China, once an organ transplant pariah, is now accepted as global leader after reform, papal recognition

By Li Ruohan Source:Global Times Published: 2017/9/6 19:23:39

Chinese model provides groundwork for ethical practices: expert

Influential figures, including Pope Francis, have commended China's reform of its organ donation system.

Doctors say they no longer feel "inferior" during international exchanges since China banned the use of organs taken from executed prisoners in 2015.

Last year, 4,080 Chinese people voluntarily donated their organs, according to the top health body, the second highest in the world.

Doctors bow in silence to a deceased patient who donated all his organs in an operation theater in Hefei, East China's Anhui Province. Photo: VCG

A few years ago, Wang Haibo did not expect that he would ever get a chance to proudly show off China's organ transplant system at an international conference, as China was once a "pariah" in the field.

"I felt very sure and proud about the progress of the reform, and I am full of expectations for the future," Wang told the Global Times after he spoke at the 2017 Organ Donation Congress and the biennial congress of the International Society for Organ Donation and Procurement in Geneva, Switzerland.

Wang, who is currently head of China's computerized organ distribution system COTRS, used to feel "lonely and sad" when he was the only Chinese speaker at such events in the past. Wang, who was then working at Hong Kong University, said he was often attacked with groundless accusations at such occasions. 

 "But now more and more Chinese are attending events as China has won respect from international society via the reform," he explained, adding that there were many Chinese faces at the Geneva conference.

Modern organ transplants began relatively late in China, first being performed in the 1970s. But until 2003, the number of donations in China was still close to zero.

It's not easy to find organ donors in China. China reformed the voluntary organ donation system and banned the use of prisoners' organs in 2015.

The number of transplants in China rocketed after the reform, with Huang Jiefu, former Chinese vice-minister of health and current head of the National Human Organ Donation and Transplant Committee, estimating that the total number of operations will surpass 16,000 this year.

But there are still many challenges. Though the number of annual donors has soared from 34 in 2010 to 4,080 in 2016, the country's per million donation rate was a mere 2.98 last year, much lower than the EU average rate of 19 and the US rate of 26.


From the excluded to the model

While the process is now respectful and transparent, the situation was different a few years ago before China introduced voluntary organ donation in 2010 and banned the use of prisoners' organs in 2015.

The reform was highly praised by international organ donation and transplant groups, the WHO and Pope Francis.

The pope's appreciation of the reform was conveyed in a letter addressed to Huang in late August. The letter was written by Marcelo Sanchez Sorondo, chancellor of the Vatican's Pontifical Academy of Sciences (PAS), and a close personal friend of Pope Francis.

Marcelo wrote the letter after attending an August organ transplant conference in Kunming, Southwest China's Yunnan Province and visiting the transplant departments of local hospitals.

That was the first time a PAS representative attended an organ transplant event in China. The conference came a few months after Chinese representatives were invited, also for the first time, to the PAS Global Summit on Organ Trafficking and Transplant Tourism at the Vatican City in February.

Also in attendance at the conference were other leading international experts, including Nancy Ascher, president of The Transplantation Society (TTS), an organization composed of more than 6,700 medical professionals from over 105 countries and regions that had previously placed an academic embargo on China.

The embargo prevented Chinese physicians who had harvested organs from prisoners from presenting at international congresses, publishing articles in medical journals and achieving membership of TTS.

When Nancy was training as a surgeon, she and her classmates were encouraged not to interact with China because there were concerns about unethical practices.

However, in the August meeting, on behalf of TTS, Nancy openly encouraged China's involvement in international transplant activities and scientific exchanges at the conference.

"China is well on its way to make the changes, and will soon be the world's global leader in organ donation," she said.

The reform has also enabled Chinese to take up senior positions in international societies.

Wang Haibo is now serving as the councilor of the International Society of Organ Donation and Procurement and the councilor of the Declaration of Istanbul Custodian Group, which is coordinating global efforts against organ trafficking and transplant tourism.

