Rocked by accusations of rights abuses, China is cracking down on organ trafficking. As Glen McGregor writes from Beijing, new regulations have made organs more rare and spurred a western-style campaign for education, donor cards and registries.
Not far from Beijing's fabled Summer Palace, a peasant couple sat in the boardroom of a military hospital one morning last month and listened as a group of white-coated doctors discussed whether they would approve surgery to save their son's life.
Every Friday, the ethics committee of the People's Liberation Army Hospital, 2nd Affiliate, meets to review its growing list of organ transplant cases. On this day, the committee considered whether 27-year-old Gao Wei, the son of a farmer, would be allowed to get a kidney from his mother.
Mr. Gao was hospitalized with kidney failure and was undergoing regular dialysis treatment. In China, as in much of the West, kidneys are scarce. At this hospital alone, between 300 and 400 patients need kidneys and, without a family donation, most face waits as long as five years. Mr. Gao's best chance for survival was his mother.
The resident presenting the case to the committee described the status of Mr. Gao and his mother, Lei Yongfang, as a PowerPoint presentation with CT-scan images of their kidneys flashed overhead. Outside in the hallway, three more families waited their turns to pitch their cases.
One doctor expressed concern about the mother's health and indications she had had tuberculosis at one point. Was this a long-standing problem, he asked.
I've never had my body checked before, Ms. Lei admitted. My first exam was for my son.
The doctor leading the meeting turned to face Mr. Gao. We will try our best to save your life, he said. You should cherish your mother's kidneys, your mother's life.
Overcome, Ms. Lei and her husband burst into tears.
That the hospital would allow a western journalist to watch this most private of proceedings indicates how strongly China is trying to overcome questions of unethical practices and human rights abuses surrounding organ transplantation.
In past years, China has been accused of allowing a black market trade in organs and allowing foreigners to purchase organs taken from executed prisoners -- allegations that the Chinese government eventually admitted. Some allege that followers of the banned spiritual movement Falun Gong were slaughtered to provide fresh kidneys, livers and corneas for wealthy foreigners -- charges the Chinese vehemently deny.
But with the 2008 Beijing Olympic Games approaching, China is eager to put a positive spin on its organ transplantation practices and mitigate concerns of human rights abuses.
Chinese doctors, in particular, want to see China's image reformed. The Chinese Medical Association has brought me here -- at their expense -- to show the machinery of Chinese organ donation at work under a new regulatory regime introduced earlier this year.
At the PLA hospital in Beijing, transplantations are overseen by Dr. Shi Bing Yi, vice-chairman of Chinese Transplantation Association and one of the heaviest hitters in China's transplantation community. Under Dr. Shi's direction, the hospital performs about 60 organ transplants a year, mostly kidneys.
While organ transplantation has been possible in China for more than 20 years, there has been a boom in surgeries over the last five years. Western critics have suggested that the surging numbers are evidence of unethical organ harvesting practices and prove that China slaughters practitioners of the banned spiritual movement Falun Gong to sell their organs to foreigners.
But Dr. Shi says the reason for the rising numbers is far less nefarious. He points to the large number of Chinese surgeons who went to study organ transplantation in the West in the late 1990s.
More than 100 travelled to Europe to learn more advanced transplantation techniques.
Dr. Shi himself studied at Cambridge. Now those doctors are back in China and performing thousands of surgeries every year.
Dr. Shi admits, however, that criminals who receive death sentences are still an important source of organs transplanted in his hospital. About half of kidneys come from living relatives and a very small number are from brain-dead bodies or cadavers. The rest?
"Executed prisoners," Dr. Shi says.
It is unclear if the same ratio exists elsewhere in China. Dr. Shi says tracking of both the number of executions and transplants across China has been spotty.
In all the surgeries he performs, he insists, the executed criminals voluntarily consented and the documentation of their consent is rigorous.
