Transplant Medicine at a Crossroads 2015

Transplant Medicine at a Crossroads:

Ethical Standards Bent to the Breaking Point

The August 2015 Organ Donation and Transplantation Conference held in Guangzhou, China, confirmed that Chinese authorities are reluctant to be open to international scrutiny on its organ trade practices.

The organ procurement situation in China must not be ignored or trivialized. For more than three decades China has boldly violated international ethical standards by harvesting organs from executed prisoners, and has committed crimes against humanity by harvesting organs from non-convicted, non-consenting vulnerable prisoners of conscience. China announced several times in the past to end the practice, yet it continues unabated.

The last announcement of reform came in December 2014. It was made by an individual doctor, and was not an official directive of the Chinese government. It triggered a premature recognition and support from doctors and officials around the world. Medical organizations, led by individual doctors, accepted the statement at face value and have taken for granted that this was sufficient for significant reforms to commence. Leading representatives of medical organizations attended the recent Guangzhou conference and expressed support for the announcement of new developments. The confidence that this time there would be real change was mainly based on the exchange between a few Western and Chinese doctors and a cursory, pre-planned six-hospitals-in-ten-days-inspection-tour.

Issues	Considerations
1. Announcement by Huang Jiefu in December 2014 to end using death row prisoners as organ sources was not legally binding	Upon reviewing the white boards and websites of the Chinese Health Ministry in the months after the announcement, there were no official statements issued. Including the PRC National Health and Family Planning Commission, which manages the China Organ Transplant Response System (COTRS). The statement came from Huang Jiefu, an individual doctor, not from government officials. The announcement did not include any strategy, concrete outlines, or procedures how to end the three decades of reliance on executed prisoners.
2. Organ procurement from executed prisoners is still legal in China and the organs are defined as voluntarily donated.	In China, the 1984 provisions are still in place and authorities are permitted to harvest organs from executed prisoners— in violation of international guidelines set by the WMA, WHO, and TTS. For more than three decades China has violated international ethical standards by harvesting organs from executed prisoners without consent. Without strict legal framework, the habit and easy access to such organs is not easily abandoned. Investigative reports and eye witness accounts have verified that this practice has extended to harvesting organs from non-convicted, non-consenting vulnerable prisoners of conscience, who would otherwise not be put to death.
3. Prisoners of conscience remain at risk	Huang Jiefu’s announcement did not include a categorical statement to also end the organ harvesting from prisoners of conscience. To date, China has not committed to ending the organ procurement from victim groups like the Falun Gong, Uyghurs, Tibetans, Christians and others, who are exploited for their organs. [1]
4. Falun Gong remains the key target group	The continuous persecution of Falun Gong since 1999, with systematic, targeted medical exams, including blood tests, urine tests, x-rays, and ultrasound, have been reported by witnesses, survivors and their families. These targeted medical exams were also witnessed by detained non-Falun Gong practitioners. This is cause for great concern that forced organ harvesting from prisoners of conscience has not been halted. There is an implausible discrepancy between the insensible medical screening of prisoners and a simultaneous exposure to physical harm: torture, medical neglect and human rights abuses in the detention camps and prisons. The international community must remain vigilant and scrutinize any promises made by the Chinese authorities, or medical professionals, and seek independent verification that no individual or group is at risk of being killed for their organs.
5. New national donor register lacks transparency	In the first half of 2015, Huang Jiefu gave interviews stating that death row candidates should be defined as “citizens who have the right to donate their organs.” This implies that prisoners are in a position to give free, voluntary consent, which is ethically and philosophically refuted, and violates ethical standards as set forth by the World Medical Association (WMA) and other declarations. Voluntary civilian donors may be mixed with incarcerated prisoners—now renamed “citizens”—”donors” in one collective system, making traceability of organ sources impossible.
6. Lack of transparency and independent investigations	To date no independent investigators have been allowed to freely scrutinize the organ procurement pathways in China. Is it vital that independent international inspections verify any purported changes, report suspected violations, and verify the congruence between announcements and actions.
7. Rapid growth of the citizen donor registry must be monitored carefully	Data from other countries shows that it takes decades for a voluntary public organ donation system to be successfully operational and yield a sufficient amount of organs. Any claims of a fully operational public organ donation system in China, within three to four years of inception, is dubious and raises serious humanitarian concerns. For the public donation system to be truly “voluntary,” it would require time to educate the public and build trust. Quick growth points to coercion or other mechanisms that may be behind the rapid increase in the organ registry. The Red Cross Society of China offers financial incentives to the relatives of deathbed patients in violation of WHO Guiding Principles—a practice that bears resemblance to commercial organ trafficking.
8. The new organ donation system in China raises doubts as it may disguise a continuation of mechanisms of the previous practice	Chinese media is quoted saying that almost all donated organs in 2015 were wasted. While Huang Jiefu mentioned in several interviews in the first half of 2015 that death row prisoners are “citizens” who are permitted to donate organs—one article even speaks of “encouraging” prisoners to donate—he describes it in November as a merely “philosophical” consideration. After the unilateral re-definition of death row prisoners as “citizens” with the right to donate organs, this could be perceived as another attempt to deflect international criticism through the use of semantic manipulation. Huang Jiefu explained the steep increase of “voluntary organ donations” this year with a poll among “middle young students,” of whom “70%” were willing to donate organs. However, it is unlikely that “middle young students” will pass away shortly after signing up for organ donation, and thus do not explain for the sudden increase in organ donations. The officials claim that the organs were procured from elderly deathbed patients. The explanation for the openness for organ donation (“70% of middle young students”) is misleading.

