Ethical organ transplantation is based on altruistic organ donation. According to ethical standards as defined by WMA, WHO, TTS, and the Declaration of Istanbul, this requires free, voluntary and informed consent from the organ donor. In 1984, China implemented a regulation permitting the procurement of organs from executed prisoners. The regulation has resulted in death row prisoners being “worth more dead than alive.” This situation has distorted the principle of voluntary consent. The conflicting interpretation of the required consent in China has sparked a controversial debate among medical doctors worldwide. The practice in China is not only a violation of ethical standards but criminal when organs are removed without prior consent.
On May 17, 2013, an AP article quoted former vice-minister of health Huang Jiefu as saying, “There was little hope of changing a requirement that family members give consent before organs are donated.” Three days later, in an interview with Australian ABC TV on May 20, 2013, he said “Consent is not presumed consent – written consent from the prisoner himself or herself as well as his or her family [is needed].” Yet, the suggested idea that prisoners would provide “written consent” is already misleading and contradicts ethical standards. Prisoners deprived of their freedom are not in the position to provide consent, and a “written” consent-while in detention-does not indicate altruistic organ donation and therefore does not meet the ethical requirements.
According to the Chinese Global Times, Dr. Yang Chunhua from the First Affiliated Hospital of Sun Yat-Sen University in Guangdong Province recently stated, [Chinese] “authorities used executed criminals’ organs without their consent.” The procuring of organs without prior consent is unacceptable to the medical profession and ought to be prosecuted.
The implementation of free, voluntary and informed consent is a critical prerequisite for ethical organ procurement. The desperate need for transplant organs in China must not justify the means to procure them.
In 2009, Dr. Chen Zhonghua from the Institute of Organ Transplantation of Tongji Hospital stated that only 130 people had signed up for organ donation between 2003 and 2009 and that the vast majority of organs come from executed prisoners. After initiating a pilot organ donor program in 2010, there were only 1,804 organs donated by 2013. While this number of donated organs cannot explain the source for over 10,000 transplants per year, it does raise the question of how the sudden increase in voluntary organ donors, as announced by Chinese officials, could happen so quickly, particularly after years of virtually no organ donations throughout the country.
Accountability and transparency are central factors to ensure ethical organ procurement. This also applies to the recently announced computerized organ allocation system in China. It is envisaged that all procured organs, including those harvested from executed prisoners, will be entered into the computer system. While it monitors the use of all procured organs, it does not provide transparency about the origin of the organs. It opens a new ethical discussion regarding whether this computerized allocation system might simply “launder” these organs and “whitewash” their origin making it more difficult to trace the origin of the organs. It will also make it more difficult to monitor voluntary, informed consent. Despite China’s recent announcement that Chinese hospitals would start to refrain from using organs from executed prisoners, the computerized allocation system can channel these organs through the backdoor into the hospitals. The crucial aspect of ethical organ allocation does not start with a computerized system; it starts before, with ethical organ procurement.
It is of utmost importance that the international community continue to thoroughly monitor the developments in China and encourage an accurately reported mechanism of free, voluntary and informed consent for organ donation.
(Photo courtesy of Nathalie Paco)
Dr. Rafael Matesanz is the Director of the National Transplant Organization (ONT) in Spain. After its foundation in 1989, the ONT 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 also contributed to the development of a new transplant law in Spain in 2010.
In this exclusive interview, Dr. Matesanz shared his thoughts and experience with 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?
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.
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?
Probably most of the transplant physicians all over the world know perfectly well 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.
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?
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.
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?
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.
As of October 1, 2013, three months after its launch, the DAFOH petition to the United Nationshas received global support from more than 447,498 people. The petition asks for an immediate end of the forced organ harvesting from prisoners and prisoners of conscience in China. The signers come from different parts of the world and indicate the growing awareness of this crime against humanity.
The signatures are being collected in 33 countries spanning four continents with the help of volunteers and medical organizations.
The signature campaign for the petition will continue until November 30, 2013.
The petition has three urgent calls to the United Nations:
- Please call upon China to immediately end the forced organ harvesting from detained Falun Gong practitioners in China.
- Please initiate further investigations that lead to the prosecution of the perpetrators involved in this crime against humanity.
- Please call upon the Chinese government to immediately end the brutal persecution of Falun Gong, which is the root cause for the forced organ harvesting from Falun Gong practitioners.
SIGN THE PETITION
Deadline November 30, 2013
News In Review:
June 2013 – October 2013
Parliamentarian Actions and Events
Expressing concern over systematic, state-sanctioned organ harvesting from prisoners of conscience in China, and calling for the U.S. government to condemn China’s organ harvesting practices, House Resolution 281
has gained large support since its introduction on June 28, 2013, with 150 cosponsors, 21 of whom are members of the Foreign Affairs Committee.