Meanwhile, many international journals, such as Transplantation, are now encouraging Chinese doctors to publish their research and data, according to Wang.

China was also urged by senior officials from TTS, PAS and WHO to take a leading role in the global governance of organ transplants and the fight against organ trafficking.

Huang said this change is incredible, given China's pariah status just a few years ago.

Marcelo also invited Huang to attend a UN meeting in late September to present the "China Mode" as an approach to combating organ trafficking worldwide.

The "China Mode" features strong government engagement as a significant contributor to the country's reform and progress, together with administrative and legislative efforts to help facilitate the reform.

"The model developed by China is an example for other countries and provides groundwork for ethical practice against organ trafficking for other countries to follow," Campbell Fraser, an international human organ trade expert at Griffith University in Australia, previously told the Global Times.

Work with pride

The changes brought by the reform are strongly felt by transplant surgeons, who said their life-saving careers haven been given a new dignity. 

"Organs from executed prisoners were procured at execution sites and in shallow conditions. The whole process gave no pride to doctors, which made many quit being transplant surgeons," an experienced liver transplant surgeon told the Global Times on the condition of anonymity.

"There would have been no future in China's organ transplants if this practice continued, the future of this career should be in hospitals instead of in execution grounds," said Huang.

"Many doctors felt they were inferior when attending seminars or conferences in other countries, though they are as good as foreign surgeons in terms of skills," Chen Jingyu, deputy head of the Wuxi People's Hospital in East China's Jiangsu Province, told the Global Times.

"Lung transplant skills are very sophisticated in China. The quality of donated lungs is poor in China as many lungs were harvested after it was announced that the patient is heart dead, which means the patient's life is supported by ventilators and the risk of infection is high," said Chen.

Chen performed around 136 lung transplant surgeries in 2016, almost 70 percent of all the lung transplant surgeries in China. At busy times, he performed six surgeries within 24 hours.

"Being a transplant surgeon in the country with a fifth of the world's population is a holy career, and now we are working with pride as the progress has been made in so short a time," said Chen.

According to doctors, one of the most amazing changes is how fast a comprehensive donation and transplant system has been built from scratch.

Before the computerized organ distribution system COTRS was launched in 2011, patients needed to find organs by themselves, which led to rampant organ trafficking, said Wang.

Currently, patients in need of transplants can register with the COTRS system and wait for the system to allocate them an organ.

According to Huang, there are 40,000 patients on the COTRS waiting list. On average, a patient needs to wait 27.5 days for a donated liver and 141.8 days for a kidney, according to research from China Organ Transplantation Development Foundation.

"All the organs donated by deceased donors also must go through the COTRS system to find their recipient as mandated by the National Health and Family Planning Commission's regulation enacted in 2013. There's no exception and the matching is automated so as to minimize human intervention," said Wang.

The 2013 regulation also stipulates that those who interfere with or bypass the system to distribute organs will be disqualified from participating in healthcare and investigated for criminal responsibility.

Those who forge medical documents to unfairly acquire organs, and who fail to implement the distribution assigned by COTRS, will also be investigated for criminal offenses, it added. 

The computerized system, which functions 24 hours a day, can make a match in less than a minute, using a complicated algorithm to allocate the organs based on factors including patients' medical situation and their distance from the donor.

Another step forward China has taken is that organ donation has become normalized as more and more people are learning about the concept and are agreeing to become voluntary donors, said Wang.

By the end of August, more than 300,000 people had registered to be organ donors since 2010, and 73 percent of the registrations were done on online platforms, such as Alipay and WeChat.

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

The next move of the reform is to increase the number of doctors and hospitals qualified to conduct transplants, and to improve the efficiency of the parties involved in the process, said Huang, adding that he is confident that China will be able to contribute more to the world with the strong support from the government.
Newspaper headline: Change of heart

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