Huang Jiefu, director of China’s Organ Donation Committee, made an alarming proposal on December 19, 2014, saying that Taiwanese patients would be able to get organs for transplantation flown over from mainland China to be transplanted in their own hospitals. This form of “transplant tourism” has been generally frowned upon globally, especially under the circumstances under which China makes such an offer: the organ source is prisoners and prisoners of conscience with inexplicably short wait times.
December, 2014, saw a period of activity in China’s transplant program that has not been observed at any time prior. China announced plans to halt taking organs from executed prisoners by January 1, 2015. Despite dire organ shortages on the mainland, this news was immediately met with expectant western media optimism that overlooked a deceptive twisting of reality and doublespeak by China’s transplant authorities: a redefinition of the words “donate,” “donor,” and “citizen” were a part of the announcement. Chinese prisoners will now be permitted to donate their organs, “If they wish to do so.”
The redefining of basic organ donation terminology aimed at whitewashing Chinas unethical organ procurement practices, with promises to fall into line with global standards, has failed to appease. International inquiry and demands for investigation on the ground in China are aimed at uncovering the true source of China’s organs.
This insincerity was then followed by an unprecedented business offer to expand organ trade beyond China’s borders. Two weeks after announcing a change in its organ sourcing last December, China boldly offered an organ trade deal with Taiwan.
Taiwan media reported that China wanted cross straits “surplus organ trading” with Taiwan. “China will actively establish a platform for cross-strait organ donation and exchange,” announced Huang Jeifu, director of the China Organ Donation Committee and former vice-minister of health, at a medical conference on the island. Huang highlighted that livers and kidneys could be preserved at 4 degrees Celsius for between 16 and 24 hours, adding that “There are a lot of direct cross-strait flights,” and that transportation and technology would not be problems. (News report in Chinese)
Huang’s plan of cooperation between the two countries aims at enabling Taiwanese patients to get transplants without having to travel to the mainland. In light of how China has decried severe organ shortages with hundreds of thousands of patients waiting for organs at home, an offer to engage in supply and demand trade with another country suggests a large, lucrative organ bank at home.
By its actions, China has announced a transplant organ surplus. The offer was met with unprecedented opposition as thousands of Taiwanese doctors and human rights lawyers refused to collude with China, urging their government to decline any offer at organ trading in light of evidence that China relies on taking organs from its hundreds of thousands of prisoners of conscience in prison camps. According to the Taiwan Association for International Care of Organ Transplants, the number of co-signing physicians reached over 5,000.
The notion that China has the organ resources to close the gap between organ supply and critical levels of demand in other countries is unprecedented. All countries currently endure extensive transplant wait lists and severe organ shortages, and no countries offer surplus organ trade. The turnaround for the new organ deal offer came just a week later when Taiwan’s Ministry of Health and Welfare responded that Huang’s idea was “not feasible,” and the ministry “wouldn’t accept organs from the mainland.”
Taiwanese transplant doctors publicly raised the alarm to help patients make judicious decisions after the public media reports increased awareness of China’s organ trade offer. Administrators and doctors at Taiwan University Hospital, the biggest hospital in Taiwan, placed a large poster in the hospital with the following notice:
“The outpatient clinic of the Taiwan University Hospital has never recommended patients to go to Mainland China for kidney transplantation. If anyone uses the name of our Hospital transplant team as a pretext to encourage patients to go to the Mainland for transplant surgery, please do not be fooled.”
Photo: Patient notice at Taiwan University Hospital
The hospitals’ organ transplant team doctors signed the poster voicing concern that patients needing transplants may be approached by transplant traffickers and stated a warning on the poster that doctors who may be pretending to be from Taiwan may approach patients and suggest that they travel to China for organs, and that the warning was also issued for other hospitals.
The number of domestically donated organs in China has been reported as critically low for decades due to taboos against donation and ancient cultural beliefs concerning reverence to the state of the body in death. Despite some degree of effort by the government to encourage donation, such as unethical monetary incentives, the Chinese people adhere to the cultural tradition against donation. Yet, Chinese media recently reported Huang as contradicting this widely known factor in statements he made to the media less than a year ago. “Organ donation is very common among our nationals,” Huang said during a recent announcement, and that somehow China has vaguely “set more relaxed conditions for organ donations.”
He offered no details or data on this profound social change in Chinese citizens attitudes towards voluntary donation.
The Chinese government’s claim is especially difficult to accept given the logistics of organ donation in China. With an average voluntary donation rate of only 0.6 per million, China is not in the position to meet its own demand for organs. Doctors Against Forced Organ Harvesting, DAFOH, has reported details on the current statistics on voluntary donation in China.
Even this year’s purported 1,500 voluntary donors are not enough to supply organs for its 10,000 planned transplants. And, the organ donation practices are murky: the Red Cross Society of China—not affiliated with the International Red Cross—is mobilizing organ donors by paying 100,000 RMB ($16,000), a practice that violates 3 of the 11 Guiding Principles of the World Health Organization (WHO).
Organs found unsuitable after procurement, and other problems with organ usage, add further demand. Still, Chinese transplant centers advertise unprecedented wait times for organ transplants, as little as days to weeks. In the United States, survey data on organ donation, allocation and usage revealed that first, almost two-thirds of respondents were registered as organ donors, but national transplantation statistics showed that less than half of potentially recoverable organs were actually recovered and found suitable for transplantation. (Sung, 2008)
Consequently, despite recent favorable trends showing an increase in organ donation globally, the demand for healthy organs continues to outpace supply by a significant margin. Many organs may fail in the process of attaining one successful transplantation, so the number of organs needed far exceeds the numbers of actual transplants. Thus, wait times are a direct reflection of supply.
The New York Times (2014) reported in September 2014, that in the United States there were about 16,900 kidney transplants in 2013, while the waiting list for kidneys currently exceeds 100,000 patients. The average wait time for a transplant has risen to almost five years; more than 4,000 people die each year while waiting and a great many more, possibly thousands, become too sick to undergo transplantation and are dropped from the wait list.
In the system of today’s China, the handling of information within the media plays a central role. What in the west is casually called “propaganda” is a sophisticated system of controlling information in China. Chinese media aims to influence the west with various social and political factors, particularly in the area of transplant tourism and organ trading. What is barely known in the West is that China has developed an influential department, the United Front Department, with the specific tasks of building alliances abroad, isolating enemies, and controlling world media.
Major medical journals in the west traditionally avoid publishing opinions influenced by public media, or extending propaganda into the medical field. China’s transplant practices have been revealed and so sharply criticized by high profile medical groups that its transplant authority, in attempts to appease a broad audience of dissent, is now apparently directing propaganda at the international medical community with a new transplant nomenclature that defies reality.
With the recent announcements and organ trade offer, China is directing its outreach at the international medical community on one hand, and baiting countries by offering lucrative business arrangements between colluding institutions abroad, transplant hospitals and medical centers in China on the other. The independence of science and truthful inquiry is at stake. An early wake up call to medical journals is needed before it expands further.
New organ donation terminology that poses as reform may find its way from major media reports into the medical journals. Controlling medical journalism to parrot support of China’s cloaked reform might be a way to bide time and continue taking organs from prisoners unencumbered. Defining prisoners as voluntary “citizens” who can freely donate organs, and refusing to acknowledge prisoners of conscience as the primary organ bank is the cornerstone of China’s transplant reform. The practice remains unacceptable for the international medical community.
R.S. Sung et al., (2008). Organ Donation and Utilization in the United States, 1997-2006, 8 Am. J. Transplantation 922, 926 fig.5 (2008).