A Canadian patient’s receipt of a kidney transplant after waiting just three days during a recent visit to China raised an immediate red flag among surgeons at the Montreal-based Transplantation Society: a turnaround that quick indicates the organ likely came from an executed prisoner.
The case adds to doubts among many doctors internationally about whether China has met its pledge to stop harvesting the organs of executed inmates. The practice is condemned by the World Health Organisation and others because of concerns over coercive procedures and fears it could encourage executions.
China officially claims it ended the harvesting of executed inmates’ organs in January 2015. Some foreign doctors who have worked in China say authorities are behaving more responsibly, but other observers say China has not done enough to prove that it has fulfilled that pledge.
China sought to use the Transplantation Society’s decision to hold its annual meeting in Hong Kong this month as validation of its transplant programme. But Dr Philip O’Connell, the society’s president, rejected that interpretation, even if it appeared some reforms had been successful.
“We realise that this isn’t going to change in a day,” O’Connell said. “It’s not going to go from a system that was using organs from executed prisoners, that was driven by corruption and where organs were being paid for … to a system that’s completely open, transparent and ethical.”
In a country that routinely suppresses discussions of human-rights issues and cracks down on lawyers and independent groups, government officials and state media have been relatively open about China’s problems with organ donation.
Dr Huang Jiefu, head of the system that supervises transplants in hospitals, has been the public face of China’s attempts to change its transplant practices. Huang publicly admitted in 2005 that doctors used executed prisoners’ organs. In 2011, Huang and other officials estimated that two-thirds of transplanted organs from the deceased came from executed prisoners.
Huang said last Friday that he was confident hospitals under his purview were moving to donated organs, but that black-market surgeries persisted.
“We still have a long way to go,” he said.
A former deputy health minister, Huang said he spoke to top government officials about reforms they needed to make to win the world’s confidence. These include a crackdown on organ trafficking and more regulations on how organs are procured. China also needed to train far more doctors and hospitals to perform surgeries, he said.
“Our organ transplantation must be 100 per cent reliant on civilian, voluntary organ donation,” Huang said. “Otherwise, we cannot stand on the world stage.”
China is believed to execute more people than any other country in the world, though the total number is kept secret. Amnesty International estimates the annual number is in the thousands.
According to the government, Chinese doctors performed 10,057 organ transplants last year. Health officials have also said they expected to increase the number of hospitals that could perform transplants. By its own estimates, China has about 300,000 patients a year in need of organs, a challenge that will only get bigger as the population ages. Its national rate of donors leads Japan and most other Asian countries, but is far behind the United States and most nations in Western Europe.
Chinese government statistics often engender deep scepticism, and critics of China’s organ donation practices say they are not convinced. Some critics, citing China’s history and the prevalence of black-market surgeries, contend the true number of transplants is much higher than the official numbers, and that executed prisoners remain the source for many of those organs.
Dr Torsten Trey, executive director of Doctors Against Forced Organ Harvesting, said international visitors were not seeing enough of the system to judge the accuracy of China’s statistics or claims of progress.
“The change was not successful, because there is no change,” Trey said in an email.
Dr Michael Millis, a transplant surgeon at the University of Chicago, said he had visited “several dozen” transplant centres in China as part of his volunteer work in the country. One sign of a shift, Millis said, was that doctors at those centres used to have routinely scheduled surgeries. Now, they talk of having multiple surgeries in one day or days without any surgeries. That indicated they were operating on the up-and-down schedule of a system fuelled by voluntary donations rather than executions, Millis said.
Millis said reports like the recent case with a Canadian suggested black-market surgeries still occurred, though not at the scale alleged by others.
In the case of the Canadian, the Transplantation Society was alerted soon after the patient returned to Canada and told his doctors he had purchased a kidney and required follow-up care. The society sent a letter to Huang calling for an investigation just ahead of its annual global meeting in Hong Kong.
What happened next could be considered a positive sign by those working with China. Huang said Chinese officials revoked the licenses of the surgeon and the hospital, and a criminal investigation was launched into the surgery.