DAFOH Interview with Prof. Dr. Jacob Lavee, January 2014
DAFOH: How did you first learn of forced organ harvesting in China and what motivated you to investigate further and take action to address it?
Dr. Jacob Lavee: My first encounter with forced organ harvesting in China happened in 2005 when I was approached by a patient of mine, who has been hospitalized in my department for more than one year as top priority candidate on the Israeli waiting list for heart transplantation, with the amazing message that he was told by his medical insurance company to travel to China in two weeks’ time as he was scheduled to undergo heart transplantation on a specific date. When asked how come such an operation can be scheduled ahead of time, the patient responded he did not bother to inquire. The patient had indeed gone to China and underwent the operation on the exact date as promised ahead of time. This was the first time I have been made aware of the possibility to undergo heart transplantation in China as no Israeli patient has ever gone there for this operation before and the fact that one can get it on a specific pre-scheduled date was a total surprise to me and got me researching. What motivated me to take actions were not only the chilling facts of forced organ harvesting but also the fact that the Israeli patients going to China for organs were fully reimbursed by their insurance companies, thereby providing a de-facto recognition of the Chinese transplant activities as being legal and ethical.
DAFOH: In 2008 Israel adopted a new transplant law that distanced it from transplant tourism and reduced the occurrence of acquiring trafficked organs by Israeli citizens. At the same time domestic organ donations were successfully encouraged. What has changed in the area of altruistic organ donation in Israel since 2008?
Dr. Jacob Lavee: The 2008 Israeli Organ Transplant Law, which banned the reimbursement of any organ transplant performed abroad if it has been performed against local laws and if the prohibitions of the Law with regard to the trade in organs were not met, has practically closed the gates of Israel for outgoing transplant tourism in general and to China in particular. Meanwhile, unique regulations set by the law which incentivize organ donation after death, such as prioritizing candidates for transplantation who have been long term registered donors during organ allocation, have significantly increased organ donation rates in Israel, from 7.8 to 11.4 donors per million.
DAFOH: When investigating the transplant laws from other countries, what was most inspiring to you?
Dr. Jacob Lavee: Our work on the Organ Transplant Law with the members of the Health Committee of the Israeli Parliament started in 2006, long before the Declaration of Istanbul has been formulated in 2008. Nevertheless, it has been quite obvious to us that the law has to include both measures to block transplant tourism and organ trafficking as well as measures which would maximize local organ donation – both from deceased and from living donors – in order to strive and become self-sufficient in organ transplantation. To achieve these goals, we have investigated transplant laws of other countries but could not identify any particular one which would be suitable for the Israeli public and therefore have formulated our own unique law which eventually turned out to be fully complying with the Declaration of Istanbul.
DAFOH: In the DAFOH newsletter (Fall 2013) we interviewed Dr. Raffael Matesanz, Director of Spain’s National Transplant Organization (ONT), about the transplant law in Spain. What are the advantages and disadvantages of the Israeli opt-in model versus the Spanish opt-out model?
Dr. Jacob Lavee: One of the options we have considered while formulating the Israeli Law was the opt-out model as practiced in Spain and in several other European countries, like Belgium, Austria and Portugal. We have dismissed adopting this model as it did not seem to reflect the true wishes of our people by assuming their wish to donate their organs after their death. Moreover, it has become very obvious that even in those countries which have adopted the opt-out model, the close family members are consulted before actual organ donation, even if the deceased has not opted out of donation during his life. It has therefore seemed to us that maintaining the opting-in model would best reflect the true wishes of the deceased, providing a sort of a written will to his relatives regarding his wishes regarding organ donation and making their consent much easier. However, in order to further increase the number of registered donors, our ministry of Health has recently adopted my recommendation to implement by law in addition the mandated choice model in which the question whether one wants to register as an organ donor will be mandatorily posed in every issuing or renewal of the identification card, passport or driving license.
DAFOH: Some doctors from Spain are currently assisting China with the implementation of the Spanish model of organ donation. Aside from the practice of unethical organ harvesting from executed prisoners, China is known for forced organ harvesting from non-consenting prisoners of conscience. Investigations by David Kilgour, David Matas, Ethan Gutmann and others offer established evidence. Would the Spanish model, when applied to prisoners in China, run the risk of legalizing an unethical, criminal procedure?
Dr. Jacob Lavee: As far as I am informed, the planned Spanish aid to the newly organized Chinese organ donation system will not include the adoption of the opting-out model but rather the implementation of their very developed organ donors maintenance, consenting family members and organ allocation methods. There is no doubt that the opting-out model is definitely unsuitable for China, a country in which brain death is not accepted by the majority of the people and is not even recognized by law. Even their newly suggested alternative method of utilizing organ donors following circulatory death after brain death will take long before it is accepted by the masses.
DAFOH: A lack of transparency prevents the international community from knowing the true extent of unethical organ procurement in China, and if the newly announced reforms are being carried out. When faced with ethics violations of this magnitude the international community should have, under international law, the ability to demand access to China’s transplant figures and be allowed to have outside observers monitor the situation within China. How can this be achieved and how can physicians who take the medical oath—primum, non nocere—constructively engage with physicians who are violating the basic principles of medical ethics?
Dr. Jacob Lavee: Although it is important to welcome and encourage any positive steps in the right direction towards just and fair organ donation and allocation in China, it is premature to be celebrating the end of the current gruesome practice just yet. Although Minister Bin Li expressed the resolve of the PRC Government that the reliance of transplant centers upon organs from executed prisoners must cease, there has not been any move yet towards abolishing the 1984 law which legalizes such practice. Moreover, if the resolve to stop this abhorrent practice is genuine indeed, why then it has been announced to be phased out over a year and not abolished immediately? Furthermore, if organs retrieved from executed prisoners or from non-consenting prisoners of conscience will be distributed by the newly planned computerized organ allocation, with the active involvement of the corrupted Chinese Red Cross, then this system is at risk of becoming a “laundering” mechanism for illegally harvested organs, the origin of which will never be traced.
The international community – medical and diplomatic alike – should require firm actions of China to abolish the law which currently permits the use of organs from executed prisoners and ban such use under any condition; to fully implement such ban without any delay in all hospitals, including military hospitals, regardless of the burden it will impose on the waiting lists for organ transplantation; and to facilitate international monitoring to verify these changes.
Dr. Jacob Lavee is a cardiac surgeon and the Director of the Heart Transplantation Unit at the Sheba Medical Center. He is an Associate Professor of Surgery at the Sackler Faculty of Medicine of the Tel Aviv University in Israel. He was formerly the chairman of the Israel Society of Cardiothoracic Surgery and president of the Israel Society of Transplantation. As chairman of the Heart and Lung Transplantation Committee of the Israel National Transplant Center he suggested and spearheaded the inclusion of some major clauses in the Israeli Organ Transplantation Law 2008, which have outlawed organ trade and transplant tourism and have increased significantly organ donation in Israel.