Chinese leaders affirm commitment to Hangzhou Resolution on ethical organ donation and transplantation

by Michael Woodhead
Chinese health officials and hospital leaders have committed to upholding the new ethical framework for organ donation and transplantation as outlined in the recently signed Hangzhou Resolution.
In a update statement, officials and transplant surgeons affirmed the new five point plan that will outlaw practices such as use of organs from executed prisoners and the 'sale' of organs to foreign buyers.
The new statement also includes a list of 38 Chinese transplant centres that have already confirmed  to have stopped using organs from prisoners, with others "anticipated in the days ahead".
The statement published in Hepatobiliary Pancreatic Diseases International is co-authored by China's leading transplant specialist Professor Huang Jiefu  and international transplant specialists including Dr Francis Delmonico, President of the Transplantation Society.
It notes that the Hangzhou Declaration commits China to adopting  a new organ transplantation system overseen by the National Health and Family Planning Commission (NHFPC) and the Red Cross. The new system will set up a national voluntary organ donation scheme and a new organ procurement and allocation system that is based on clinical needs and which is "open and transparent". China will set up a human organ transplant clinical network based on 169 authorised transplant centres, an organ registry system and an organ donation regulatory system.
"The NHFPC expressed the resolution of the government of China that the dependence upon organs from executed prisoners must be terminated. The government of China has affirmed its commitment to prohibit transplant tourism and to shut down organ trafficking and transplant commercialism," the statement says.
The move to the new organ donation system will also mean that China is no longer the subject of an academic boycott on organ transplantation.
Health minister Li Bin also pledged her commitment "to bring China back to the international community and to promote an academic exchange based upon the five-point NHFPC plan elaborated."
The next step will be to implement the agreement in all China's provinces. The statement says China will also host a meeting this year with leaders of the major international transplantation societies and WHO representatives.
"The meeting will affirm the new resolution in the practice of organ donation and transplantation in China. The meeting will be a milestone for China transplant professionals to practice according to the international standards set by WHO Guiding Principles."
Meanwhile, in a public show of support for the new organ transplant system, senior Chinese leaders have registered to donate their organs.
Officials including Chen Zhu, vice-chairman of the Standing Committee of the National People's Congress and a former minister of health; and Hua Jianmin, head of the Red Cross Society of China added their names to the new online organ registry at the Beijing Union Medical College Hospital .
The registry, overseen by the society's China Organ Donation Administrative Center, is available for people aged 18 and over who are willing to be organ donors after their death.
In December, the State Council issued a guideline related to funeral reform, encouraging Party members and officials to register to donate their organs after their death, according to China Daily.

International transplant specialists call on Xi Jinping to end corruption in China's organ transplant system

by Michael Woodhead
The international professional group representing organ transplant specialists has written an open letter to Xi Jinping, urging him to take personal action against ongoing corruption in the organ transplant system in China. 
A group of eminent surgeons belonging to the Transplantation Society have written a strongly-worded letter to the Chinese president, saying the latest government moves to overhaul China organ transplant system are not working, with some Chinese hospitals continuing to openly advertise the sale of organs from executed prisoners to private buyers.
Dr Francis Delmonico and seven colleagues say Chinese transplant surgeons have been the subject of a long-running embargo in international academic circles because of their country's practice of selling organs taken from executed prisoners. The Transplantation Society says it welcomed China's latest moves to ban these unethical practices, and the implementation of a new ethical system of organ donation and transplantation based on clinical need. However, the group says the new system is already looking to be a sham and the rules against organ trading a "paper tiger" because of ongoing commercial trading or organs by some Chinese hospitals. Their letter cites the example of a liver transplant for a Saudi teenage girl recently done for a price of $200,000 by a Tianjin hospital. The transplant turned out to be wholly unsuitable because the liver was scarred and diseased and the girl died. The transplant was illegal unethical and should never have been done, but the Tianjin hospital that did it is still advertising organs for international buyers at www.cntransplant.com. The Transplantation Society doctors say this is just one example of how unaccountable and corrupt the organ transplantation system continues to be in China. They also note that many of the Chinese doctors and officials involved in corrupt organ trading in the old system have already taken up positions of responsibility in the new system.
"These centers are both jeopardizing the public trust at home and tarnishing China’s reputation on the international stage," they write.
"Thus, we ask the Chinese government for an immediate and sustained resolve, to monitor compliance by Chinese professionals in performing organ donation and transplantation in accordance with NHFPC and international standards. The fledgling national organ allocation computer system that has been developed must be authorized as the sole distributor of organs to ensure transparency and fairness. Otherwise, the perception will be that one corrupt system of organ donation in China has simply been replaced by another," they conclude.

