China stops using executed prisoners as a source of organs for transplants

By Lydia Stewart Ferreira

According to the Lancet, China will stop using executed prisoners as a source of organs for transplants as of January 1, 2015. After January 1, 2015, “only voluntary donated organs from civilians can be used in transplants.” This decision was officially announced December 3, 2014 by Jiefu Huang, the former vice-Minister of Health at a seminar of China’s Organ Procurement Organization. While China needs to be commended for this government initiative, I find the fact that this initiative takes effect in 2015 quite shocking.

China has one of the largest organ transplant systems in the world, yet it has one of the lowest levels of organ donation – with a rate of 0.6 per 1 million people. In a 2011 Lancet article, Huang and colleagues reported that 65% of transplants in China used organs from deceased donors, more than 90% of whom were executed prisoners. The Lancet also reports that since 1984, it has been legal in China to harvest the organs of executed prisoners with the consent of the prisoner or their family. It was not until 2007 that China implemented its first legal regulatory framework for the oversight of their organ transplant system. In 2013, China went on to establish a national electronic organ allocation system.

Clearly, China has had a government endorsed organ procurement system. However, this procurement system has been internationally condemned by medical, scientific and human rights organizations. There were concerns about coercion, exploitation, undue inducement, non-existent consent, unjustified paternalism and the corruption of organ allocation. This organ procurement system used by China was legal under Chinese law. It is not clear to what extent illegal organ procurement – through transplant tourism and the black market sale of organs – was and is also taking place in China.

The Lancet states that a self-sufficient organ donation and transplant system in China requires not only confronting the increasing prevalence of chronic disease and the black market trade in organs – but also a shift in public attitudes towards organ donation, the integration of organ donation into the national health system and the need to implement medical strategies to prevent organ damage and the need for transplantation.

I agree – but China can go further. Unquestionably, China is struggling with an increasing domestic demand for organs that outstrips its ‘voluntary’ supply. At a minimum, China must comply with existing international agreements on organ trafficking and transplant tourism – such as the 2008 Declaration of Istanbul, the 2000 UN Protocol to prevent, suppress and punish the trafficking of persons, and the 2004 WHO Guiding Principles to prevent organ trafficking and transplantation tourism. However, China can move beyond this minimum and become a world leader by collaborating with international organizations and nation states to design and implement a transparent, legal and ethical organ procurement system.

DOI: https://dx.doi.org/10.1016/S0140-6736(14)62462-4

Full article in the Lancet here.

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