In a post to his Facebook page, Moshe Feiglin, Deputy Speaker of the Israeli Knesset, said “There are moments in life when it is forbidden to remain silent. One of those moments is now. China’s Propaganda Minister is receiving royal treatment in the Knesset. The man is responsible for hounding and quashing the liberty of his own people. He is responsible for the propaganda in a state in which people are imprisoned in concentration camps, from where their organs are removed and sold. We cannot ignore these crimes. I call upon my colleagues, Knesset Members, not to bow before the Chinese regime. We respect the Chinese nation, but not the evil regime that rules there today. We and the entire free world must denounce these evil leaders. If not, we lose our human image.”
In a United Nations Web TV video of an open session of the Human Rights Council, a Chinese delegate twice attempts to silence an NGO from raising the issue of organ extraction from detained Falun Gong practitioners in China. Several countries then spoke in favor of allowing the NGO to be heard, including the US, UK, France, Ireland, Czech Rep., Sweden, Germany, Norway, Estonia and the Netherlands. The NGO was then permitted to complete the statement on forced organ harvesting. These events can be seen in chapters 23, 24 and 25 of the video.
The 13th Congress of the Asian Society of Transplantation, and the 49th Annual Congress of the Japan Society for Transplantation were held in September. David Matas, renowned Canadian human rights lawyer spoke at the conference and had a poster presentation of his study and investigation into the Chinese Communist regime’s forced organ harvesting practices. Matas also spoke at the Annual Conference of the Pharmaceutical Association in Osaka.
In an effort to bring greater awareness to forced organ harvesting, a workshop was held at a hospital in Winnipeg, Manitoba including presentations from David Matas, international human rights lawyer, Kirk Allison, Director of the Program in Human Rights and Health at the University of Minnesota, and Dr. Damon Noto, DAFOH Spokesman. The three presenters also spoke at a rally on the steps of the legislature
organized by social work students at the University of Manitoba.
Forced Organ Harvesting in the Media
In an article in The Atlantic entitled “China Harvests the Majority of Its Organs From Executed Prisoners,” author Yaqiu Wang states that “this practice, done without consent, highlights the problems with the country’s legitimate organ donation system.” He describes the circumstances surrounding an execution in July and provides a useful analysis of organ donation in China.
An official conference held in the Knesset entitled “The Responsibility of the State of Israel Regarding the Issue of Forced Organ Harvesting from Prisoners of Conscience in China” provided Knesset members and other high profile supporters with witness testimony of human rights abuses within Chinese prisons. The conference resulted in a statement that included a promise to continue to demand an end to China’s organ harvesting practices and other human rights abuses.
Nearly 30 year ago, a top secret regulation was issued that began China’s organ harvesting crimes. In an article this October, the 1984 Regulation – the Provisional Regulations Regarding the Use of Corpses and Organs from Executed Inmates by the Supreme People’s Court, Supreme People’s Procuratorate, Ministry of Public Security, Ministry of Justice, Ministry of Health, and the Ministry of Civil Affairs – is explained in context.
Spain: “Admitting the sale of organs is going back to the law of the jungle”
In this translation of an article in the Spanish La Gran Epocha, Rafael Matesanz, Director of the Spanish National Transplant Organization, explains elements of the Spanish Criminal Code which seek to stop organ trafficking and unethical transplant tourism.
DAFOH Press Release
In 2007, the Chinese Medical Association pledged to the World Medical Association to end organ harvesting from executed prisoners. Now, six years later, the pledge remains unfulfilled and has even reversed course, as China refers only to “phasing-out,” not ending the practice. The international community considers the harvesting of organs from prisoners unethical. It is unacceptable to only gradually “phase-out” this crime against humanity.
2013 Report of the UN Special Rapporteur on Trafficking in Persons Cites State Organs
State Organs is referenced on the eighth page of the report “Trafficking in persons especially women and children,” where UN Special Rapporteur Joy Ngozi Ezeilo states, “a very different picture of organ ‘trade’ involves the harvesting by the State of organs of persons who have been or are being executed. Allegations of such practices have been leveled at a number of countries, including in East Asia, from where consistent and credible evidence has emerged.”
President of the Italian Society for Safety and Quality in Transplantation, Prof. Filipponi explains “The question of the origin of the organs used for transplantation purposes in China can not, and should not be summarily dismissed under the principle of self-determination of each nation. It concerns us, because the entire scientific community and civil society require a loud voice that the principles that govern medical activities are the same at all latitudes.”