Chinese hospitals offer millions to poach doctors from Taiwan

Top medical specialists in Taiwan are reportedly being offered millions of yuan to work in mainland China, and scores of doctors are already taking up the offer to "moonlight" at the weekend.
The Focus Taiwan news channel makes the claim that doctors are being offered as much as 100 million yuan to relocate to the mainland, and there are already 50-60 "holiday knife jugglers" flying from Taiwan to China at weekends to perform surgery or give consultations at hospitals there.
Cardiac transplant surgeon Dr Wei Jeng (left), who is head of the Heart Center at Cheng Hsin General Hospital in Taipei said several Chinese hospitals had made him high-paying job offers in recent times but he had turned them all down.
However, he said many of his colleagues had taken up the offers of  mainland work and the current joke among local physicians that "if you try calling on doctor friends on the weekends, you'll find they are all on the mainland."
While the 100 million yuan claim may be hype, the reality is that doctors in Taiwan earn about NT$8,000 per clinic but can make up to NT$50,000 per clinic in China. And many are doing so. A doctor who used to be a senior manager at a Taiwanese-funded hospital in China said he knew of many Taiwanese doctors earning hundreds of thousands of Taiwan dollars a month by doing weekend moonlighting shifts in China. This has lead to fears of a medical brain drain. Dr Wei said the lucrative offers from China were taken up because the Taiwan national health insurance system paid doctors relatively poorly.
A spokesman for the health ministry acknowledged that 90% of doctors in Taiwan earned their main income from the national insurance scheme and it would be impossible for the health ministry to match the huge pay offers made by Chinese hospitals to Taiwanese medical professionals.
To try retain doctors, the the Taiwan government was planning to set up special medical tourism zones to attract private paying patients from overseas, he said.
Local doctors urged the Taiwan government to make the medical system more attractive to doctors by cutting down on paperwork and improving benefits.

Hospitals warned of disciplinary action for illegal organ transplants

translated by Michael Woodhead
All hospitals in China that do organ transplantation must follow new ethical guidelines or face being banned from doing transplants and losing their funding, a senior official has warned.
Hospitals will also be banned from making arrangements with courts to accept organs from executed prisoners.
Dr Huang Jiefu, director of the the National Health and Family Planning Commission Committee on Human Organ Transplant Clinical Application Management, said all 169 transplant centres will have to take part in a new organ donation supervision and inspection system that will ensure that the system for transplants is fair, open and ethical.
Speaking at China's annual meeting of organ transplantation specialists at Shanghai Jiaotong University, he said any hospital and any practitioner that does not adhere to the voluntary donation system and the shared organ program after the death of a patient will have their authority to do transplants revoked and also have funding removed.
Dr Huang said all hospitals must take part in the new computerised organ sharing database set up by the former Ministry of Health and the Red Cross Society. All organ transplants must be done according to the principles of the new system, which are based on clinical need and priority rather than financial payment, he said. Priority categories for organ donation should be  region, condition , age, wait time and meeting screening requirements.
The new system also means that hospitals must sever all links with law courts to procure organs from executed prisoners, he added.
The new human organ donation regulations " strictly prohibit hospitals and transplant organs and the courts to have a direct link to use organs, and all organs sources should be traceable," said Dr Huang
With the support of the State Council , the National Health and Family Planning Commission and the Red Cross Society of China will jointly set up an Organ Donation and Transplantation Management Committee.

Hangzhou Resolution commits China to ethical organ donation

Just a month ago, Xia Qiang, a surgeon from Shanghai Renji Hospital, and his team made history by completing the first two transplant operations using organs donated by residents in the city.
Such operations are taking place with increasing frequency across China, showing a determination to move from sourcing organs from executed prisoners to acquiring organs from citizens willing to donate.
China is the top country in the world in terms of carrying out organ transplants as well as for having the most patients waiting for transplants. According to official figures from Chinese health authorities, more than 1.3 million patients wait for organ transplants each year while only 10,000 are lucky enough to get one. The rest try their luck in the underground black market.
Prior to 2010, the majority of Chinese organ transplants came from executed prisoners, prompting criticism from the international community.

