As criticisms mount, China regulates organ transplants
TIANJIN, China - China’s organtransplant system was once a cause of international scorn and outrage, as doctors harvested organs from prisoners condemned to death by criminal courts and transplanted them into patients who often paid dearly for the privilege.
After years of denials, China now acknowledges that history and has declared that the practice no longer occurs - largely thanks to the perseverance of a health official who, with the quiet backing of an American transplant surgeon, turned the system around over the span of a decade.
That official, Huang Jiefu, built a register of voluntary donors, overcoming both entrenched interests that profited from the old ways and a traditional Chinese aversion to dismemberment after death. In true modern Chinese fashion, donors can sign up through a link and app available through the ubiquitous Alipay online payment system. More than 230,000 people have done so, and a computerised database matches donors with compatible potential recipients, alerting doctors by text message as soon as organs become available.
Leading transplant experts outside China, including oncesevere critics, have slowly been won over.
“There has been a substantial change in China which has been in the right direction,” said Jeremy Chapman, a leading Australian physician and former president of the Transplantation Society who in the past had harshly censured Chinese transplantation practices.
Yet sceptics still abound, and a darkly sinister accusation continues to be heard.
Just last year, the US House of Representatives passed a resolution condemning “statesanctioned forced organ harvesting” in China, and accusing the Communist Party of killing prisoners of conscience - held in secret, outside the usual criminal prisons - to feed the transplant industry.
Huang and his allies in the transplant industry around the world dismiss those allegations. In their eyes, the China that has emerged on the world stage as a financial and technological power, with a rising and increasingly sophisticated middle class, has successfully done away with a wicked practice from the past.
The use of prisoners’ organs had left China a global pariah in the transplant field. Relying on prisoners caught in a corrupt and inhumane legal system, China had built the world’s second-largest transplant industry after the United States’. It was effectively an unregulated system in which organs were being delivered not to the most deserving recipients but to the highest bidders. Vast profits were generated as medical ethics were set aside.
“Financial interests were driving malpractice,” Huang said. “The allocation of organs had become a game of wealth and power, with no social justice.”
Thousands of organs were being harvested from executed prisoners every year, but over the course of a decade, Huang has garnered support at the highest levels of government and succeeded in pushing China’s medical establishment into dropping the often-lucrative practice.
Since 2010, Huang has slowly built the register of voluntary donors, who now meet the needs of patients who require transplants. Such a register is a breakthrough for China.
The turn toward reform began in 2006, when Huang was the first to publicly acknowledge an open secret in the medical industry - that prisoners’ organs were the basis of the nation’s fast-growing transplant industry.
Huang’s efforts to clean up the system, with the quiet backing of University of Chicago transplant surgeon Michael Millis, surmounted stiff resistance - and met with scepticism and sometimes lurid allegations that continue to dog their work.
“It has been very tough going over 10 years,” Huang said in an interview in his office in Beijing, as he described his battle against powerful vested interests.
Huang and Millis both work for medical centres with close links to the Rockefeller Foundation and its spinoff the China Medical Board (CMB). They met at a Rockefeller CMB-sponsored meeting nearly a decade ago. They discovered a shared concern about the workings of China’s transplant industry.
The pair agreed that an abrupt end to the use of prisoners’ organs was not feasible and would only create a black market. Instead, they resolved to work for gradual change. With a grant from the CMB, and with Millis as Huang’s main consultant, they began to investigate alternative approaches.
China had more than 600 organ transplant centres in a sprawling, unregulated system. That number was whittled down to about 160 registered and approved centres in 2007, when legislation was also introduced to outlaw organ trafficking and ban foreigners from coming to the country to receive Chinese organs.
The public was brought on board with the help of the Chinese Red Cross, and sceptics in China’s medical profession were gradually won over by Huang’s persistence and his ability to secure official support.
Last year, Huang said, 4,080 donors supplied organs after their deaths, and 2,201 living donors gave organs to relatives. In total, China performed 13,238 organ transplant operations, mostly of kidneys and livers, but a few hundred hearts and lungs, too. None of those came from prisoners, Huang said.
“Our system is transparent and traceable,” he said. “We know where every organ comes from and where every organ goes.”
That may overstate the reality, but Huang’s allies say that irregularities are now the exception rather than the rule.
Chinese law does not explicitly rule out using organs of prisoners condemned to death by the criminal courts, and Huang himself was quoted in Chinese media in late 2014 and early 2015 as saying prisoners could “voluntarily” donate organs.
Huang now disavows those comments, insisting there is “zero tolerance” for using any prisoners’ organs in the hospital system. But in a country of 1.3 billion people, he said at a Vatican conference in February, “I am sure, definitely, there is some violation of the law.”
Lawyer Yu Wensheng said that one of his clients had shared a Beijing prison cell with a man facing the death penalty last November and that the condemned man was given a form to sign to “voluntarily” donate his organs.
Death-row prisoners, he said, were “given the choice not to sign the forms, but they would receive much more mistreatment and suffer much more. If they sign, their last days of life would pass more easily.”
Yet the supply of organs from executed prisoners seems to have been drying up because the number of death sentences appears to have fallen dramatically after a 2007 mandate requiring the Supreme Court to review all capital cases.
When she introduced the House resolution condemning China’s organ-transplant system, Florida congresswoman Ileana Ros-Lehtinen declared, “We cannot allow these crimes to continue.” She accused the “ruthless dictatorship” running China of persecuting peaceful practitioners of the Falun Gong spiritual movement, and of the “sickening and unethical practice” of harvesting organs without consent. The basis for this allegation is research compiled over many years by David Matas, a Canadian human rights lawyer, David Kilgour, a former Canadian politician, and Ethan Gutmann, a journalist, who assert that China is secretly carrying out 60,000 to 100,000 organ transplants a year, mostly with organs taken from Falun Gong practitioners held in secret detention since a crackdown on the movement in 1999. But research and reporting by The Washington Post undercut these allegations.
Transplant patients must take im mu no suppressant drugs for life to prevent their bodies from rejecting their transplanted organs. Data compiled by Quintiles IMS, an American health-careinformation company, and supplied to The Post, shows China’s share of global demand for im mu no suppress ants is roughly in line with the proportion of the world’s transplants China says it carries out.
Xu Jiapeng, an account manager at Quintiles IMS in Beijing, said the data included Chinese generic drugs. It was “unthinkable,” he said, that China was operating a clandestine system that the data did not pick up.
Critics counter that China may also be secretly serving large numbers of foreign transplant tourists, whose use of im mu no suppressant drugs would not appear in Chinese data. But this assertion does not stand up to scrutiny. — Washington Post
Financial interests were driving malpractice. The allocation of organs had become a game of wealth and power, with no social justice. – Huang Jiefu, health official