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UPDATED: April 16, 2012 NO. 16 APRIL 19, 2012
China acts to address legal barriers and conduct awareness campaigns to boost organ donation
By Li Li

DONORS HONORED: Students from Tianjin University of Traditional Chinese Medicine pay tribute to a wall of names at a memorial for organ donors on March 21 (ZHANG CHAOQUN)

Due to the scarcity of donated organs patients around the world regularly die while waiting for life-saving transplants. The prospects for those on a transplant waiting list in China are particularly gloomy as at least 150 people scramble for every donated organ.

According to the Ministry of Health, about 1.5 million people in China need transplants every year, but only around 10,000 transplants are performed due to the lack of available organs.

Vice Minister of Health Huang Jiefu said in March that within three to five years China plans to create a transparent national organ donation system and ban organ donations from death row. According to a paper published by Huang in 2011, more than 65 percent of the organs used in transplants in China had been taken from executed prisoners as of 2009.

According to a 1984 regulation, organs can be taken from an executed inmate only when nobody collects the corpse, the inmate has expressed his or her willingness to donate organs or the inmate's family members consent to the harvesting.

The practice of harvesting organs from executed prisoners not only is ethically controversial but also raises safety concerns. Huang, who worked as a transplant surgeon for a long time, said that the rates of fungal and bacterial infections in organs taken from executed inmates are often high, which explained why the long-term survival rates of organ transplant recipients in China are below those of the most advanced countries.

Huge demand, low supply

In China, the quality of donated organs rather than the skill of surgeons is seen to be the major cause of post-transplant deaths. Chinese surgeons can perform a wide range of transplant surgeries and according to the World Health Organization, the number of organ transplant procedures in China is surpassed only by the number performed in the United States.

Zheng Shusun, one of China's top liver transplant surgeons, said that the success rate of China's liver transplant surgeries is above 99 percent and the post-transplant survival rates of recipients in one year, five years and 10 years are 90 percent, 80 percent and 70 percent, respectively.

Fu Shaojie, a seasoned kidney surgeon from Nanfang Hospital in southern Guangdong Province, said that the survival rate of patients undergoing kidney transplants 10 years after the operation has reached 80 percent.

According to official statistics, China has around 1 million patients suffering from end-stage kidney disease who can be cured by a transplant and about 300,000 patients of end-stage liver disease who need transplants. However, less than 4,000 kidney transplants and less than 1,500 liver transplants were conducted in China in 2011.

Fu said that the majority of his uremia patients are in need of a donated kidney that is a match. "Many of them die while waiting for a donated kidney," Fu said.

Chinese customs call for people to be buried or cremated with the body intact. One die-hard superstition has it that if an organ is taken from a body after death, the person in question will be reborn with a handicap in that organ in his or her next life.

China didn't have a publicized case of cadaver organ donation until 2003 when the parents of nine-year-old Tian Jin donated his kidneys after the boy was killed in a traffic accident. Despite some pubic awareness campaigns in recent years, the rate of cadaver organ donation in China is a negligible 0.03 per 1 million people, which lags far behind that of other countries.

Though China's current regulation states that citizens can become organ donors if they write a will of donation, such a desire is not always honored. Shen Weixing, Vice Dean of the Law School of Tsinghua University, said that in practice if family members oppose organs being taken away from the cadaver, no medical professional will insist on harvesting the organs.

Unlike many other countries, applicants for a driver's license in China are not asked whether they want to be organ donors in the event of death. During an online survey about the possibility of introducing such a system in China at news portal Xinhuanet.com, 74.8 percent or 5,177 respondents said they wouldn't accept such a system as it is too inauspicious while only 21.8 percent were supportive.

The acute shortage of donated organs has driven the development of underground networks that profit from illicit organ deals and transplants.

In February 2011, the Standing Committee of the National People's Congress, China's top legislature, adopted an amendment to the Criminal Law, which for the first time singles out criminal activity related to transactions involving human organs. It states that those convicted of "forced organ removal, forced organ donation or organ removal from juveniles" could face homicide charges.

Despite this, the black-market organ trade is still a problem. Last June, a 17-year-old high school student from east China's Anhui Province sold one of his kidneys for 22,000 yuan ($3,492) through an underground dealer without telling his parents and used the money to buy an iPad2 and a laptop computer. The news caused an online furor with thousands of comments lamenting the poor enforcement of laws.

In March, a Beijing court prosecuted 16 people for organizing the illegal sale of 51 human kidneys worth about 10 million yuan ($1.6 million) in what is China's biggest organ trafficking case to date.

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