Taiwanese urge to avoid unethical organ transplants in mainland China

Medical and legal specialists yesterday discussed legislative developments on regulating organ transplants abroad and urged the Taiwanese government to recognize the seriousness of the organ-harvesting crimes perpetrated in China and to legislate against organ transplants using illicit or unknown organ sources.
In a round-table discussion organized by the Foundation of Medical Professionals Alliance in Taiwan, doctors and human rights advocates invited by the Taiwan International Care Association for Organ Transplants called any organ transplant done at the expense of another person’s life and “organ harvesting” undertaken without the consent of the organ providers “a crime against humanity.”
In the context of the growing global demand for organ transplants in recent years, illegal trafficking and trade of human organs and transplant tourism have raised serious concerns and caused raging controversies.
Among these issues, unethical organ-harvesting practices in China are a major problem that requires wider awareness and attention, the experts said.
This is especially true for Taiwanese, the association said, adding that data from the Department of Health showed that more than 88 percent, or 1,754, of Taiwanese patients who underwent organ transplants went to China for their operations between 2000 and 2011.
Not only do organs that come from questionable origins expose patients in Chinese hospitals to medical and legal risks, they might also have come from prisoners of conscience and executed prisoners, putting the patients in an ethical bind, the care association said.
Source: Taipei Times

Donor database will remove dependence on executed prisoner organs

Computerised organ donor database will improve supply and remove the need to source organs from executed prisoners.

China is set to expand a computerized system to ensure transparent and fair allocation of donor organs, said Vice-Minister of Health Huang Jiefu.
The system is expected to expand nationwide early next year for transplants around the mainland.
Once that happens, donated organs from different procurement organizations will be shared by all transplant centers to improve efficiency and ensure the most medically needy patients benefit, according to Wang Haibo, director of the China Organ Transplant Response System Research Center at the University of Hong Kong.
"The system that is now used only by some will be expanded to all of the transplant centers on the mainland after the coming Spring Festival," said Huang in Guangzhou.
By the middle of November, China had recorded about 480 such organ donations involving 1,294 donor organs under a trial project initiated by the Ministry of Health and the Red Cross Society of China in March 2010.
Of the donations, 47.5 percent came after cardiac death and 43.5 percent after both cardiac and brain death. Those after brain death accounted for the rest, statistics from the allocation system showed.
According to Shi Bingyi, director of the organ transplant institute at No 309 Hospital of the People's Liberation Army in Beijing, the best organ donations come after brain deaths.
Thanks to the project, "China's long-term dependence on executed prisoners as a major source of organ donations for transplants is expected to end within two years", Huang noted.
"We have to create a new deceased organ donation system which is in line with Chinese social and ethical norms, which will also be pragmatic by respecting our nation's reality," he said.
Meanwhile, to ensure the quality of donor organs and transplants, health authorities are considering introducing a set of standards to better manage and evaluate procurement organizations.
At present, China has 164 organ transplant centers recognized by the Ministry of Health and each has a procurement organization comprised of medical professionals from different specialties, Wang said.
According to him, the organization's work includes promoting deceased organ donation, detecting and approaching potential organ donors, coordinating donations, launching computer-assisted organ allocations, donated organ preservation and transportation, and data collection and research.
"The cooperation of organizations made organ sharing among different hospitals possible but its operation should be based on the wide use of the organ allocation system," he noted.
Allocations have been largely hospital based, which can lead to a waste of donated organs and raises public concern about fairness, Wang explained.
Li Peng, a doctor with the procurement center of the General Hospital of Guangzhou Military Command of the PLA, said that it helped facilitate organ donations and improve the efficiency of donated organ use.
According to Li, the procurement center is affiliated to the hospital rather than the transplant center and is led by the hospital president.
It is comprised of dozens of employees, many of them medics in departments such as neurology and intensive care, he said.
"It also freed organ transplant doctors from organ donation coordination work," he said.
Donated organs harvested by different organizations would all get allocated via the system according to factors like medical urgency, waiting-time, medical compatibility and the distance between donor and recipient, he added.
"Such an independent organization coupled with the allocation system could make the process more transparent to ensure fair allocation," Li noted.
Source: China Daily

