TTS Interactions with China - July 31, 2016
Over the past month there has been several public comments regarding past and current transplant practices in China and The Transplantation Society’s (TTS) response to these issues. As our international congress is being held in Hong Kong this year, we felt it important to restate our position on the use of organs from executed prisoners, organ trafficking and transplant tourism regardless of the country of origin.
The Transplantation Society’s response to China, and to unethical practices in other countries, has been clear and consistent. Our stance on China’s use of organs from executed people has been unambiguous and has been in place for more than a decade. TTS has made strong and public statements against organ trafficking, the use of organs from executed people, and transplant commercialization in all countries. We refuse to accept presentations at our meetings and conferences or to publish academic articles where organs from executed people have been used, and have published our position in the press and academic literature. Several recent examples are the following: Lancet [letter]. 2014, 384(9945): 741, Transplantation 2014, 97: 795-6 and Transplantation 2015, 99; 1-2. Partly in response to these issues, TTS, in partnership with the International Society of Nephrology, established the Declaration of Istanbul.
In addition to our public policy stance, TTS demands the highest of ethical standards from our members. All members must sign an ethics statement (available on our website) and adhere to the ethical principles of the Society. In particular, this prohibits members from using organs from executed people and from being involved in unethical commercialization and organ trafficking. Any transplant professional, who uses organs from executed prisoners is prohibited from TTS membership. This, with the prohibition by Transplantation, the American Journal of Transplantation and other major medical journals on publishing articles where organs are sourced in this way has been one of our most effective tools to highlight our stance and bring about change, not only in China, but in other regions where unethical practices are occurring. There has not been, nor will there be, any change in our policy, nor change in our stance on these issues. With regard to the upcoming international congress in Hong Kong, we have asked all presenters, from all countries, to confirm that no organs from executed prisoners were used and that their presentation conforms with the ethical standards of the Society. The Scientific Program Committee of the upcoming international congress has applied clear ethical and scientific guidelines to remind all presenters of Scientific papers of their responsibilities for truth, clarity and disclosure.
We have reminded all Chinese presenters of our specific requirement with respect to the (non) use of executed prisoners organs and required their disclosure of the origin of all organs. This has been required and assurance supplied on three occasions in writing. All submissions in which executed prisoner organs were used have been rejected, as have all submissions where there has been no response to any of our requests for declaration.
With respect to China, it is our impression that there has been a change in policy and practice in China. With the leadership of Dr. Jiefu Huang, the Chair of the China Organ Donation and Transplant Committee, there has been a progressive period of reform in organ donation. This began in 2005 with the registration of transplanting centres and reducing the number of transplant centres from more than 600 to 168. It was followed by the 2007 State Council Regulations on Transplantation, and the Huangzhou Resolution in 2013. In 2010, the first pilot program of DCD organ procurement from Chinese citizens was commenced. These events preceded the public announcement by the Chinese government of the ban of the use of organs from executed prisoners and the statement that the only legal source of organs was from “citizen donation”. During this time, I and other senior members of our Society have visited several transplant centres in China and to the best of our ability, we believe that these centres are no longer using organs from executed people and that organs from deceased citizen donors are allocated by a centralised computerised organ allocation system called COTRS. This assessment has been corroborated by a broad range of sources including but not restricted to; , the University of Chicago representative to the China Medical Association, and officials of the World Health Organisation.
Based on these assessments, the senior leadership of The Transplantation Society is now engaging with selected transplantation programs in China and, where appropriate, supports those in China who are agents for change. Our policy of engagement was reviewed by the TTS Ethics Committee in 2014 and was found to be consistent with our ethical statement, and with WHO international standards and the principles of the Declaration of Istanbul. It must be remembered, we are a Society of medical professionals. We deal primarily with individuals, not governments. We have an obligation to assist those professionals who are working in difficult environments and, in return, we demand that they adhere to our ethical standards. Holding our international congress in Hong Kong is aimed at further engaging and educating individual scientists and clinicians from countries in Asia, including the People’s Republic of China, on all aspects of transplantation, including the ethical expansion of organ donation, both deceased and living donors. Our attendance, on the 21st and 22nd August 2015 at the China National Organ Procurement Organisation Alliance in Guangzhou was at the request of the newly formed National Organ Donation and Transplantation Committee of China. We decided to accept the invitation as it provided an opportunity to offer advice and guidance on the development of an ethically based, transparent, deceased organ donor program, which must be free of corruption and financial incentives. In large part our perception that things have changed for the better was confirmed by our attendance at this meeting and from visits to Chinese transplant centres in several Chinese provinces.
One fifth of the world’s population lives in China and they carry a high burden of end organ failure. The ordinary Chinese citizen desperately needs access to a competent, ethically based, organ donor program that is free of corruption. Provided that organs are not sourced from trafficked individuals or from executed people we feel that we have an obligation to provide expertise to help them. Like all other people of the world they deserve access to this life saving treatment.