A condemned prisoner should be able to donate an order in a bid for redemption, should he choose, Dr. Shi says.
"If criminals insist, I don't think we should betray them," he says.
The use of prisoners as donors remains a sensitive and contentious point. The Chinese government says that the new rules adopted over the past two years ensure that prisoners who agree to be organ donation have given full and informed consent. Prisoners agree as a way of showing remorse for the crimes, it claims.
But to much of the international community, the practice remains abhorrent -- with or without written consent. Even the Chinese Medical Association this fall adopted a new policy on organ donation, agreeing that no prisoner's consent could be truly free of coercion.
In September, the association said it agreed with the World Medical Association's position that "the organs of prisoners and other individuals in custody must not be used for transplantation except for members of their immediate family."
Less clear is whether Chinese Medical Association doctors will follow the organization's lead and stop using organs obtained from death row. The association's position is in no way binding on the Chinese government, but it has put the organization at odds with the Chinese ministry of health, which sets national regulations for organ transplant.
"They are able to have their own opinion," said ministry of health spokesman Mao Qunan. But the ministry sets the rules, not the medical association, he said.
Mr. Mao says the new government regulations codified this year make transplants for foreigners illegal in all but the rarest of cases. Regulations requiring that living donors be blood relatives are designed to stop the trafficking in organs. And transplant hospitals must now be accredited by the ministry of health. Where once there were more than 400 hospitals performing transplants, today there are only 164, and they all risk losing their licenses if they violate any of the new rules.
The overhaul has left China with an even greater shortage of organs. The government is trying to set up a national organ allocation network similar to those in western countries and is still trying to develop a law on brain-death to help increase the supply. But in a country of 1.3 billion people, these fledgling initiatives can't come close to meeting the demand for organs.
"I think it's a big problem, an international problem," says Dr. Zhu Tongyu, a transplant surgeon in the department of urology at the Zhongshan Hospital in Shanghai.
Dr. Zhu is helping lead a drive to convince Chinese to consider donations of organs from living family members. He says he's up against a stubborn cultural resistance to organ donation. Kidneys, in particular, are seen as a key to overall health and many Chinese are averse to donation, even to family members. He translates a Chinese saying, "If kidney is good, everything will be fine."
Men are particularly reticent to consider kidney donation, as many Chinese see the kidney as the root of male sexual vitality.
Dr. Zhu is currently producing an hour-long documentary for Shanghai television that chronicles how many of his patients have saved from death or dialysis by kidney donation from relatives.
Dr. Zhu and the Zhongshan hospital are still featured on the website of Meditours, a Kelowna, B.C., company offering medical tourism.
The site describes the organ-transplant facilities at Zhonghan and says foreigners can get a new kidney for $75,000. But Shaz Pendharkar, Meditours owner, says the webpage is out of date.
The transplant business in China has completely shut down in the past year, he says.
On the day the Citizen visited Zhongshan, there were several Chinese patients recovering from transplant surgery -- all received organs from relatives -- but the few patients in the foreigners' ward were there for other types of treatment.
In a quick tour of the post-op wards, Dr. Zhu checked in on his patients, including Shen Yanping, a 24-year-old who received a kidney from her mother.
Ms. Shen's plan to become a Japanese-Mandarin translator was put on hold after university as she tried to manage her kidney disease. Now, with her new kidney, she hopes to go back to work.
The organ recipients he treats, Dr. Zhu allows, are the lucky ones. At his hospital more than 300 patients are on the waiting list and many will die before they get the organs they need.
Dr. Zhu is among of the first in Shanghai to carry an organ donor card, in an attempt to generate a new source of organs. It looks a bit like a gold credit card and has the cellphone numbers of the bearer's next of kin.
His is one of the first batch of 10,000 printed -- a number he admits will be useless. Another 100,000 might help.
"We need one million cards in Shanghai," he says. "That would be a good start."
(The Ottawa Citizen, Sunday, November 25, 2007)