use of organ from executed chinese prisoners
They all were young Chinese-Americans recently returned from China with excellent function of their newly transplanted kidneys.
Most were vague as to the origin of their newly transplanted organs; some cited “distant relatives” whereas others claimed not to know the source.
Recently, however, several patients have given me the above response. I suppose that I should not have been so surprised to get that answer, but I was nonetheless.
As I psychologically recoiled, I thought to myself, “What am I going to do here?”
In order to obtain a kidney transplant in the USA, patients with renal failure register at transplant centres and are placed on a waiting list.
The more fortunate of these patients have relatives, spouses, or friends who are willing to donate a kidney to enable timelier transplantation.
Without such a living donor, the waiting time can be quite long until an appropriate organ becomes available—up to 5–8 years in some parts of the USA and considerably longer in several other parts of the world.
Not surprisingly, this can lead to anguish and acts of desperation for those who wait.
Several reports have recently surfaced about several problems with organ transplantation, such as organ trafficking, the sale and brokering of such organs, and the topic of this essay: the transplantation of organs from executed prisoners in China.
Unfortunately, these transplantations have become more common because of an unfortunate application to healthcare of one of the laws of economics—supply and demand.
The establishment in 1984 of the United Network for Organ Sharing (UNOS) in the USA, although it helped to organise and centralise a previously haphazard system of organ distribution, has unfortunately failed to change one fundamental problem with transplantation: there are not enough organs to go around.
From May 31, 2004, 85 609 people were registered with UNOS as awaiting an organ transplantation. Of these, 58 201 were waiting for kidney transplantation.
In the 10 years from 1990 to 1999, the total number of people registered with UNOS increased from 21 914 to 72 110, an increase of 230%. During the same period, the number of cadaveric donors increased from 4509 to 5822, an increase of only 29%.
In 2003, only 15 129 of 53 000 people on the waiting list received a kidney transplantation (8665 cadaver and 6464 living donor), meaning that only 29% of patients on the list were transplanted that year, and only 16% were transplanted with cadaver organs.
During the same year, 3342 patients awaiting kidney transplantation died while on the waiting list (6%), and 880 (2%) were deemed too sick to undergo transplantation.
Unfortunately, the proportion of patients transplanted continues to decline and the number of patients who die while on the list continues to increase.
There have been several proposals to stem the tide. Most US transplantation programmes have aggressively pursued alternatives—they have widened the criteria under which they will consider cadaver donors in an attempt to increase the potential cadaver pool.
Even so, only trivial increases in the number of cadaveric donors have been recorded over the past decade. We have been more aggressive in pursuing living donation, not only of kidneys, but of other organs as well.
The problem is even more acute in many other areas of the world where the number of cadaver donors is vanishingly small, especially in countries where cultural or religious rules do not allow for the recognition of brain death such as in many countries in the Far East.
Partly in response to cultural factors as well as in response to economic factors, China has adopted the policy of the use of the organs of executed prisoners for transplantation.
The debate concerning the use of an executed prisoner's organs for transplantation proceeds on several levels, the first being the entire notion of capital punishment, which is considered acceptable by some governments although its appropriateness in and of itself is not for discussion here.
However, most people and governments who support capital punishment do so for only the worst crimes, such as murder or treason.
It is used sparingly and on few occasions. China, however, classifies more than 68 offences as capital, including under some circumstances car theft, embezzlement, and discharging of a firearm.
Each year, the number of executions in China exceeds by at least two fold the total number of executions in the rest of the world combined.
Official government figures put the number of executions at around 5000 annually, but independent groups and Chen Zhonglin, a National People's Congress delegate quoted in the China Youth Daily estimate the actual number to be twice that.
Of this figure, it is estimated that 1600 executed prisoners will donate some 3200 organs annually.
The Chinese government has denied this activity, but in 1984, the government issued a policy paper entitled Provisional Regulations […] on the Use of Dead Bodies or Organs from Condemned Criminals, which stipulated that prisoners were to be executed by means of shooting.
Furthermore, “The dead bodies or organs of the following categories of the condemned criminals can be made use of—if family members refuse to collect the body, if the prisoners volunteer their bodies before execution, or if the families consent”.
These regulations are a disingenuous technique by the government to assure “consent” from the prisoners, no matter what the actual desire of the individual or his family.
Prisoners are commonly abandoned by family members because of shame or fear of repercussions, assuring that a substantial number of prisoners fall under the first category above.
It is conceivable that some prisoners, from a sense of altruism, would consent of their own accord but it is highly unlikely, given the widespread knowledge of the government's duplicity in this area.
Consent is only one of the issues raised by these circumstances. The concept of brain death is not well defined or fully accepted in China.
As there is no requirement for certification of brain death before organ procurement, this situation can lead to the potential for the procurement of organs from prisoners who are not brain dead.
There are eyewitness accounts of continued movement and spontaneous respirations in some prisoner-donors, indicating that these people have been subject to the removal of their organs while they are, strictly speaking, still alive.
Finally, there is the issue of the intimate involvement of the doctors and surgeons who do transplantations regarding executions and procurements, which would not happen without the agreement and full participation of the doctors involved.
This situation represents a substantial breach of medical ethics for these doctors in that the primary tenet of our profession, to do no harm, is violated on a continuous basis.
We all witness first hand the anguish of our patients as they wait, seemingly endlessly, for organs to become available; desperation leads to desperate acts. Nevertheless, this desperation does not justify illegal or unethical actions.
When the issues of economic gain and government complicity are intertwined into the equation, it is evident how problematic this situation has become. What are some of the possible solutions?
First and foremost, members of the international transplantation community can individually and collectively speak out. We can shun the Chinese transplantation professionals, but I believe that this is shortsighted.
Although it is clear that the complicity of the surgeon who will do the transplantation is needed, it is important to consider that the orders come from above—the hospitals' administration, the military, and ultimately the government.
We must let the Chinese government and military know that they are not deceiving us. We know what they are doing, and we condemn it.
The international human rights community, in conjunction with the transplant community, has initiated contact with multinational pharmaceutical companies in order to put economic and scientific pressures on China.
They have begun to put together educational seminars for the Chinese transplantation community directed at addressing these issues and other ethical issues.
Moreover, the international transplantation community must address the issue of those practitioners outside of China who refer their patients to China for transplantation—the participants and purveyors of so-called transplant tourism.
Without these international travellers, the Chinese transplantation community would fold from lack of business.
It is our duty to speak out against this gross violation of human rights and medical ethics. We must be strong and unequivocal in our condemnation of the use of executed prisoners' organs for transplantation.
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