Shanghai hospitals begin organ collection and transplant program

The organ donation program will replace current ad-hoc organ collection and distribution methods

Shanghai's government yesterday announced the first group of 17 city-level hospitals to carry out human organ collection and transplants.
The announcement marked an official start of work under a national organ donation system in the city.
Under the system, all information about donated organs and patients with organ failure will be put into the national organ distribution and sharing network to ensure organs are given to the patients in the most need on the waiting list.
The measure is expected to change the previous organ distribution situation to a more scientific and fair use of organs.
"Previously, hospitals got organs through their own sources and just used these organs for their own patients," said Dr Fu Zhiren, director of Changzheng Hospital's organ transplantation department. "Sometimes their own patients who are not the most critically sick got the organs, while other patients in more urgent conditions don't have an organ."
He said a national organ distribution network open to all qualified hospitals and patients can ensure a better use of limited organs.
Shanghai has established an expert commission for human organ donation to guide donation and transplants and a city-level expert diagnosis team, which will be involved in death evaluations of donors.
The national organ donation system run by the Red Cross Society of China was established in 2010 and was put into a pilot operation in 16 regions in March 2010.
The system will help China gradually phase out its reliance on organs from executed prisoners, Vice Health Minister Huang Jiefu said in Guangdong Province last month. By September 30 of this year, 38 domestic hospitals had obtained 1,279 organs from 465 donors in the system, Huang said.
The national trial has adopted the criteria of donations after both cardiac death and brain death. Shanghai will also follow such criteria and the death of each possible donor will be evaluated by his or her own doctors and the expert team.
China passed an organ transplant law in 2007, which has greatly strengthened supervision of organ transplants. However, the law failed to solve problems such as questionable sources, an acute shortage of organs, and illegal organ transactions.
About 1.5 million people are on the waiting list for organ transplants in China each year, but only about 10,000 of them get a donated organ due to the lack of organs.
Source: Eastday

Hunan transplant surgeon jailed in iPhone-for-kidney case

Surgeon Song Zhongyu, who carried out an illegal kidney transplant operation, was sentenced to three years

China has jailed seven people including a surgeon over the case of a teenager from one of the country's poorest areas who sold his kidney and bought an iPhone and an iPad 2, state media reports.
High school student Wang Shangkun, 18, suffered renal failure after receiving an illegal transplant operation in April last year, Xinhua news agency said.
He had agreed to sell one of his kidneys after meeting the gang through an online chatroom and received 22,000 yuan ($3350) for the organ, although it was sold on for almost 10 times that amount.
A total of nine defendants were found guilty of intentional injury, although two did not face punishment because of their minor roles in the crime, Xinhua said.
He Wei, who organised the illegal transplant, was sentenced to five years' jail on Thursday.
Surgeon Song Zhongyu, who carried out the operation, was sentenced to three years with a reprieve of five years, the agency said.
He and Song both received more than 50,000 yuan each through the transplant.
Wang's mother, Ou Linchun, had previously told Beihu district people's court in the city of Chenzhou, Hunan province, that her son did not sell his kidney specifically to purchase the Apple devices.
"My son was tempted by the illegal organ traders and might have been afraid of getting caught with such a large amount of money, so he bought a cell phone and a tablet PC," she said, according to local media reports.
The defendants, who did not check Wang's age before the operation, paid him compensation worth more than 1.47 million yuan, Xinhua reported, which added to the court's leniency in sentencing.
Authorities said in August that Chinese police had arrested 137 people, among them doctors, suspected of trafficking human organs in a nationwide crime ring that profited from the huge demand for transplants in China.
Read more: SMH