International News Briefs
“This is no time…to take the tranquilizing drug of gradualism” – Rev. Martin L. King, Jr.
Recently, China has announced its intention of phasing-out the harvesting of organs from executed prisoners by 2015 and the introduction of the China Organ Transplant Response System
(CORTS), a computerized organ-allocation system.Unfortunately, CORTS lacks transparency: the matching process and information about the organ donors are not open to the public or to an independent third party. With regard to the announced 2015 time frame, Chinese officials speak vaguely of ending the reliance on executed prisoners
, not of the complete cessation.
Doctors Against Forced Organ Harvesting (DAFOH) holds that the announcement and the introduced systems are misleading and insufficient.
In 2006, China Daily reported the number of transplants in China as high as 20,000, with 90 percent of the organs coming from executed prisoners. Attention and pressure by the international community in the past few years have contributed to the recent developments and indicate that we need to continue our efforts to call for an immediate end of the organ harvesting abuse.
Once the practice is recognized as unethical, there is no excuse to continue it. We call upon the international community to join us in calling upon China to immediately and unconditionally end the unethical harvesting of organs from executed prisoners and all prisoners of conscience.
Videos, Books, Web, Reports, Interviews
Dear Colleagues and Friends,
It is not an exaggeration to say that the increasing international awareness of China‘s unethical organ procurement practices has contributed to recent developments in China. Officials have announced the phase-out of organ harvesting from executed prisoners, the establishment of an organ donor system and the start of a computerized organ allocation system. One can say: International attention and subsequent public pressure have an effect.
What was, and still is, missing in this series of measures are the crucial factors of transparency and openness to international scrutiny. The medical profession shares research findings with colleagues around the world. Medical doctors should also share the duty of ethical peer supervision worldwide.
A recent AJT Report  quotes Chinese health officials as saying, “The new system adheres to World Health Organization (WHO) guiding principles and is compliant with the Declaration of Istanbul.”
We disagree with this statement. Several of the WHO guiding principles on Human Cell, Tissue and Organ Transplantation are far from being adherent at this point, and this warrants exploration.
Guiding principle 1 requires consent. Given the ethical guidelines of the WHO, the WMA and TTS, prisoners are not in the position to provide free, voluntary consent. Thus, previous and continued organ procurement from executed prisoners and prisoners of conscience cannot be considered to meet the requirements for consent.
Guiding principle 5 states, “organs should only be donated freely, without any monetary payment,” yet one of the primary organ donation systems in China, the one supported by the Red Cross Society of China, engages donors through financial incentives, worth up to an annual income.
Guiding principle 7 states that health care professionals should only “proceed with the removal, intermediate management or implantation of cells, tissues or organs when donations are unpaid and truly voluntary.” If every transplant surgeon in China abided by guiding principle 7 unethical organ harvesting and transplant abuse would come to an immediate end in China.
But, guiding principle 7 not only exhorts medical professionals who are directly involved, it continues with an important addition (for western medical professionals) stating, “failing to ensure that the person consenting to the donation has not been paid, coerced or exploited breaches professional obligations and should be sanctioned by the relevant professional organizations and government licensing or regulatory authorities.” Guiding principle 7 suggests that medical organizations like WHO, WMA, TTS and others should sanction medical professionals in China when they fail to ensure the “professional obligations.” After more than two decades of harvesting organs from executed prisoners it is unacceptable to ignore the ethical violations and continue turning a blind eye.
Guiding principle 10 requires traceability and guiding principle 11 requires transparency and openness to scrutiny. If China, as stated, adhered to the WHO guiding principles, then guiding principles 10 and 11 could be immediately implemented. It might require time to establish an organ donation program and build a computerized organ allocation system. But, if China were really willing to abide by international ethical standards, then they could immediately implement transparency and openness to scrutiny and retract the plan to “phase-out” the unethical organ harvesting practice. The international community should challenge this by demanding immediate implementation of transparency and traceability of all organs.
China does not meet the criteria for the above WHO guiding principles, thus we do not agree with the statement that China “adheres to the WHO guiding principles.”
It is central to humanity and to the preservation of medical ethics that the international community continue to closely monitor the developments in China.
Torsten Trey, MD, PhD
Executive Director DAFOH
1Pondrom S. A new transplant program in China. American Journal of Transplantation 2013; 13: 2511-2512.
Doctors Against Forced Organ Harvesting (DAFOH) aims to provide the medical community and society with objective findings of unethical and illegal organ harvesting. Organ harvesting, the removal of organs from a donor, without free and voluntary consent, is considered a crime against humanity, as well as a threat to the integrity of medical science in general. This edition of our newsletter offers up-to-date information on international efforts to stop unethical organ harvesting.