Public Organ Donation System in China Largely Depends on Monetary Incentives for Families of Deceased Relatives

The public organ donation system in China, primarily organized by the Red Cross Society of China, is largely based on monetary payments for families whose relatives just passed away. Under the umbrella to offer poor families financial support in a financially distressed situation, triggered by the high expenses of the medical treatment in the hospital, organ donation coordinators approach the deathbed patient’s relatives to offer a financial solution. What appears to be social support and an attempt to justify payments for organs, reveals itself as a domestic form of organ trafficking. This approach is in violation of WHO Guiding Principles on organ transplantation 5 – 8.


Further information on payments for organs:

This official Red Cross website of Sep. 2015 says that in May 2015 the Hubei Provincial Government promulgated rules for the management of a Hubei Province human organ donation relief fund; that the Provincial Red Cross later implemented standard payments of 50,000 to 90,000 yuan per donor family; that seven families received payments according to these standards already in July and August 2015.

This Hubei news article of Sept. 2015, refers to this relief fund and reports 7 donor families received a total of 510,000 yuan according to the decision of the review team. [1] [2]

Similar payments existed reportedly already 2012 in Zhejiang Province:

“By the end of August, 53 people had voluntarily donated their organs in Zhejiang province, according to Gao Xiang, vice-executive of the Red Cross Society of China Zhejiang Branch.
The branch and the financial authorities of the province offered the family of each donor 20,000 yuan (US $3,171) in compensation and a further 14,000 yuan to help pay for the funeral service,” he said. Financial assistance paid to the families of donors does not exceed 50,000 yuan. “It’s very limited. But it shows the humanitarian spirit of the Red Cross,” he said.”

Further information on income and salary levels in China:

These payments are not as limited as they appear but rather carry a coercive factor because they are excessively high within the Chinese society.

37,000 yuan or even 50,000-90,000 Yuan (at the time: US$7,500-13,500) ) seem to be already pretty high compared with average incomes in big Chinese cities but they are excessively high compared with the income of poor rural families with financial difficulties.

Reported incomes in China:

“Of course, incomes vary greatly from region to region, with most of the wealthier residents residing in the cities. In rural areas, the average disposable income drops to $1,000, but in China’s largest cities like Shanghai, Beijing and Shenzhen, it’s around $12,000 a year, per person.”

Here are detailed statistics for Hubei rural household incomes. The poverty threshold in China ist 2.300 Yuan annual net income of farmers. Jan 12, 2015:

“In an effort to expand the safety net for those in poverty, the Chinese Government raised the poverty threshold to 2,300 yuan (US$374) annual net income of farmers in 2011.”

72000 Yuan (= the average payments for the 7 Hubei families) is even more than the average annual income of urban families in rich regions.

Reported incomes in NY Times:

“Average annual income for a family in 2012 was 13,000 renminbi, or about $2,100. When broken down by geography, the survey results showed that the average amount in Shanghai, a huge coastal city, was just over 29,000 renminbi, or $4,700, while the average in Gansu Province, far from the coast in northwest China, was 11,400 renminbi, or just under $2,000. Average family income in urban areas was about $2,600, while it was $1,600 in rural areas.”

And this source says, donors are mostly from the rural poors and 90% of them or their families asked for “financial aid” in return for their organs.

Article in USA Todayin in USA Today:

“From March 2010 to March 2012, pilot programs persuaded just 207 people to donate their organs after death, according to the Red Cross Society of China, which operates the transplant system. Those donors were mostly from the rural poor, and 90% of them, or their families, asked for “financial aid” in return for their organs.”

A similar Chinese source says:

“According to Hao Linna, many of the donors were from underprivileged rural families and many filed applications for financial aid.”

Even the Vice Minister of the Red Cross, Zhao Baige, admitted these payments are a problem.

“Although China needs a financial compensation programme for deceased organ donation, undesirable consequences have emerged. Of the 207 deceased donors, the proportion of poor donors is much higher than that of other donors. The vice minister of the Red Cross, Zhao Baige, said in an interview that 90% of 207 deceased donors’ families faced financial difficulties. This indicates that some of these families consented to donation because they were in need of financial assistance. With the developing economy, the continued increase in deceased organ donation rate dependent on this policy is doubtful in the long run. In addition, some donors’ families in needy circumstances have suffered great stress, as they were thought to have sold organs of their deceased loved ones.”

A doctor at the hospital of Zheng Shusen admitted explicitly high sums are paid as a gratitude for consenting to donation. Wednesday, 16 January 2013:

“Viewpoint: Financial compensation for deceased organ donation in China

by Dr Qiang Fang, Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou.

… Financial compensation can be considered to include two main forms, the ‘thank you’ form and the ‘help’ form. ‘Thank you’ compensation includes three aspects. First, Zhejiang Red Cross Society will pay for basic funeral expenses, which cover body transportation, cremation and ash urn storage. Then the Society will offer the donors’ families USD 1,600 for the cost of purchasing a grave plot. In addition, the donors’ families will be provided with USD 3,200 allowance. This kind of compensation is gratitude on behalf of the Society for consenting to donation. If the families of deceased donors face hardship, Zhejiang Red Cross will offer them extra compensation, which can be no more than USD 4,800.”

Further details:

A document by the Hubei government (notice) defines precisely which donor families are eligible for the payments:

Provincial People ‘s Government Office on the issuance of Hubei Province;

Notice on the Administrative Measures for the Use of Human Organ Donation and Relief Funds (Trial Implementation)

“…. Article 9: Where three of the following three types of circumstances are met, it may be submitted to the Red Cross Application for assistance. The Red Cross gives humanitarian aid to different situations.

(A) Donors families’ situations are particularly difficult.

  1. The donor’s family loses the main labor force;
  2. Parents of the donor are sick, over 65 years of age, without a living guarantee;
  3. The spouse of the donor has a long illness or has no fixed income;
  4. The donor family has a minor child needs to support;
  5. Donors’ families are sick and have no permanent residence or income;
  6. The donor family members are in line with the national special hardship support personnel.

(B) of the donor family more difficult.

  1. The annual disposable income of the donor is less than 10,000 yuan;
  2. The parents of the donor are over 65 years of age and have difficulty in living security.
  3. The spouse of the donor has no fixed income;
  4. The adult children of the donor are not employed;
  5. Donors’ families meet the national minimum standard of living assistance.

(C) donor family difficulties.

  1. A donor’s family loses a non-essential labor force;

(2) The annual disposable income of the donor is less than 20,000 yuan;

  1. The parents of the donor are over 65 years of age and the parent does not have a source of income.
  2. Donors’ families have children to go to school;
  3. The family of the donor is caused by an accident.

[10,000 Yuan=1450 USD being equivalent to 4 USD per day donor income]

An Organ Donation Management Center Circular [2] defines the standard for relief payments.

“Hubei Province, the use of human organ donation relief fund Management approach “the implementation details.

其救助标准为五至九万元人 民币” (The standard of relief is RMB 50,000 to 90,000 yuan).

[This is 7,270-13,086 USD]

Hubei news article of Sept. 2015 refers to this relief fund and reports 7 donor families received a total of 510,000 yuan. Yuan according to the decision of the review team.

The payment standard of 50,000 to 90,000 Yuan is more than 2.5 to 9 times higher than the upper limits for the disposable annual income of the deceased donor (10,000 or 20,000 Yuan).

This is beyond reasonable doubt much higher than mere reasonable and verifiable expenses incurred by the donation. These unethical payments happened already as the news article demonstrates.