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IN THE SPOTLIGHT: Bleaching Organ Procurement Crimes in China

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Jacob (Jay) Lavee, MD
I2C2 Committee Member Leviev Heart Institute, Sheba Medical Center &
Sackler Faculty of Medicine, Tel Aviv University
Tel Aviv, ISRAEL

For the past thirty years China has been practicing the procurement of organs from executed prisoners for the purpose of organ transplantation [1]. My own personal involvement with the Chinese organ transplantation system started back in 2005, when a Status 1 candidate for heart transplantation notified me that his medical insurance company had instructed him to travel to China in two weeks' time, as he was scheduled to undergo heart transplantation. I later learned that the patient did, indeed, travel to China where the operation took place on the exact date that had been promised [2].

Enacted in 1984, the Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Criminals authorizes the procurement of organs following a criminal's execution if no one claims the body, the prisoner volunteers to have his corpse so used, or if the family consents to such actions [3]. These regulations have allowed the emergence of a flourishing organ transplantation industry in China to accept around 10,000 cases each year [4]. The term "industry" is not incidental, as credible sources have indicated the illegal and corrupt market for atrocious forced organ procurement, which caters to both national and international organ transplant candidates alike and includes anyone from court bailiffs to prison personnel and even hospital physicians [5].

In the past, Chinese authorities have consistently denied the use of organs from executed prisoners for transplants. It wasn't until 2005 that the practice was brought to light via public admission made by Dr. Jiefu Huang, then Vice Minister of Health of the People's Republic of China, that, apart from a few traffic victims, more than 90% of deceased donor organs in China came from executed prisoners [6]. However, even admitting this source of organs cannot explain the large annual number of organ transplants that occur in China as, even without official announcements regarding the numbers of executed prisoners, there is ample indirect evidence that this source has been diminishing over the years [7].

Several independent researchers suggest that specific minority groups in China are being persecuted with the specific intent to facilitate transplantation [8,9]. The focus of most comprehensive investigations into alleged forced organ procurement from minority groups has been Falun Gong practitioners. The conclusions of these investigations suggest that a large number of Falun Gong prisoners of conscience have been put to death on the basis of unverifiable offenses. There is also evidence that other minority groups, such as Uighur Muslims, Tibetans and Christians, have suffered a similar fate. However, State Chinese authorities have been unyielding in their denial of this additional source of organs, but have refused to provide verifiable information about officially proclaimed organ sources.

Despite numerous statements over the past years alleging plans to phase out the reliance on organs procured from executed prisoners, no such cessation has occurred. However, international medias have recently reported, based upon statements made during a plenum of the Chinese State Council in October 2014, that, as of January 1, 2015, organs for transplantation will no longer be obtained from executed prisoners [10,11]. Even more recently, on December 3, 2014, Dr. Jiefu Huang, now Director of the Chinese National Committee on Organ Donation and Transplantation, announced that after January 1, 2015, only voluntarily donated organs could be used for transplantation [12,13].

Unfortunately, the enthusiasm with which these recent Chinese announcements have been accepted has caused a critical part of the alleged new reform in organ donation to be overlooked [14]. Not only has there been no new announcement from China regarding the abrogation of the 1984 rules, but, in repeated interviews, Dr. Huang made it clear that death row prisoners could still donate their organs if they wished to do so [15,16,17,18]. This would require that death row prisoners be redefined as "citizens" who have "the right to donate organs", thus rendering organ procurement from executed prisoners "voluntary donations from citizens". The principal change in this new reform, then, would be only that China would begin to integrate this new source of "voluntary organ donation" into its new computerized organ allocation system for such donations, thereby bleaching its unethical source [18]. In emphasizing that future organ donations by death row prisoners will require agreement by both the prisoners themselves and by their families, the same as is required of citizens, Dr. Huang inadvertently confirmed that, thus far, organs have been procured from executed prisoners without their explicit consent [17]. Moreover, in a recent paper Dr. Huang clearly states that "if we brutally interrupt the source of organs from executed prisoners, it would inevitably lead to loss of lifesaving hope for many of patients with organ failure" [19].

In support of the assumption that Chinese officials do not anticipate any drastic decrease in organ supply for transplantation soon, Dr. Huang recently offered Taiwan the opportunity to establish a cross-strait organ exchange platform that would enable Taiwanese patients to get transplants without having to travel to China [20]. This offer is particularly surprising as there are already 300,000 patients in China waiting to be one of the annual 10,000 transplant patients.

Finally, the recent reports from China indicate that the Red Cross Society of China has been officially recognized as the organization that will be in charge of organ donation and allocation. It should be noted that in the first two years of the pilot organ donation system, the majority of ''voluntary'' donations from true citizens were reported to be obtained by the Red Cross Society of China following payments made to the families of a deceased individual[21]. These large sums, some equivalent to twice the annual income of the family, are offered as incentives to ''donate'' their loved one's organs, thus exemplifying a different, but still forbidden and internationally denounced, form of promoting organ donation.