NOTE: The Chinese people have a cultural aversion to organ donation due to ancient traditions of not altering the body after death. It may take years for the general population to develop acceptance of donation despite mass marketing and re-education campaigns by the Chinese Communist Party to shift public opinion. Also, the short time span between the start of the new voluntary registry and the sudden availability of organs suggests that registered organ donors are implausibly dying shortly after signing up for donation.

Two case studies for further consideration:

International medical community should seek independent verification

On April 21, 2015, a forum on China’s organ harvesting practices was organised in Brussels by the Policy Department A for the ENVI Committee, with the collaboration of the Human Rights Unit for the DROI Sub-committee. In his presentation at the EU parliament’s workshop (video streaming at 1:16:40), Dr. F. Delmonico, referring to a letter from the Chinese ambassador, stated that “It is now against the law of China,” to harvest organs from executed prisoners. However, in an article from August 27, 2015, Huang Jiefu is quoted as stating “the only regret is that the long-appeal of a human organ donation law has not yet been introduced,” suggesting that the quoted claims of the Chinese Ambassador in April 2015 were unfounded and that there was not an organ donation law in place. The letter statement of the Chinese ambassador was therefore misleading and wrong and should not have been presented at the workshop in the EU Parliament. This example may unveil a recurrent pattern of Chinese officials using western doctors unwittingly as a mouthpiece for their political agenda, providing doctors from the West with statements that are misleading or even false. Caution and scrutiny is advised.

Ethical responsibilities of international medical Schools

International Medical schools should halt training doctors from China, or any other country, where unethical organ transplantation practices are known to occur. China Gate published an interview with a doctor, who trained at the University of Pittsburgh in 2011, later returning to China to practice transplantation surgery. News media quoted him as saying that his hospital performed, on average, about 500 transplants a year: liver, kidney, cornea, heart, small intestine, pancreas, lung, skin and bone marrow transplants. The doctor stated that living donor transplantation is still in its infancy in China; the vast majority are cadaveric organs, of which a large proportion are from the bodies of executed prisoners as a source of organs. The doctor described the case of a drug trafficker who was quickly convicted and executed one day prior to a patient organ transplant. He spoke of the “annual 1.5 million people who need a organ transplantation,” in China, and described in detail how he helped to harvest organs from a prisoner immediately after execution.

Conclusions:

Organ harvesting from prisoners of conscience in China remains completely ignored and unaddressed. Until otherwise proven, Falun Gong practitioners remain the primary target for organ harvesting due to the ongoing persecution and the subsequent access to millions of persecuted people, who are subject to forced medical exams; other victim groups include Uighurs, Tibetans, and Christians. Chinese authorities must end the abuse of organ seizure from unwilling persons within the prison system and comply with international ethical guidelines.
Chinese media at the Guangzhou conference reported that “the long-awaited human organ donation law has not yet been introduced.” Therefore, as of now, there is no legal ground to say that China has ended the transplant abuse from executed prisoners or prisoners of conscience.
A lack of transparency continues surrounding the “reformed” organ donation pathways and registry. The amalgamation of death row prisoners as “donors” into the civilian organ database poses serious ethical concerns as it will be impossible to trace an organ source to origination. The new COTRS may become a profitable system to whitewash unethically procured organs; the source of organs cannot be traced to origin, thus it will remain unclear if incarcerated non-voluntary prisoners’ organs were registered.
Any significant sudden increase in apparent voluntary donors must be treated with skepticism. Based on the experience of functional donor registers in developed countries it takes decades for the system to be operational and to yield desired results. The sudden yielding of thousands of organs in a region that is traditionally reluctant to donate organs is suspicious. Describing prisoners as “citizens with the right to donate organs” is a semantic twist that attempts to deflect international criticism. Now, almost a year later, this is described as “philosophical,” or conceptual, suggesting that the previous practice remains disguised and unsolved.

[1]
BBC radio report, https://archive.is/FQ5Xe;
SBS report, https://archive.is/oo6Gh;
European Parliament Resolution, https://archive.is/7tkm1;
Workshop, https://archive.is/etenw