Interview with Dr. Rafael Matesanz, Director of the National Transplant Organization

Dr. Rafael Matesanz is the Director of the National Transplant Organization in Spain. After its foundation in 1989, the National Transplant Organization contributed to increase the organ donation rate in Spain from 14 donors per million population (pmp) to over 35 donors pmp in 2011. Dr. Matesanz has also contributed to develop the new 2010 transplant law in Spain.


Dr. Rafael Matesanz


DAFOH: Why is it urgent for physicians, medical professionals, and policymakers in the West to focus on the problem of forced organ harvesting in China?

Dr. Matesanz: I think that most of the international community agrees that forced organ harvesting is unacceptable from an ethical point of view. It means something like coming back many centuries in the history of civilization. Thus, all people involved in transplantation and policy makers should be perfectly aware of this phenomenon and try to force Chinese authorities to stop it.


DAFOH: What are the reasons why transplant (and other) doctors around the world ignore the situation of unethical organ harvesting in China? Is it because of not wanting to believe the underlying crimes against humanity, powerlessness, conflicts of interest or just being clueless what to do about it?

Dr. Matesanz: Probably most of the transplant physicians all over the world know perfectly what is happening because it has been told and written many times. The problem is that for an individual person, the possibility to have influence in this regard is practically null, and the story is so horrible that there is a trend to keep it out of their minds.


DAFOH: Like Israel, Spain’s transplant law has set the example that a growth in voluntary organ donation and a ban of transplant tourism is feasible. Why would other countries hesitate to adopt similar laws and join this approach to end unethical organ procurement practices?

Dr. Matesanz: The inclusion in the Spanish Penal Code of a punishment not just of those who sell an organ but also of those who promote, facilitate or advertise the procurement or illegal trafficking of human organs or their transplantation, and even of those who consent to receive a transplant knowing its illicit origin—independent if in or outside Spain—, is a clear definition of a policy against transplant tourism. This penal code covers all the possibilities. The problem with some rich developed countries is that transplant tourism of their citizens abroad is something like an “escape valve” for their organ shortage and many surgeons and policy makers “understand” people who go abroad to buy an organ.


DAFOH: The new transplant law in Spain is considered by many as one of the most advanced and comprehensive transplant laws. Would it make the positive impact of this law even stronger if other countries adopted similar transplant laws?

Dr. Matesanz: The Spanish legislation has been very useful to ban any temptation of transplant tourism for Spaniards going abroad or for advertising and commercialization, or whatever the real objectives in the Internet are. However, this legislation would only reach its full meaning against organ trafficking if most countries adopted similar measures. In the same direction as it is happening with drug trafficking, there are people who mainly sell because there are people who buy, and here is the real problem. Only international agreement can solve organ trafficking.


DAFOH: When comparing the transplant laws from other countries, which transplant laws did you find most inspiring, and what part inspired you? What could have been done even better in the Spanish transplant law?

Dr. Matesanz: With respect to the general transplant laws, there are no great differences in comparison with those of most of the western countries: altruism, banning of commercialization and so on. What is really different is the Spanish penal Code and the punishment of a person who goes abroad to buy an organ. This principle of extraterritoriality does not exist in the legislation of any other country applied to transplantation but curiously I took the idea when a similar law applied to pedophilia was approved in Germany. Fortunately, the Spanish government and parliament are very sensitive to the suggestions of the ONT and they approved the proposal.


DAFOH: With the globalization and expanding transplant tourism, national transplant laws might need adjustments to respond to the specific situations. Recently, China announced to phase out the organ harvesting from prisoners. Yet, Chinese officials speak of an indefinite deadline, and transparency about the organ sources is still lacking. Can the international community be relieved at the announcement, knowing that executed prisoners were the main source of organs for more than two decades?

Dr. Matesanz: Since 2005, the Chinese government has made several announcements in this direction when they first recognized the problem and then agreed to find a solution, but the process has gone and goes terribly slow for a problem of such a magnitude. The key points should be transparency and a clear decision to stop these practices. However, I am afraid that the lack of a significant alternative in China to find organs for transplantation and many economic interests are the real obstacles.


DAFOH: In 2006, David Matas and David Kilgour started with their investigations on organ harvesting from Falun Gong practitioners in China. They have compiled a compelling list of pieces of evidence. One of the pieces are phone recordings in which Chinese doctors admitted that they use “fresh” organs from Falun Gong practitioners who were detained for their spiritual belief. Do you think the new Spanish transplant law can contribute to end this forced organ harvesting from prisoners of conscience in China? What else should the medical community do to ensure that prisoners of conscience, like Falun Gong, are not killed for their organs?

Dr. Matesanz: I guess that the adoption of similar laws in other countries and the fact that the medical community would stop to “understand” and justify the patients who go to China, buy these organs and come back to seek medical aftercare, would be the only possibility to end these practices. A part of the transplant community has great responsibility despite their passive conduct in the present situation.


DAFOH: This year, Oscar Garay became the first victim of the new Spanish transplant law when he publicly advertised and promoted transplantations in China, which is liable under the new law. His case drew attention to China’s transplant business where more than 10,000 transplantations are performed every year. Did you ever experienced any pressure or threats from China before or after passing the new transplant law? What were the reactions from Chinese doctors about the new Spanish transplant law?

Dr. Matesanz: No, we never received any kind of pressure nor feedback from China. You should know that there have been only 3 Spanish patients who travelled to China for a liver around 2008 and nothing more. This is simply a drop in the ocean when compared with patients from other countries.


DAFOH: What are your next steps to combat unethical organ harvesting, and how do you think medical organizations and governments can act better to help ending it?

Dr. Matesanz: We are collaborating very actively with international bodies like WHO, the Council of Europe or United Nations, and professional societies like TTS or the Custodian Group of Istanbul Declaration in all kinds of initiatives to combat organ trafficking. The most important step now is a project of an International Convention against organ trafficking lead by the Council of Europe. We are firmly pushing for this project although unfortunately we are also aware of strong pressures from some countries to stop it or to make it much more “light”. This is a simple demonstration that it is not an easy path, but I am sure that we go into the right direction.