Response by Dr. Torsten Trey et al.
in reply to Drs Shi Bing-Yi and Chen Li-Peng
April 2, 2012
Referring to the Letter “Organ Transplantation and Regulation in China”,
published in JAMA, November 2, 2011—Vol 306, No. 17; p.1863-64
The authors Drs Shi and Chen state that “the organ procurement procedures are strictly compliant with specifications”, without further explaining how these specifications are defined. If the “specifications” refer to the guiding principles on human organ transplantation of the WHO and the ethics guidelines by the WMA, then those specifications would suggest completely refraining from harvesting organs from prisoners, as their consent is – independent from the procedures – not freely given. However, the free consent is the commonly acknowledged foundation for organ donation. Thus if the authors claim to be “strictly compliant with specifications”, we would expect that the authors would approach the Chinese government and demand an immediate halt of organ harvesting from executed prisoners or living prisoners of conscience.
Furthermore, stating that the practices in China ”strictly followed the guiding principles” of the WHO, conflicts with another phenomenon:
Many recipients of organs who return to their countries arrive at home without any further medical summary to indicate the pre-, peri- and post-operative events, medications and results. The receiving clinicians in the foreign country have been tasked or assumed to continue effective treatment without any customary courtesy referral or summary letter to assist with and plan for further care. It has also been observed that the recipients were quickly discharged (as early as 7 days after transplantation), neglecting the needs for further close follow up and expected diagnostic or therapeutic procedures. The patients will be left without proper referral arrangement. Some of the patients did indeed return with significant surgical and/or medical complications including anastamotic breakdown requiring urgent surgical exploration and hepatitis viral seroconversion or significant immunologic complications, to name a few examples.
Some of these aforementioned exemplary results of the recent transplant practices in China do not reflect or support the claims made by the Chinese authors that they adhere or subscribe to transparent, ethical and professional practices in organ transplantation, as suggested by the guiding principles of the WHO.
We would like to comment on another aspect of those “specifications” of the WHO. In their original Commentary the authors state that the Chinese government “strictly followed the guiding principles of the World Health Organization for organ transplantation”.
Among the guiding principles of the WHO we find the principles 10 and 11, which refer to traceability and transparency.
WHO Principle 10 demands traceability of transplanted organs back to the donor and Principle 11 demands: “The organization and execution of donation and transplantation activities [ …] must be transparent and open to scrutiny.”
If organization and management of organ donations were really transparent and open to scrutiny and organs could be traced back to the donor in China, an independent international institution would be able to check the transplant documents. In that case, an international inspection would be able to oversee, if transplanted organs stemmed from executed prisoners or people in freedom, and if the organs were harvested with or without consent from detained Falun Dafa practitioners and others.
If China doesn’t allow such an independent investigation or blocks the access to the respective information, then it is not compliant with the WHO guiding principle that organization and execution of organ donation must be transparent and open to scrutiny.
Therefore we disagree with the statement that “organ procurement procedures are strictly compliant with specifications.”
Consequently, we also have to reject statements, such as “if a sentenced convict would like to donate his organs”, or “the convict…. must submit an official application”. Signing an “official application” while in detention remains an unacceptable procedure regardless the procedures. In our letter we refer to the ethical standards of the WMA, which state that prisoners cannot provide free consent.
Besides, using the terminology “informed consent statement” is misleading. The critical point in the discussion about ethics in the context of organ donation is that the donor provides “free” consent. “Informed consent” does not necessarily exclude coercion. Being asked before execution to “confirm his organ donation again”, – possibly with a rope around one’s neck -, might be considered “informed consent”, but certainly not “free consent”.
The authors state they have “never heard of this many [20,000] transplants per year in China; the number in 2006 was 11,000.”
We quote media from China:
The China Daily in December 31, 2005, under the headline “Organ transplant regulation drafted”, wrote:
“Statistics suggest that at least 2 million patients in China need organ transplants each year, but only up to 20,000 transplants can be conducted because of a shortage of donated organs.”
The China Daily on May 5, 2006, under the headline “New rule to regulate organ transplant”, wrote:
“Sources claimed that at least 2 million patients in China need organ transplants each hear, but only 20,000 transplants can be carried out because of the shortage of donated organs.”
