Commentary
Organ Transplantation in China Jeremy R. Chapman, AC, MD, FRCP, FRACP1
C
hina is a complex country with a large and diverse population challenged by swift and transformative economic growth. Some commentators see the emergence of China as an economic superpower, as simply a return to the normality that existed for 1800 of the last 2000 years, with the last 200 years merely an aberration. In our field of transplantation, the pathway for Chinese medicine has also been aberrant for much of the last 15 years, deflected into a sordid, shameful, corrupt, and unethical grab for money through sale of organs to the highest bidders from inside and outside of China. Organs for sale from executed prisoners reviled the world, both because of the intrinsically unethical source of organs and realization that this demand was probably driving increased approvals for execution. The volume of this activity also distorted development of organ donation programs across the world and led to extreme predation on the wealthy sick. The nations of the world responded to the global problem of transplant commercialism through the World Health Assembly1 and physicians of the world responded through the Declaration of Istanbul.2 The Government of China also made significant changes in control of their programs from 2007 onward.3 Accusations that the Chinese response was ineffective and insufficient, combined with a deep mistrust, expressed especially by expatriate Chinese groups, has typified the past 8 years. The pressing community need for organ transplantation in China is numerically, and in every other way, greater than in any other nation. In 2014, the transplant rate in China reached only 1.2 people per million population. There is thus a huge task ahead of those responsible for the health of China, where the need for transplants is estimated by the Chinese Health Authorities at 300,000 per annum, which if achieved, would certainly make China the global transplantation superpower. The rate of execution over the past 10 to 15 years in China has been variably estimated by such organizations as Amnesty International at between 2000 and 3000 per annum. That number started to fall as Chinese government changes before the 2008 Olympics came into effect and when delegation of the power to execute was withdrawn from provincial governors by the Chinese People's Court in Beijing. Most transplant centers in China have realized that organs from executed people cannot meet the needs of anyone ex-
1
Westmead Hospital, Sydney, NSW, Australia.
The author declares no funding or conflicts of interest. Correspondence: Jeremy R. Chapman, AC, MD, FRCP, FRACP, Westmead Hospital Sydney, NSW 2145 Australia. ([email protected]). Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0041-1337/15/9907-1312 DOI: 10.1097/TP.0000000000000797
1312
www.transplantjournal.com
cept the venal and the corrupt. Thus, from 2010 onward, a concerted effort has been made by an increasing number of centers to seek donation from the community through conventional donors who die in intensive care units. Complicated by the lack of brain death laws, transplant programs have, of necessity, turned to donation after death from cessation of circulation, and the group of brain dead donors who also have cessation of the circulation before donation. The numbers of such donors has risen progressively and perhaps with this encouragement, a number of major centers declared, in the Hangzhou resolution, that they would no longer use any organs from executed people.4 On December 4, 2014, Jeifu Huang announced on behalf of the National Organ Donation and Transplantation Committee of China, the breakthrough that many have been hoping to hear. China has, from January 1, 2015, made voluntary public organ donation the sole legitimate source of deceased transplantable organs in China. Use of organs from executed prisoners is now, by government mandate, illegal. From January 2015 to the end of March 2015, there have been 548 cases of deceased civilian organ donation, providing over 1400 organ transplants, with an additional 180 living donor transplants. The point has been made by the Chinese leadership that executed prisoner organ transplantation cannot coexist with civilian organ donation.3 China has now started on the long road to increase its organ transplant rate through the conventional and ethical programs of donation after death in intensive care. It is thus timely that we publish in this issue the first analysis of Chinese health professional attitudes to organ donation, brain death, and transplantation.5 The study shows that organ donation and transplantation are well known by health professionals; brain death is seen by the majority as acceptable for diagnosis of death; and doctors are better informed on the subject than nurses. There are many weaknesses in such studies, including this one; however, it is not the data that are most important, but the fact that researchers in China have seen it important to study the problem. The data on civilian organ donation in the early months of 2015 are part of the story, but it would be naive to believe that all of the powerful Chinese transplant programs, addicted to the wealth emanating from commercial organ transplantation, will suddenly turn their huge hospital complexes around. There is a large task ahead for those who work under criticism both at home and abroad to create a Chinese transplant program for the Chinese. Perhaps, now is the time for the international community to assist and cement in place the development of this alternative practice. This journal and our companion journal, Transplantation Direct, will not knowingly publish any clinical or experimental work that includes use of any material or data from executed people—no matter which country the work is from. Transplantation
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
■
July 2015
■
Volume 99
■
Number 7
Commentary
© 2015 Wolters Kluwer
That policy remains unchanged and supports the policy of The Transplantation Society and the principles of the Declaration of Istanbul. We do hope to see innovation in the clinical sciences of donation and transplantation, emanating from Chinese centers, published in these pages in the years ahead. REFERENCES 1. Chapman JR, Delmonico FL, Groth C. The World Health Assembly Resolution on human organ and tissue transplantation. Transplantation. 2010;90(3):236–237.
