China erases the stain of har­vest­ing pris­on­ers’ or­gans

The Washington Post - - FRONT PAGE - BY SI­MON DENYER IN TIANJIN, CHINA

China’s or­gan-trans­plant 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 com­put­er­ized data­base matches donors with com­pat­i­ble po­ten­tial re­cip­i­ents, alert­ing doc­tors by text mes­sage as soon as or­gans be­come avail­able.

Lead­ing trans­plant ex­perts out­side China, in­clud­ing once se­vere 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 skep­tics still abound, and a darkly sin­is­ter ac­cu­sa­tion con­tin­ues to be heard.

Just last year, the U.S. House of Rep­re­sen­ta­tives passed a res­o­lu­tion con­demn­ing “state-sanc­tioned 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.

When cor­rup­tion ruled

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.

Pro­ceeds of ‘mal­prac­tice’

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 fast­grow­ing 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 skep­ti­cism 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 cen­ters with close links to the Rock­e­feller Founda- tion 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 cen­ters in a sprawl­ing, un­reg­u­lated sys­tem. That num­ber was whit­tled down to about 160 reg­is­tered and ap­proved cen­ters 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 skep­tics 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.

Ex­e­cuted pris­on­ers

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.

Trans­plant al­le­ga­tions

When she in­tro­duced the House res­o­lu­tion con­demn­ing China’s or­gan-trans­plant sys­tem, Rep. Ileana Ros-Le­hti­nen (R-Fla.) 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 im­muno­sup­pres­sant drugs for life to pre­vent their bod­ies from re­ject­ing their trans­planted or­gans. Data com­piled by Quin­tiles IMS, an Amer­i­can health-care-in­for­ma­tion com­pany, and sup­plied to The Wash­ing­ton Post, shows China’s share of global de­mand for im­muno­sup­pres­sants 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 im­muno­sup­pres­sant drugs would not ap­pear in Chi­nese data. But this as­ser­tion does not stand up to scru­tiny.

Jose Nuñez, head of the trans­plan­ta­tion pro­gram at the World Health Or­ga­ni­za­tion, which col­lects in­for­ma­tion on trans­plants world­wide, says that in 2015 the num­ber of for­eign­ers go­ing to China for trans­plants was “re­ally very low,” com­pared with the traf­fic to In­dia, Pak­istan or the United States, or in com­par­i­son with trans­plant-vis­i­tor num­bers in China’s past.

Chap­man and Mil­lis say it is “not plau­si­ble” that China could be do­ing many times more trans­plants than, for in­stance, the United States, where about 24,000 trans­plants take place every year, with­out that in­for­ma­tion leak­ing out as it did when China used con­demned pris­on­ers’ or­gans.

And lawyers who have de­fended Falun Gong prac­ti­tion­ers also re­ject al­le­ga­tions that those pris­on­ers’ or­gans are be­ing har­vested.

“I have never heard of or­gans be­ing taken from live pris­on­ers,” said Liang Xiao­jun, who said he had de­fended 300 to 400 Falun Gong prac­ti­tion­ers in civil cases and knew of only three or four deaths in prison.

In China, de­spite state re­pres­sion, fam­ily mem­bers can be de­ter­mined in speak­ing out and seek­ing van­ish.

If tens of thou­sands of Falun Gong prac­ti­tion­ers were be­ing ex­e­cuted every year, that in­for­ma­tion would emerge, ex­perts say.

A U.S. con­gres­sional com­mis­sion on China, the State Depart­ment and the Falun Gong com­mu­nity web­site have sep­a­rately tried to es­ti­mate the num­ber of po­lit­i­cal pris­on­ers in China, and the fig­ures range from 1,397 to “tens of thou­sands” — and even that up­per num­ber is sig­nif­i­cantly lower than the 500,000 to 1 mil­lion claimed by Gut­mann and oth­ers. jus­tice when rel­a­tives

‘She al­ways liked to help’

The sym­bolic fo­cal point of China’s or­gan trans­plant in­dus­try is the Ori­en­tal Or­gan Trans­plant Cen­ter, a gleam­ing 14-story build­ing in the north­east­ern city of Tianjin that is the largest of its kind in Asia.

In the lobby, a sleek pro­mo­tional video ad­ver­tises the cen­ter’s ex­per­tise in sup­ply­ing liv­ers, lungs, hearts and pan­creases to save thou­sands of lives every year.

On a re­cent visit, a hand­ful of pa­tients from Pak­istan, Libya and the Mid­dle East were ob­served in trans­plant wards. Two Pak­istani fam­i­lies said they had brought their own donors with them, al­though one ad­mit­ted that the donor was not re­lated to the re­cip­i­ent, in breach of Chi­nese law.

The fam­i­lies said they were pay­ing $70,000 to $80,000 each for the op­er­a­tions.

Wei Guoxin, pub­lic re­la­tions di­rec­tor at Tianjin First Cen­ter Hos­pi­tal, which runs the trans­plant cen­ter, said ac­cu­sa­tions that China used or­gans from Falun Gong prac­ti­tion­ers were “ridicu­lous” and part of a con­spir­acy against the coun­try. But she did not re­spond to sub­se­quent re­quests for data on the trans­plants car­ried out at the cen­ter or the num­ber of for­eign pa­tients served.

But in Bei­jing, doc­tors say a steady stream of or­gans is flow­ing in from vol­un­tary sources.

When 72-year-old Lu Wen suf­fered a brain hem­or­rhage on New Year’s Eve and was put on life sup­port, her hus­band, Zhao Hongxi, had no hes­i­ta­tion in agree­ing that her or­gans be used to save oth­ers’ lives.

“She al­ways liked to help oth­ers and wanted to con­trib­ute,” said Zhao, a re­tired en­gi­neer in the Peo­ple’s Lib­er­a­tion Army and a loyal Com­mu­nist Party mem­ber. “If the or­gans are us­able, they should be used to help oth­ers, as a way of length­en­ing her life.”

His two daugh­ters soon agreed, al­though 47-year-old Zhao Wei said she hes­i­tated at first: She had imag­ined hold­ing her mother’s hand when the life sup­port sys­tem was turned off, but the need to swiftly re­move her or­gans made that im­pos­si­ble. Still, she said, she soon came around to the idea, her Chris­tian faith help­ing her to ac­cept her fam­ily’s de­ci­sion.

“While I waited down­stairs in the hos­pi­tal for my mother to die, I felt huge love,” she said.

GIULIA MARCHI FOR THE WASH­ING­TON POST

Tianyi, 5, who was to re­ceive liver tis­sue from his fa­ther in a le­gal trans­plant, was the sub­ject of dis­cus­sion by his mother and a doc­tor at Bei­jing Friend­ship Hos­pi­tal in Jan­uary. Skep­tics of China’s claims of re­form­ing its trans­plant sys­tem say ir­reg­u­lar­i­ties con­tinue in se­cret.

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