Voluntary and Informed Consent is the Decisive Criterion
for Ethical Organ Procurement
By Torsten Trey
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 meet the ethical requirements and therefore does not indicate altruistic organ donation.
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 came 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 continues to thoroughly monitor the developments in China and encourages an accurately reported mechanism of free, voluntary and informed consent for organ donation.