The Transplantation Society and this journal, Transplantation, have made clear statements about the unacceptable practice of use of organs from executed people, no matter in which country or which decade.1,2 In 2015, this journal published an editorial, to make clear the ethical position that this journal takes with respect to publication of scientific material of any kind, in which one or more of the organs has been sourced from people who were executed.3
The position of the Chinese government—which was the last country to permit the use of organs from executed people—was defined in December 2014 and the practice banned from January 2015.4 A recent article published by Rogers et al5 has raised the question as to whether articles published in the Transplantation Journal in the intervening years of 2006, when the policy of The Transplantation Society was promulgated, and 2015, when organs from executed prisoners were banned, were contravening the society’s policy.
The source of organs in China has been through several phases over the past 20 years, with small numbers of living donors and deceased donors in the early years. A great expansion of donation then occurred through the turn of the century and in the first 5 years of the 21st century, largely if not exclusively, from the use of organs from executed people. In 2010, the first 11 Chinese transplant programs began a program of ICU donors using Donors after Circulatory Death,6 which was expanded substantially in 2014, becoming the exclusive source for deceased donor organs since then. In retrospect, it is clear that the large majority of organs transplanted in the period 2006–2010 were from executed people and that between 2010 and 2015 the organs from 11 known centers were largely from conventional donation by people dying in intensive care units.
The literature search by Rogers et al5 identified 17 journals publishing >5 articles each in which they decided that ethical guidelines may have been breached. There was a total of 5 articles published by Transplantation which they determined were likely to have breached The Transplantation Society guidelines. As a result of this publication, we examined our own journal for articles published by authors working in China to determine if there were potential breaches of ethical guidelines current at the time of acceptance for publication.
There was a total of 13 articles from Chinese authors on the subject of clinical transplantation, including the 5 identified by Rogers et al. Of these, 4 were reviews with no original material or included only living donors as subjects of the study. The remaining 9 did not define the origin of the transplanted organs and were thus considered using the Committee on Publishing Ethics’ protocol7 and the authors were contacted. All articles had signatures from the authors in our files attesting the approval by institutional ethical review committees, since it is not possible to publish in the journal without this attestation, whether or not a statement is included in the text of the article. One article was accepted for publication before the promulgation of the Society guidelines, and one author responded to enquiry with a clear description of the single deceased organ donor described in their article which identified the donor as an altruistic deceased donor who died in intensive care. The authors of the remaining 7 articles either did not reply to our enquiry or did not provide validation of the source of the organs used in their study. The authors’ institutions were asked to respond in the absence of a response from their authors, but no additional responses were received within the next several months. Thus, 7 articles are being retracted by this journal for breach of ethical guidelines that were in place at the time of original submission and at the time of publication. It is clear, with the benefit of hindsight, and through the Chinese Government’s subsequent clarifications of their practices, that most deceased donors were from executed people, before the Government implementation of Donation after Circulatory Death in 2010 in selected hospitals and widely from 2015. This was not transparent to reviewers and editors at the time of original acceptance for publication of these articles.
We take this opportunity to reiterate the position of The Transplantation Society2 and also repeat the advice provided to authors in 2015.3Transplantation and our sister journal, Transplantation Direct, will not knowingly publish any material that has been derived in any part from the use of organs from executed people. A number of Chinese authors know, from recent experience, that manuscripts that are not explicit about the source of the organs presented in their articles, are returned for that information to be provided. A minimum requirement for all authors in all countries is to consider the origin of the transplanted organs described in their article and that the necessary ethical boundaries and approvals for research are in place and transparent.
1. Tibell A. The transplantation society’s policy on interactions with China. Transplantation. 2007;84:292–294.
2. Haberal M, Cantarovich M, Muller E, et al. Call for an end to unethical transplant practices: a concerted effort by the transplant community. Transplantation. 2019;103:647.
3. Chapman JR. Organ transplantation in China. Transplantation. 2015;99:1312–1313.
4. Shuping D, Lingzhong X. China to stop using organs from executed prisoners for transplantations. BMJ. 2015350.
5. Rogers W, Robertson MP, Ballantyne A, et al. Compliance with ethical standards in the reporting of donor sources and ethics review in peer-reviewed publications involving organ transplantation in china: a scoping review. BMJ Open. 2019;9:e024473.
6. Huang J, Wang H, Fan ST, et al. The national program for deceased organ donation in china. Transplantation. 2013;96:5–9.