Health minister performs liver transplant - but some question his qualifications

Professor Huang Jiefu is a transplant surgeon as well as China's deputy health minister

by Michael Woodhead

China's deputy health minister Professor Huang Jiefu was wearing his surgeon's hat when performed a liver transplant in Guangzhou this week - but some cynics have questioned his qualification to do so.
The health minister, who is a transplant surgeon by training, performed a liver transplant from a 50-year old woman at Lingnan Hospital, Sun Yat-sen University Third Affiliated Hospital, to highlight China's new organ donations pilot
The 66-year old deputy minister like to keep his hand in as a transplant tsurgein and is never far away from the operating table, performing an average of two operations a week at the Beijing Union Medical College Hospital .
Professor Huang paid tribute to the deceased woman and her family for donating the organs saying: "this death saved three lives and in addition also allows two people to see with corneal transplants, which is a great thing."
Professor Huang has the vision that China can build a sustainable ethical and national organ donation transplant system. He lead the way in setting up the Chinese Human Organ Transplant Ordinance promulgated in May 2007, and has been open in admitting to the international community to the fact that China had been using organs from executed prisoners as a major source of transplants - but now wants to change that.
"Since the donor organ pilot, organ transplant regulations have achieved significant progress in Guangdong and voluntary organ donations next year may exceed the number of death row inmates organ. Of course, we do not opposed to the death row inmates voluntary contributions. "
However, after the publicity over the latest transplant procedures by the minister some Chinese citizens took to microblogging sites such as Weibo to question whether he was fully licensed and qualified to do so, and questioning how he could be both a senior government minister and "moonlighting" as a practicing clinician.
Professor Huang responded with good humour to allegations that he was an "illegal doctor".
"I have been licensed as a doctor since I graduated from medical school, I wrote China's national textbook on liver transplants, I do liver transplant teaching videos, and I am also been recognised by medical organisations in Australia and in the United States. Being a practising surgeon is the most important thing in the world to me - how could I not have a medical license in this country? " 　　In response to the accusations of  "moonlighting" argument, Professor Huang responded that although he is a Ministry of Health official, his most fundamental role is still as a doctor, "The media calls me Minister Huang, but I actually prefer the title of Professor Huang. The priority in my life and career has always been to help and treat the patient, and I have always had career satisfaction and pride through the surgery I do with my hands, seeing patients to restore health."
Read more: Jiankan Bao

Attempts to establish a voluntary organ donor system in China face many obstacles

The outdated and sometimes cruel organ donor system in China is failing patients and organ donors.
The Ministry of Health, in cooperation with the government-affiliated Red Cross and its branches around the country, has been busy since November 2009 reorganizing transplant services and building a national system for recruiting voluntary donors and fairly allocating transplantable livers, kidneys, corneas and other body parts.
Assigned to lead the effort is a Hong Kong University team supervised by Wang Haibo, at the La Ka Shing Faculty of Medicine and the initiative’s chief engineer. The ongoing task has involved building a database and setting medical standards that blend established international practices with health ministry regulations and domestic circumstances.
Three years on, though, the program designed to match voluntary donors and needy recipients has faced one setback after another.
And it’s thus yielded scant results: Only about 400 transplants from organ donors have been conducted since the ministry and Red Cross started working together to link donors and patients in March 2010. More than 100 of these have been in Guangdong Province, which includes Shenzhen.
Indeed, the ministry says every year only about 10,000 of some 1.5 million ill people across the country who need a transplanted organ are fortunate enough to get one.
And a significant number of these transplanted organs come from not willing benefactors but deceased prison inmates — a common organ-harvesting practice that China has pledged to phase out.
“Why is it so hard to do something good?”
That question, in fact, has long been on minds at the highest levels of China’s health system. Offering a short-form answer Aug. 22 was Vice Health Minister Huang Jiefu, who has urged reform for the nation’s organ donation arrangement.
 “What holds us back are not traditions or morals, but our system,” Huang said. “If China cannot establish a voluntary organ donation system for its citizens, inevitably there will be a severe organ shortage.”
The system’s failures have roots in a lack of confidence that’s worsened over the years because the richest and best-connected transplant candidates have enjoyed easier access to organs than most Chinese people.
Potential volunteer donors often hesitate or decide against offering organs because they don’t want to support a system that helps only high-status patients with enough money to pay the right people.
The ministry has tried to rebuild trust since putting Wang’s team to work in 2009 and announcing in December 2010 that procedures for patients “applying for human organ allocations and transplant sharing should conform to medical needs and adhere to the principles of fairness, justice and openness.” 

Read more: Caixin Online