nytimes.com
DIDI KIRSTEN TATLOW
November 16, 2015
BEIJING — When a senior Chinese health official said last year that Chinawould stop using prisoners’ organs for transplants as of Jan. 1, 2015, human rights advocates and medical professionals around the world greeted the announcement with relief.
It seemed to end a decades-long form of human exploitation in which hundreds, perhaps thousands, of organs of executed prisoners were harvested each year.
But organs from prisoners, including those on death row, can still be used for transplants in China, with the full backing of policy makers, according to Chinese news reports, as well as doctors and medical researchers in China and abroad. “They just reclassified prisoners as citizens,” said Huige Li, a Chinese-born doctor at the University of Mainz in Germany.
The December announcement by Huang Jiefu, a former deputy health minister and chairman of the National Health and Family Planning Commission’s Human Organ and Transplant Committee, was “an administrative trick,” said Dr. Otmar Kloiber, the World Medical Association secretary general.
The association opposes the use of organs from prisoners in any country that has the death penalty, saying there is no way of knowing if such donations are truly voluntary.
The relabeling of prisoners has enabled Chinese officials to include them in a new, nationwide “citizen donation” system that China is building to reduce its longstanding reliance on organs from prisoners. The move has been described in multiple state reports quoting Dr. Huang and other officials.
In January, People’s Daily reported that voluntary donations from citizens had become the sole source of organs for transplant. It quoted Dr. Huang as explaining: “Death-row prisoners are also citizens, and the law does not deprive them of their right to donate their organs. If death-row prisoners are willing to donate their organs to atone for their crimes, then they should be encouraged.”
In March, Dr. Huang told The Beijing Times, “Once the organs from death-row prisoners who have voluntarily donated are included in our national distribution system, they are counted as voluntary citizen donations.”
Dr. Kloiber said the World Medical Association was aware of reports that China was continuing to use prisoners’ organs, in contravention of the association’s ethical standards. The China Medical Association is a member of the world body.
The only exception under the association guidelines, Dr. Kloiber said, was donations for immediate family members.
“The practice there is unethical and should be changed to an ethical practice,” he said of China. “Administrative tricks don’t make it ethical.”
The December announcement came at a meeting of the new China Organ Procurement Organization Alliance. It is one of several organizations set up in recent years to help transform China’s system from one depending heavily on organs from executed prisoners to one of voluntary donation, as in many developed nations. The alliance, Dr. Huang and National Health and Family Planning Commission officials could not be reached for comment.
At the meeting, Dr. Huang said: “From Jan. 1, 2015, we will completely stop using death-row prisoners’ organs as a transplant source. The only source will be organs from dead citizens who have voluntarily donated.”
The discrepancy between that public statement and current practice is coming to light as doctors begin to speak publicly about what they call major changes in their country’s troubled organ donation system.
Broadly, China is trying to construct a more transparent system with a central organ pool for all, amid public anger at corruption and lack of equal access.
Previously, multiple medical centers operated, often secretly, to procure organs from prisoners or poor migrant workers and supply them to politically well-connected or wealthy patients, according to officials and researchers. Now, the government says it is working to create a single pool that will be fairly managed with organs distributed according to medical need.
China began to solicit organs from the public in 2010. In a 2011 article in the medical journal Lancet, Dr. Huang said about 65 percent of transplants in China had been done with organs from dead donors, of which more than 90 percent were executed prisoners. The rest had been provided by living donors.
When Chinese officials said last year that they would no longer use prisoners’ organs, that meant they would no longer systematically harvest organs from death-row inmates, Dr. Li said.
Dr. Huang “is separating dead prisoners’ organs into two groups,” Dr. Li added. “One is the traditional style, ‘I don’t care if prisoners agree or not, we’ll use them,’” which has been illegal since 2007, he said. That year, a new law on organ transplants banned trafficking in organs and removing them without written consent, although it did not mention prisoners.
“When he said, ‘We will completely stop using prisoners’ organs,’ he meant stop using that illegal component,” Dr. Li said.
Still, China deserves credit for trying to change the system by encouraging more voluntary donations outside prisons, Dr. Kloiber said. “We have to acknowledge they are willing to discuss this,” he said.
Anecdotal evidence from Chinese doctors points to progress, but also suggests continuing problems.
Many Chinese are reluctant to donate organs because of Confucian traditions that consider the body a gift from parents to be buried or cremated intact. Also, many people have been reluctant to donate because of a widespread assumption that in a corrupt system their organs would not be fairly used.
“A majority of the lungs I transplanted last year came from convicts,” said Dr. Chen Jingyu, a national transplant specialist and a surgeon at Wuxi People’s Hospital. He said he and his team did 104 lung transplants in 2014.
He and many other surgeons expected that, with the announced policy change, they would face a severe shortfall. But after Jan. 1, he said, the feared decrease did not happen. He expects about 150 lung transplants in China this year, about the same as last year.
