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China’s announcement to end organ harvesting from executed prisoners by January 1, 2015:
Distinguishing propaganda and sleight of hand from reality
When Huang Jiefu, former vice minister of health and current director of the Organ Transplantation Committee in China announced in December 2014 an end to the policy of harvesting organs from executed prisoners by January 1, 2015, there was widespread acclaim for this intention. Many media outlets greeted the declaration with optimism, saying it represented an important step to correct a policy that had become a global scandal.
Unfortunately, that acclaim was premature. There is little reason to be confident that China has actually ended its policy of forcibly harvesting organs from prisoners, or that it would agree to transparent monitoring and verification by global health groups
Huang’s own pronouncements have been enough to raise suspicion. In an interview with the Phoenix Satellite Television on January 11, 2015, for example, Huang was asked if there will be organ donation from death row prisoners after 2015, voluntary or involuntary. He replied:
“We certainly do not want to use the words like organ donations from death row inmates anymore. In the developmental process of organ transplantation, all countries in the world began with death row inmates’ donations.”
While his first statement on terminology is merely a rhetorical dodge, the second statement is a blatant falsehood. Transplantation medicine outside of China did not begin with harvesting organs from executed prisoners. Medical doctors traveling to China for conferences or trainings should be made aware that they were wrongfully depicted in such a way before the Chinese society and that this is most likely part of the information control to trivialize the Chinese malpractice by pulling western ethical standards down to a low level and depicting China as equal to the west in practice.
Huang elaborated further:
“I’m not saying I oppose death row inmates’ donations. If the death row inmates are truly moved by their conscience, then it’s not impossible.”
Ethical standards, as upheld by the global medical community, refute the notion that prisoners can give anything like free and voluntary consent to organ donation. As the World Medical Association (WMA) declared in 2012:
“In jurisdictions where the death penalty is practised, executed prisoners must not be considered as organ and/or tissue donors. While there may be individual cases where prisoners are acting voluntarily and free from pressure, it is impossible to put in place adequate safeguards to protect against coercion in all cases.”
In the past, when Huang was asked if organ donations in China were voluntary, he replied:
“China has no citizens organ donation system. So, the Pandora’s box was opened. Now, we have to dress up other people, have to cover up other people.”
Huang’s response suggests that the organ procurement process has not always followed ethical or legal standards. If this is the case, then it should be investigated and those who are involved in killing for organs brought to justice. A cover-up does nothing to ensure ethical and legal organ procurement practices in the future.
Huang elsewhere describes the development of the organ donation program in China, which, if accurate, would be nothing short of preternatural. While it took about 20 years for the U.S. to build a functional, ethical and sustainable organ donation program, China claims to have overcome thousands of years of traditional cultural beliefs against organ procurement, before and after death, in just four years, stating:
“Before 2010, there was no donation system, so people had nowhere to donate. 2014 was the year when we really started working on organ donation nationwide. Up till now, we have nearly 1,700 cases, which equates to nearly 5,000 organs. This year, we have almost 2,000 to 2,500 organs that have been donated by living-related donors. Putting them all together, in 2014, 80% of organs transplanted came from voluntary citizens donations.”
The purported increase from 0% to 80% of organ transplants sourced from a voluntary organ donation system—within 4 years—immediately raises questions:
• An ethical system is based on the voluntary choice to donate organs. In order to encourage free, voluntary organ donations in society widespread information and education are essential. Yet there has been little effort in China to promote organ donation nationwide.
• Voluntary donation comes with a reasonable balance of approval and refusal based on long held ethical moral standards. If there is any bias within the “voluntary decision” it may hint at coercion or other factors that disqualify the action as freely given.
• Only a fraction of those who register to donate will then eventually give consent to donate their organs upon death. This is something that has been observed worldwide in voluntary organ donation programs. Furthermore, there is usually an anticipated lapse in time between registering for organ donation and the time when the organs will become available, which usually means the death of the donor.
