A Welcomed New National Policy in China

In this issue of Transplantation, Huang Jiefu, Haibo Wang, and other prominent leaders from China report the development of a new national policy for organ donation and transplantation in China. This policy is welcomed by the international community as an alternative to a practice that has been predominant in China, recovering organs from prisoners sentenced to death.

WHY NOT RECOVER ORGANS FROM EXECUTED PRISONERS?

It is a fundamental principle of The Transplantation Society (TTS) that organs and tissues are given freely and without coercion. That principle has been affirmed by the Declaration of Istanbul and the World Health Organization and adopted by the 63rd World Health Assembly in May 2010 (^{1, 2}). Inmates of a prison condemned to death are not truly free to make an autonomous and informed consent for organ donation—and the medical history of such a prisoner may be suspect and unreliable. Further, the financial incentive for those transplanting organs from executed prisoners was seemingly provoking a demand to increase the number of those being executed, so that more organs could be available, especially for rich patients traveling from foreign destinations. Thus, TTS proclaimed unambiguously in November 2006 its opposition to the recovery of organs and tissues from executed prisoners or from any other individual where an autonomous consent would be questionable.

In that 2006 TTS memorandum to all of its members, TTS also commended the statement of Vice Minister Huang Jiefu exclaiming an intent to change the prevailing unethical Chinese program. Henceforth, the Ministry would foster a legal framework for the oversight of the practice of organ donation and transplantation, establish credentials for Chinese transplant professionals, ban the purchase and sale of human organs, prevent organ trafficking and transplant tourism, and ultimately establish an alternative program deceased-organ donation and promote a national self-sufficiency that included deceased and living donors.

DEVELOPMENT OF THE ALTERNATIVE PROGRAM

The report by Dr. Huang et al. now details components of this comprehensive intended plan that have been implemented. After the establishment of regulations by the State Council of China (referenced to be its highest executive authority), China conducted a series of pilot trials obtaining organs from donors after circulatory death. The new national program is derived from the experience of those trials and by the necessity to respect a current Chinese cultural hesitation to determine death by neurologic criteria. Thus, categories of donations after circulatory death particular to China have been developed. The initial data of these pilot trials have been reported elsewhere (³), but it is evident that China has the technical capacity to move away from transplanting organs from executed prisoners and to do so without delay. The direction of the Chinese Ministry is also noted emphatically in the Huang report: “any accredited transplant hospital that fails to develop a deceased organ donation program will have their transplant license and OPO license revoked.”

WHAT REMAINS TO BE DONE?

If China is to sustain a successful program of deceased-organ donation, the Chinese people must trust a national system that distributes organs equitably. Therefore, this policy article highlights the development of the China Organ Transplant Response System designed to allocate organs transparently—identifying recipients from a computerized waitlist.

Nevertheless, it appears that a battle for the authority to distribute organs has now been engaged within China. In the recently published article by Wu and Fang (⁴), they describe a Red Cross program that would pay families of the deceased for donor organs. The response of the international community should be clear, however, that such a proposed program attributed by Wu to the Red Cross would be contrary to the World Health Organization guidelines. If financial compensation is to be given to families of the deceased to solicit consent of organ donation, why should those families trust that a determination of death has been given without a suspected motive of declaring death to sell organs? How will the society trust that organs are being allocated fairly if the deemed authority does not do so by a computerized waitlist? The State Council of China seems to have anticipated such difficulties by its regulations calling for “fairness, justice, and transparency” in determining the medical need of waitlisted patients. These regulations must be upheld.

In May 2013, the first China OPO International Forum was to be convened in Shenzhen, China—with workshops undertaken to train donation coordinators. TTS is supporting this effort along with leaders from Spain, India, and Croatia, who have developed transparent programs intended to achieve a national self-sufficiency and the equitable distribution of deceased-donor organs. As a leader of that Forum, Vice Minister Huang is committing China to a new day in organ donation and transplantation, consistent with its adopted national policy. TTS is prepared to work diligently with the transplant professionals of China to achieve its new mission.