2. Participants in the International Summit on Transplant Tourism and Organ Trafficking Society of Nephrology in Istanbul, Turkey. The Declaration of Istanbul on organ trafficking and transplant tourism. Transplantation. 2008;6(8):1013–1018. 3. Huang J, Millis JM, Mao Y, et al. Voluntary organ donation system adapted to Chinese cultural values and social reality. Liver Transpl. 2015;21:419–422. 4. Delmonico FL. A welcomed new national policy in China. Transplantation. 2013;96:3–4. 5. Hu D, Huang H. Knowledge, attitudes and willingness toward organ donation among health professionals in China. Transplantation. 2015;7:1379.
Transplantation - Online Gain access to the full spectrum of transplantation. Visit Transplantation’s website, www.transplantjournal.com today! Every subscription to the print edition of Transplantation includes a full access to the online journal. Transplantation Online contains the complete text and figure content of the print journal, and has these additional features: • •
1313
Calendar of future meetings and events Links to the The Transplantation Society homepage
In order to activate the full-content of Transplantation-Online, you must register. Registration is a quick, one-time process. To register: • Go to www.transplantjournal.com • Click “Register” on the top menu bar. • Follow the activation instructions that appear on the screen. • TTS Members: You may access the journal directly through The Transplantation Society website www.tts.org and logging in as a member.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Organ Transplantation in China Jeremy R. Chapman, AC, MD, FRCP, FRACP1
C
hina is a complex country with a large and diverse population challenged by swift and transformative economic growth. Some commentators see the emergence of China as an economic superpower, as simply a return to the normality that existed for 1800 of the last 2000 years, with the last 200 years merely an aberration. In our field of transplantation, the pathway for Chinese medicine has also been aberrant for much of the last 15 years, deflected into a sordid, shameful, corrupt, and unethical grab for money through sale of organs to the highest bidders from inside and outside of China. Organs for sale from executed prisoners reviled the world, both because of the intrinsically unethical source of organs and realization that this demand was probably driving increased approvals for execution. The volume of this activity also distorted development of organ donation programs across the world and led to extreme predation on the wealthy sick. The nations of the world responded to the global problem of transplant commercialism through the World Health Assembly1 and physicians of the world responded through the Declaration of Istanbul.2 The Government of China also made significant changes in control of their programs from 2007 onward.3 Accusations that the Chinese response was ineffective and insufficient, combined with a deep mistrust, expressed especially by expatriate Chinese groups, has typified the past 8 years. The pressing community need for organ transplantation in China is numerically, and in every other way, greater than in any other nation. In 2014, the transplant rate in China reached only 1.2 people per million population. There is thus a huge task ahead of those responsible for the health of China, where the need for transplants is estimated by the Chinese Health Authorities at 300,000 per annum, which if achieved, would certainly make China the global transplantation superpower. The rate of execution over the past 10 to 15 years in China has been variably estimated by such organizations as Amnesty International at between 2000 and 3000 per annum. That number started to fall as Chinese government changes before the 2008 Olympics came into effect and when delegation of the power to execute was withdrawn from provincial governors by the Chinese People's Court in Beijing. Most transplant centers in China have realized that organs from executed people cannot meet the needs of anyone ex-
1
Westmead Hospital, Sydney, NSW, Australia.
