, the Em­manuel and Robert Hart Di­rec­tor of the Cen­ter for Bioethics and the Syd­ney D Ca­plan Pro­fes­sor of Bioethics at the Univer­sity of Penn­syl­va­nia in Philadel­phia, called for a boy­cott of Chi­nese sci­ence and medicine per­tain­ing to or­gan trans­plant in Lancet.

Ca­plan noted that or­gan trans­plan­ta­tion in China had ex­panded rapidly in the pre­vi­ous 20 years, but it had “not been ac­com­pa­nied by the de­vel­op­ment of an eth­i­cal sys­tem for re­cov­er­ing or­gans from those who die in hos­pi­tal while on life support, as is in­ter­na­tional prac­tice”.

Even though there were not enough or­gans in China for its own peo­ple, there re­mained a brisk traf­fic of “trans­plant tourists” to China who were frus­trated by the long waits in their own coun­tries and at­tracted by the “com­pet­i­tive price”.

Ca­plan and his col­leagues said that the source for many of th­ese or­gans was ex­e­cuted pris­on­ers and the in­ter­na­tional bio­med­i­cal com­mu­nity “must firmly and boldly chal­lenge the sta­tus quo”.

The an­nounce­ment that as of Jan­uary 1, 2015, China would stop us­ing ex­e­cuted pris­on­ers as a source of or­gans for trans­plant came as a re­lief to many in the med­i­cal com­mu­nity, but it also raised some con­cerns.

In ad­di­tion to over­com­ing the bar­ri­ers pre­sented by Con­fu­cian tra­di­tions, the Chi­nese health com­mu­nity has been re­luc­tant to ac­cept — so­cially or legally — the con­cept of brain death as a cri­te­ria for har­vest­ing, in­stead stick­ing with car­diac death as the sole ba­sis for do­na­tion. In more than 90 coun­tries, brain death is used as a cri­te­rion for declar­ing death.

China has made im­por­tant steps to­ward a more eth­i­cal, vol­un­tary or­gan do­na­tion sys­tem, the Lancet notes.

In 2007 it is­sued the Reg­u­la­tion on Hu­man Or­gan Trans­plan­ta­tion, es­tab­lish­ing a le­gal frame­work for over­see­ing the sys­tem. Three years later 11 prov­inces and ci­ties across the land ini­ti­ated pi­lot pro­grams for or­gan do­na­tions after car­diac death.

And in 2013, a na­tion­wide dig­i­tal net­work called the Or­gan Trans­plant Re­sponse Sys­tem was set up. Still, as Huang said, “peo­ple have con­cerns about whether the or­gans will be al­lo­cated in a fair, open, and just way”.

Huang said the 2007 reg­u­la­tions would be amended and re­named “Do­na­tions and trans­plant of hu­man or­gans in China”, so that vol­un­tary do­na­tions would be the only source.

Pris­on­ers will still qual­ify to do­nate, but their or­gans will be regis­tered and put on the na­tional data­base.

“I be­lieve the sit­u­a­tion of or­gan do­na­tions will get bet­ter and bet­ter in the fu­ture,” Huang said.

The Lancet ed­i­tors sug­gest three key things to help make that hap­pen: a sea change in peo­ples’ at­ti­tude to­ward do­na­tions, in­te­grat­ing or­gan do­na­tion into the na­tional health sys­tem, and im­ple­ment­ing health and well­ness strate­gies to re­duce ris­ing rates of end-stage or­gan dis­eases that will re­duce de­mand.

Newspapers in English

Newspapers from China

© PressReader. All rights reserved.