So far only two medical organizations, the Declaration of Istanbul Custodian Group (DICG) and Doctors Against Forced Organ Harvesting, have recognized the pitfalls in the announced Chinese reform and published statements expressing their concerns [22,23]. I was happily informed by our President, Prof. Reichenspurner, that, following my proposal, our own ISHLT Board of Directors has unanimously endorsed the recent DICG statement, which establishes their position that it is obvious that prison inmates condemned to death are not truly free to make an autonomous and informed consent for organ donation and that no legal due process exists to assure such consent.

While we all remain eager to support the Chinese transplant community and their intent to build an infrastructure of donation that complies with the internationally accepted ethical rules, we should continue to be very cautious in prematurely praising the recent announcements from China, as they seem to remain far from the desired goal.

The international community, medical and non-medical alike, needs firm and immediate action by China to abolish the 1984 rules permitting the use of organs from executed prisoners, and ban their use under any condition; to fully and swiftly implement such a ban in all hospitals, including military hospitals, regardless of the burden it will impose on the waiting lists for organ transplantation; to acknowledge that not only executed prisoners, but also prisoners of conscience, are subject to forced organ procurement and ban that practice; to stop promoting transplant tourism, and to facilitate transparency and international monitoring to verify these changes.

It is our moral duty, both as humans and as physicians who practice and promote the most noble of human gestures - voluntary organ donation - to be the leaders of these demands. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

1. A. Sharif, M. Fiatarone Singh, T. Trey and J. Lavee. Organ Procurement From Executed Prisoners in China. American Journal of Transplantation 2014; 14: 2246-2252 Available free at http://onlinelibrary.wiley.com/doi/10.1111/ajt.12871/pdf
2. Lavee J. The impact of the use of organs from executed prisoners in China on the new Organ Transplantation Law in Israel. In: Matas D, Trey T, eds. State organs: Transplant abuse in China. Woodstock, ON, Canada: Seraphim Editions, 2012, pp.108-113.
3. http://www.hrw.org/reports/1994/china1/china_948.htm#_1_21 (Accessed January 21, 2015).
4. Report of the Madrid Consultation Part 1: European and universal challenges in organ donation and transplantation, searching for global solutions. Transplantation 2011; 91 (Suppl 11S): S54.
5. Organs for Sale: China's growing trade and ultimate violation of prisoners' rights. Hearing before the subcommittee on International Operations and Human Rights of the Committee on International Relations, House of Representatives, United States Congress. Available at: http://commdocs.house.gov/committees/intlrel/hfa73452.000/hfa73452_0f.htm (accessed January 21,2015)
6. Huang J. Ethical and legislative perspectives on liver transplantation in the People's Republic of China. Liver Transpl 2007; 13: 193-196.
7. World Coalition Against the Death Penalty. Available at: https://www.worldcoalition.org/China . (Accessed January 21, 2015).
8. Matas D, Kilgour D. Bloody harvest-The killing of Falun Gong for their organs. Woodstock, ON, Canada: Seraphim Editions, 2009. Available at: http://organharvestinvestigation.net/index.html . (Accessed January 21, 2015).
9. Gutmann E. The Slaughter: Mass Killings, Organ Harvesting, and China's Secret Solution to Its Dissident Problem. Prometheus Books, Amherst, New York, 2014
10. http://www.bbc.com/news/world-asia-china-30324440 (accessed January 21, 2015)
11. http://sinosphere.blogs.nytimes.com/2014/12/04/china-sets-jan-1-deadline-for-ending-transplants-from-executed-prisoners/ (accessed January 21, 2015)
12. http://www.chinadaily.com.cn/china/2014-12/04/content_19025683.htm (accessed January 21, 2015)
13. http://www.chinadaily.com.cn/china/2014-12/05/content_19028782.htm (accessed January 21, 2015)
14. Lancet Editorial. Weaning China off organs from executed prisoners http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)62462-4.pdf (accessed January 21, 2015)
15. http://www.theguardian.com/world/2014/dec/04/china-stop-using-executed-prisoners-organs-transplant-demand-donations (accessed January 21, 2015)
16. http://news.sciencenet.cn/htmlnews/2014/3/289619.shtm [Chinese](accessed January 21, 2015)
17. http://dailynews.sina.com/gb/chn/chnpolitics/phoenixtv/20140304/12205515629.html [Chinese](accessed January 21, 2015)
18. http://usa.chinadaily.com.cn/epaper/2014-03/07/content_17331138.htm (accessed January 21, 2015)
19. Huang J, Wang H, Zheng S, Liu Y, Shi B, Shen Z, Hu S, Ye Q, Xue W, He X, Chen J, Huo F. Advances in China's Organ Transplantation Achieved with the Guidance of Law. Chinese Medical Journal 128 (2):1-3, 2015
20. http://focustaiwan.tw/news/asoc/201412190036.aspx (accessed January 21, 2015)
21. Wu X, Fang Q. Financial compensation for deceased organ donation in China. J Med Ethics 2013; 39: 378-379.
22. http://www.declarationofistanbul.org/resources/recommended-reading/ethical-analysis-and-debate/557-media-reports-announcing-an-end-to-the-use-of-organs-from-executed-prisoners-in-china-are-misleading (accessed January 21, 2015)
23. http://www.dafoh.org/pr120514/ (accessed January 21, 2015)

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