• Organ donation registries do not guarantee a reliable supply of life sustaining organs. The numbers can be elusive due to logistical factors. When young people register to donate organs, they normally have many years of life before becoming donors upon their natural deaths. People of advanced age might have a reduced life span, but their organs might not be viable for transplant purposes. A common practice by the Red Cross Society of China — not to be confused with the International Red Cross — is to provide financial incentives worth an annual salary to trigger organ donations from deathbed patients. The latter is a practice banned as unethical by 3 out of the 11 Guiding Principles on organ donation by the World Health Organization (WHO).
Finally, the number of transplant operations is determined by organ availability. A change in the organ sourcing, or organ availability, would not have an impact on the number of ill patients registered on the waiting list. Organ availability generates the number of transplants. Contrast this with Huang’s claims to the Chinese media outlet Caijing published an interview with Huang Jiefu on March 16, 2015:
“22,000 people waiting for organ transplant. This is the exact number. Why do we have this exact number now? Because after we eliminated the executed prisoners’ organs, it transformed into a transparent, sunny, traceable organ transplant system.”
Prior to the announcement of the new policy, the number of patients waiting for a transplant in China was reported at 300,000. A change in legislation on the organ sourcing from executed prisoners does not generate a healthier population that would need fewer organ transplants. The other 278,000 patients were removed from the official waiting list, however they are likely still in need of a transplant organ. Therefore they might be listed on a parallel, undisclosed waiting list, which would open opportunities for other organ markets, including black markets or with the involvement of military hospitals.
As a matter of fact, nothing in the announcement about ending unethical organ harvesting addressed the use of prisoners of conscience as organ source. Thus, there is also an increased risk that China may compensate for the loss of relying on executed prisoners as the main source of organs by intensifying dependence on harvesting organs from prisoners of conscience on demand instead. Conservative estimates place the number of prisoners of conscience in China to be maintained in the hundreds of thousands, with the Falun Gong being the largest victim group.
When confronted with the discrepancy between patients taken from the wait list, and the current number of only 22,000 candidates, Huang Jiefu replied:
“What you just said is too sensitive, so I can’t talk about it too clearly. … Because if your country has no transparency, you don’t know how the organs were obtained, the transplant numbers are also secrets. Therefore, in fact many things were messed up, you cannot be clear about it. But in fact, it is not that as soon as you have the match you can do the transplant. First, money is required. Simply put, organ transplant is not categorized as an advanced medical service in our country. It’s very difficult for ordinary people to pay the tens of thousands yuan for medical expenses. But then there are also post-surgical procedures. A liver transplant costs at least 600,000 yuan. A kidney transplant costs at least 300,000 yuan. This is an impossible amount of money for ordinary people. Many people can’t afford it so they don’t want to do it. ….. It is impossible for them to be on the wait list. We have only 169 hospitals [allowed to perform organ transplant]. They can’t even get in the door of these hospitals, how can they be on the wait list.”
When asked where the abusive practice is rooted, Huang elaborated:
“It’s just too clear. Everyone knows the big tiger. Zhou Yongkang is the big tiger; Zhou Yongkang was our chief of Political & Legal Affairs Committee, originally a member of the Politburo Standing Committee. Everyone knows this. There are newspapers every day talking about his background. So as for where executed prisoner organs come from, isn’t it very clear?”
Zhou Yongkang was, until recently, a powerful ally of former Communist Party leader Jiang Zemin. He has now been charged with allegations of corruption and expelled from the party, and has become a scapegoat for the regime. But, there is no indication that the network to which Zhou belonged has been dismantled, or that the profiteering from illegally harvested organs has ceased.
The unabated demand for transplant organs, undisclosed pathways of organ procurement and the remains of a corrupt political network that fostered the forced organ harvesting from prisoners of conscience all indicate that it is too early to applaud China for announcing this change. A verification of the claims and implementation of the announced objectives has not happened.
International inspections and verification mechanisms have to immediately follow any acknowledgment of the end of unethical organ procurement procedures in China or elsewhere.