TTS Supports China Liver Transplant Registry Efforts to Align Chinese Practices with International Standards

tts ns 2012v9i2 8 1
Participants of the national assembly convened in Hangzhou, China in March 2012

The China Liver Transplant Registry (CLTR) is underway in establishing much needed changes in China. Representatives of TTS (Francis Delmonico and John Fung) recently participated in a national assembly sponsored by the Ministry of Health and the Red Cross of China, convened in Hangzhou in March 2012. An invited keynote presentation was made by Dr. Delmonico on behalf of TTS, endorsing the efforts of the CLTR to achieve a transparency of registry events, develop an equitable system of organ allocation, and develop an ethically proper program of deceased donation as an alternative to the use of organs from executed prisoners. TTS commends the leadership of Dr. Haibo Wang in accomplishing these objectives, which are consistent with the Declaration of Istanbul's principles and the Resolution of the 63rd World Health Assembly of 2010.


The World Health Organization (WHO) has stated clearly in its Revised Guiding Principles that "donation and transplantation activities, as well as their clinical results, must be transparent and open to scrutiny, while ensuring that the personal anonymity and privacy of donors and recipients are always protected." The CLTR has an opportunity to make data transparent by an annual release of information, revealing a reduction in the practice of liver transplantation from executed prisoners. TTS supports this annual report of data from the CLTR, maintaining its position expressed in the following policy statement:

The need for transparency and for assembling comprehensive demographic data on the international practice of transplantation dictates that these data should be accepted. The source of the organ or tissue should be clearly identified and recorded as procured from an executed prisoner. Such data should not be incorporated in the total analysis of outcomes of transplantation or other scientific registry studies.

Allocation of organs:

Drs. Haibo Wang and Sheung Tat Fan have developed an objective ranking index of medical criteria for organ allocation in China to include disease severity, donor recipient age matching, blood type and HLA matching, and waiting time of the candidate. To encourage organ donation, ranking priority is also granted to those who are living donors or any of the immediate family members of a deceased donor. This direction fulfills international standards set forth by the World Health Organization that "the allocation of organs, cells and tissues should be guided by clinical criteria and ethical norms, and not financial or other considerations. Allocation rules, defined by appropriately constituted committees, should be equitable, externally justified, and transparent." The WHO has also suggested that there be Ministerial and public oversight of updated comprehensive reports regarding the system of organ allocation in order to verify equitability and transparency.

The proposed geographic distribution of organs within China is initially to the transplant center within the organ procurement organization, then to other regional transplant centers within the Province, and then finally to a national list.

New protocol for deceased donation:

The CLTR has been a leader in the development of a new program of deceased donation noteworthy for its ethical propriety and consistent with international standards. It entails the determination of death by neurologic criteria. Even though brain death is not yet legally recognized in China, the plan is to facilitate organ donation when brain death is recognized in the intensive care units. Futile support will be withdrawn from such patients after consultation with the family who derives consent for organ donation. Minister Jie-Fu Huang has termed this program "deceased donation with China characteristics." TTS endorses the implementation of this program throughout China as the alternative to the use of organs from executed prisoners.