Sound legal system and fair distribution in China’s organ transplant hailed by international community

By Li Ruohan Source:Globaltimes.cn Published: 2017/8/28 11:08:21

Facing the surging number of voluntarily donated organs, China has made every effort to establish a sound legal system to eradicate organ trafficking and to guarantee that the organs are distributed in a fair and transparent manner, experts said Friday.

At the end of July, 2,866 people in China had donated organs this year, a 33 percent increase over the same period in 2016, surpassing the total number of donations made in 2015, when China banned the use of organs from executed prisoners and made voluntary donation the only legitimate source.

According to data provided by China's health officials, in 2016 alone, China harvested organs from 4,080 donors and performed 13,263 transplant surgeries, the second highest in the world.

The number of transplant surgeries is expected to surpass 16,000 in 2017, according to Huang Jiefu, a former Chinese vice-minister of health and current head of the National Human Organ Donation and Transplant Committee. 

Currently, organ transplant surgeries are available in 173 hospitals with a target of 300 hospitals able to carry out the procedures by 2020. 

The progress  is made as China strives to eliminate organ trafficking and encourage voluntary donation, with  support from legal and social sectors, said Huang. 

Since China enacted the Regulations on Human Organ Transplantation to ban the trading of organ in 2007, the government has subsequently released more than 30 documents to provide a legal foundation for the country's organ transplantation.

Meanwhile, a computer-based system for organ distribution was launched nationwide in 2013 to make sure that the distribution is fair, ethical and traceable. 

Transparent system

The system, named China Organ Transplant Response System (COTRS), was launched in 2011 and spread across China in 2013. 

The computerized system uses a complicated while sound algorithm to allocate the organs to patients based on several factors, including their medical situation, Wang Haibo, head of the COTRS system and deputy secretary of the China Organ Transplant Development Foundation, told the Global Times. 

"Mandated by NHFPC regulation, all the organs donated by deceased donors must go through the COTRS system to find their recipient. There's no exception and the matching is automated so as to minimize  human intervention, said Wang.

"There is no privilege for senior officials or business tycoons, everyone has to wait and let the computerized system decide, a professional familiar with the organ transplant system told the Global Times on condition of anonymity. 

On average, a patient needs to wait 27.5 days and 141.8 days respectively for a donated liver and kidney, according to a research from China Organ Transplantation Development Foundation. 

For patients, if the first transplantation surgery fails, they can be enlisted again on the waiting list of the COTRS system, Zhu Jiye, director of the Organ Transplantation Center of Peking University, told the Global Times on Friday. 

For patients suffering liver failure, some of will have a higher chance of being enlisted  for a second transplantation after a failure, while the chance does not increase for those suffering from kidney failure, who will continue to be treated with renal dialysis, said Zhu. 

The system is necessary especially concerning the gap between supply and demand of donated organs, and it also is relevant to the protection of rights and dignity of donors, said Huang

Around 40,000 patients in China are on the waiting list of the COTRS system, according to Huang.  

The system is also hailed by international experts, including Francis Delmonico, former president of The Transplantation Society and a Harvard Medical School professor. 

"The COTRS system is essential that there's a computerized witness for people to trust the system, and the government should also have oversight on the system to make sure that the excellent system is fully utilized, Delmonico told the Global Times. 

Sound legal system

To Huang, the key to earn and maintain public trust lies in the country's rule-of-law system, which has laid a solid foundation to combat organ trafficking. 

China has made significant progress in the legal framework for organ transplantation in recent years, with more than 30 official documents and regulations released by the National Health and Family Planning Commission (NHFPC) and the Red Cross Society of China. 

China's Regulations on Human Organ Transplantation enacted in 2007 banned the trading of organs countrywide, and was followed by steps to criminalize the unauthorized trading of organs in 2011, a crime for which the death penalty can be handed down in severe cases.

In 2009, former Ministry of Health released a notice to ban transplant tourism, which basically eradicate the phenomenon that foreigners coming to China to receive organ transplant surgeries, said Huang. 

Law enforcement has also been strengthened on organ trafficking to protect both donors and recipients. 

From 2007 to 2016, authorities including the NHFPC and the Ministry of Public Security formed joint task forces  fought against organ trafficking and arrested 174 criminal suspects, the Xinhua News Agency reported. 

The next step in establishing the legal framework is to amend the 2007 regulation on organ transplantation, said Huang, who is also a member of the Standing Committee of the National Committee of the Chinese People's Political Consultative Conference (CPPCC). 

Huang suggested the amendment in his proposal submitted to the CPPCC National Committee this year. According to his proposal, the role of different organizations and personnel should be specified, including the National Human Organ Donation and Transplant Committee, the Red Cross Society of China, organ procurement organizations (OPO), and the COTRS system. 

OPO are responsible for the procurement of human organs from deceased donors. COTRS is a computer-based system to distribute the donated organs. The Red Cross will "participate in and promote" organ donations as well as supervise the process, Huang said. 

People's goodwill

According to Huang, the progress of the reform is closely linked with strong support from China's top leadership, as well as support from the public, as an increasing number of people are willing to donate their precious organs. 

In a poll of 2,000 people conducted by the China Organ Transplantation Development Foundation,  94 percent of respondents said they would be prepared to donate their organs after death. 

Among those unwilling to donate, nearly half complained that they did not know where to apply or that the registration process was too complicated. Under these circumstances,  the organizations involved are making innovative reforms to the donor process to ease online registration, including the involving of Alipay, an online payment platform with 450 million users. 

Potential donors can also register via WeChat and the China Organ Donation Administrative Center website. They can also go to savelife.org.cn, an organ donation registration platform managed by the NHFPC. Foreigners can register with their passport number at savelife.org.cn.

As of Friday, more than 300,000 people have registered to be organ donors since 2010, and 73 percent of the registrations were done online. 

Registration doesn't always lead to donation, as the organs cannot be procured before strict medical and ethical evaluations. Family intervention can also prevent donations. Potential donors may cancel their registration at any time.

Meanwhile, China's reform on organ donation and transplantation also include the efforts to make transplant surgeries more affordable and increase the utility of donated organs to avoid waste.

In 2016, six government agencies, including China's health and transportation authorities, jointly launched a "green passage" to ensure the fast and safe transportation of donated organs for transplant. 

According to the NHFPC , airlines should provide priority boarding services and allow planes carrying organs to depart first. 

Vehicles carrying donated organs should have priority in passing toll stations, and health staff transporting human organs could board a train before buying tickets if necessary, read the notice released by the six agencies. A 24-hour emergency phone line was also established. 

Many human organs, such as liver, cannot be stored for longer than 12 hours and kidney cannot be stored for longer than 24 hours, or they will become unusable or dysfunctional for transplant, the notice said.

Donated lungs and hearts should be delivered in less than eight hours as the organs will be ineffective if they have not been transplanted within 12 hours, and livers must also get to the hospital within 12 hours, doctors previously told the Global Times. 

The government has also included kidney transplantation surgery in the medical insurance systems in regions including Shanghai and Beijing. 

Normally, a kidney transplant surgery will cost 329,000 yuan ($49,500) in China, and the cost in the US is $260,000, according to a study from the National Human Organ Donation and Transplant Committee. 

Meanwhile, China is also mobilizing more social efforts, including NGOs and businesses to get involved in the progress, including the training of medical staff and organ coordinators. 



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