The author declares no funding or conflicts of interest. Correspondence: Jeremy R. Chapman, AC, MD, FRCP, FRACP, Westmead Hospital Sydney, NSW 2145 Australia. ([email protected]). Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0041-1337/15/9907-1312 DOI: 10.1097/TP.0000000000000797
1312
www.transplantjournal.com
cept the venal and the corrupt. Thus, from 2010 onward, a concerted effort has been made by an increasing number of centers to seek donation from the community through conventional donors who die in intensive care units. Complicated by the lack of brain death laws, transplant programs have, of necessity, turned to donation after death from cessation of circulation, and the group of brain dead donors who also have cessation of the circulation before donation. The numbers of such donors has risen progressively and perhaps with this encouragement, a number of major centers declared, in the Hangzhou resolution, that they would no longer use any organs from executed people.4 On December 4, 2014, Jeifu Huang announced on behalf of the National Organ Donation and Transplantation Committee of China, the breakthrough that many have been hoping to hear. China has, from January 1, 2015, made voluntary public organ donation the sole legitimate source of deceased transplantable organs in China. Use of organs from executed prisoners is now, by government mandate, illegal. From January 2015 to the end of March 2015, there have been 548 cases of deceased civilian organ donation, providing over 1400 organ transplants, with an additional 180 living donor transplants. The point has been made by the Chinese leadership that executed prisoner organ transplantation cannot coexist with civilian organ donation.3 China has now started on the long road to increase its organ transplant rate through the conventional and ethical programs of donation after death in intensive care. It is thus timely that we publish in this issue the first analysis of Chinese health professional attitudes to organ donation, brain death, and transplantation.5 The study shows that organ donation and transplantation are well known by health professionals; brain death is seen by the majority as acceptable for diagnosis of death; and doctors are better informed on the subject than nurses. There are many weaknesses in such studies, including this one; however, it is not the data that are most important, but the fact that researchers in China have seen it important to study the problem. The data on civilian organ donation in the early months of 2015 are part of the story, but it would be naive to believe that all of the powerful Chinese transplant programs, addicted to the wealth emanating from commercial organ transplantation, will suddenly turn their huge hospital complexes around. There is a large task ahead for those who work under criticism both at home and abroad to create a Chinese transplant program for the Chinese. Perhaps, now is the time for the international community to assist and cement in place the development of this alternative practice. This journal and our companion journal, Transplantation Direct, will not knowingly publish any clinical or experimental work that includes use of any material or data from executed people—no matter which country the work is from. Transplantation
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
■
July 2015
■
Volume 99
■
Number 7
Commentary
© 2015 Wolters Kluwer
That policy remains unchanged and supports the policy of The Transplantation Society and the principles of the Declaration of Istanbul. We do hope to see innovation in the clinical sciences of donation and transplantation, emanating from Chinese centers, published in these pages in the years ahead. REFERENCES 1. Chapman JR, Delmonico FL, Groth C. The World Health Assembly Resolution on human organ and tissue transplantation. Transplantation. 2010;90(3):236–237.
2. Participants in the International Summit on Transplant Tourism and Organ Trafficking Society of Nephrology in Istanbul, Turkey. The Declaration of Istanbul on organ trafficking and transplant tourism. Transplantation. 2008;6(8):1013–1018. 3. Huang J, Millis JM, Mao Y, et al. Voluntary organ donation system adapted to Chinese cultural values and social reality. Liver Transpl. 2015;21:419–422. 4. Delmonico FL. A welcomed new national policy in China. Transplantation. 2013;96:3–4. 5. Hu D, Huang H. Knowledge, attitudes and willingness toward organ donation among health professionals in China. Transplantation. 2015;7:1379.
Transplantation - Online Gain access to the full spectrum of transplantation. Visit Transplantation’s website, www.transplantjournal.com today! Every subscription to the print edition of Transplantation includes a full access to the online journal. Transplantation Online contains the complete text and figure content of the print journal, and has these additional features: • •
1313
Calendar of future meetings and events Links to the The Transplantation Society homepage
In order to activate the full-content of Transplantation-Online, you must register. Registration is a quick, one-time process. To register: • Go to www.transplantjournal.com • Click “Register” on the top menu bar. • Follow the activation instructions that appear on the screen. • TTS Members: You may access the journal directly through The Transplantation Society website www.tts.org and logging in as a member.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