The Medical Observer in an article dated June 27, 2008, under the title “Transplant tourists”, wrote:
“According to the China Daily, there were 20.000 organ transplants in 2005.”
In an interview with Science Times in May 2007, one of the authors, Dr. Shi Bingyi, as director of the Organ Transplant Center of the People’s Liberation Army and member of the standing committee of the Chinese Medical Association Organ Transplant Society, said:
“The number of organ transplants in China reached a historic peak in 2006, in which nearly 20,000 cases of organ transplants were performed. For the first five months in 2007, the number of organ transplants has decreased compared to that of the same period in 2006, largely due to the shortage in organ donors.”
The People’s Daily in an article dated May 19, 2010, under the title “Trial focuses on organ trafficking ethics”, wrote:
In 2010, Dr. Huang Jiefu, Vice-Minister of Health of the PRC, held a presentation at a conference on organ donation and transplantation in Madrid. He stated that in 2005 they performed 8,500 kidney and 3,018 liver transplants in China. That accounts for 11,518 transplants in 2005.
Adding – roughly – 5,000 cornea transplants and cell transplants and possibly also transplants not officially registered to the above 11,518 transplants is taking us close to 20,000 transplants.
Hence the authors’ statement that they “never heard” of 20,000 transplants appears questionable. It also underlines that WHO Principles 10 and 11 are not “strictly followed” as otherwise traceable data and transparency would enable the authors – and doctors around the world – to look into the concrete numbers and learn more about “this many” transplantations.
With regard to the authors’ statement that they “have not heard of such forced organ harvesting” from Falun Dafa practitioners, we reply:
In 2006 “Anni”, the wife of a Chinese surgeon stated publicly that her husband said to her that he has harvested 2,000 corneas from detainees, including Falun Gong practitioners.
At the same time in 2006 “Peter”, a journalist who investigated in Sujiatun, also stated that organs were harvested from Falun Gong practitioners.
In their investigation in 2006, David Matas and David Kilgour called 17 hospitals in China, pretending to need a transplant. The phone calls were recorded. In those phone calls doctors from the particular hospitals in China state in different ways that they indeed use organs from Falun Gong practitioners.
All these sources made their statements independent from each other. They are not Falun Gong practitioners and have no conflict of interests.
Why would Falun Dafa practitioners who suffer from brutal torture, torture death, force-feeding, burning, beating, brainwashing etc., be subject to blood testing, x-ray, ultrasound and physical examinations? These diagnostic procedures are expensive and are commonly used for the purpose to provide cure. However the latter appears implausible, as the respective group of people is subject to torture and persecution.
Furthermore, we would recommend to the authors to read the report “Bloody Harvest” of David Matas and David Kilgour to learn more about the amount of evidence that seconds our statement.
We therefore reply that these findings let us believe that we are beyond the point of “surmise that the organs might have been harvested from living Falun Dafa practitioners” and that we are afraid to state that in China organs are indeed harvested from Falun Dafa practitioners.
We are looking forward to see more transparency in the Chinese organ transplant system, and would suggest making the figures of executions in China transparent.
When quoting Vice-Minister of Health Dr. Huang Jiefu, who hopes that “using executed prisoners as a source of organs would be eliminated in China within the next 5 years”, we would like to refer to exactly the same source, Dr. Huang Jiefu, who stated in 2009 that the process to build up an organ donation program in the U.S. took “20 years”.
Hence the 5 years time frame appears not only ambitious but also raises the question how a cultural grounded reluctance to donate organs could be changed on a “free consent” basis in such a short time period.
We reiterate that organ donation is based on “free consent” and not on coercion. If such an organ donation program in China would indeed be implemented within 5 years, we actually would have concerns that ‘coercion’ could possibly at play and would request access to open scrutiny.
When the authors Shi and Chen close with their statement that “gradual progress in organ transplantation and regulation indicates the positive direction in which Chinese society is moving”, we would suggest proving the “positive direction” by immediately halting the organ harvesting from executed prisoners, a practice that is internationally condemned.
And in reply to the specific, but not medically related statement about the “positive direction in which Chinese society is moving“, we would demand to end the gruesome persecution of Falun Dafa practitioners, which would indicate that the Chinese society is indeed moving towards a “positive direction”.
Executive Director DAFOH