Organ donation thrives in China amid cultural challenges

BEIJING - Four terminally ill patients in Beijing have reclaimed their lives after receiving a lung, a liver and two kidneys donated by a woman who died of a cerebral hemorrhage earlier this month.

The operations brought the tally of liver and kidney transplants performed at Beijing Chaoyang Hospital since last year to seven and 14 respectively, said Zhang Xiaodong, a senior urologist at the prominent hospital.

"None of the organs used for these transplants were obtained from the court," said Zhang, referring to organ harvesting from executed prisoners, a decades-long controversial practice in China to ease demand for organs.

Zhang, who is also deputy secretary general of China Scientific Registry of Kidney Transplantation, said voluntary organ donation has mushroomed in the country since the government started vigorously promoting the cause four years ago.

Figures provided by Zhang show that in 2009, Chinese hospitals carried out over 6,700 kidney transplants, with more than 50 percent of the organs from death row inmates, only 0.04 percent from voluntary donors and the remaining from living donors who are usually recipients' family members.

However, in the first five months this year, the proportion of donated kidneys used for transplants surged to 30 percent, about the same ratio with kidneys from prisoners, he said.

Standardized system

China piloted voluntary organ donation programs in parts of the country in 2010 and made it a nationwide program in 2013, in order to cut down reliance on prisoner organs and expand ethical sources.

As of mid-August, the programs had seen more than 5,700 organs donated by 2,100 ordinary citizens after death nationwide, said Huang Jiefu, former vice minister of health who leads the country's organ donation and transplant reform, at a forum on development and regulation of organ procurement organization (OPO).

The number of volunteers who completed the donation shot up to 849 in 2013 from 34 in 2010, and reached 659 since this year, according to the National Health and Family Planning Commission.

Under the program, OPOs are empowered to extract organs, licensed hospitals can perform transplant surgery and the non-governmental Red Cross Society (RCS) and its local branches are responsible for donation publicity, registry and supervision.

In addition, the government has mandated the use of a computerized system to automatically distribute donated organs based on candidates' location, degree of emergency and compatibility with the organs, for the sake of fairness and transparency.

Before the system was employed in 2011, recipients were largely determined by hospitals. It resulted in rare organs sometimes going to deep-pocketed patients rather than those in the most dire need.

In 2012, China vowed to scrap organ harvesting from executed prisoners within three to five years, even if the country faces an acute shortage of organs. An average of 300,000 patients are waitlisted for transplants a year, but only 10,000 get their wish each year.

Rising awareness?

Zhang credited the rapid development of organ donations to tireless awareness efforts by the government and media.

According to results of a Beijing survey he launched in 2012, the majority of 2,000-plus respondents said they recognized organ donation, although not all of them were ready to donate their own.

"There's no short cut to attract donors. You have to advertise heavily and invite media to eulogize selflessness," said Li Jindong, who heads the organ donation office of Guangdong branch of RCS.

In China, organs of a deceased can only be extracted after his or her immediate family agree, regardless if the donor is registered before death.

"So the family's attitude matters. From our observation, if they have knowledge about donation, it'll save us a lot of effort in persuasion. If they don't, we're very likely to lose the potential donor," Li said.

He noted that the office sees an influx of calls inquiring about donor registry after donors' touching stories make headlines.

The number of citizens in Guangdong who have donated organs accounts for a fifth of the country's total.

Some local branches of RCS provide funds to help impoverished donors pay medical bills and funeral fees. Although the idea was initiated by the government, it has aroused doubts over cash-for-organ.

Li believes the practice, exclusive to China, will eventually fade away due to continuous improvement of the health insurance network.

Knotty challenges

The yawning supply-demand gap has put great pressure on those dedicated to organ donation promotion, but breaking traditions remains a hard nut to crack despite incremental progress.

The biggest obstacle is the belief that people should be buried or cremated, which is shared by many eastern countries, Zhang said.

"Families of some donors repeatedly told us not to publicize their kindness because they fear gossip from acquaintances," he said, adding that some who died waiting for organs that never came were unwilling to give their organs to others.

He Xiaoshun, vice president of the First Affiliated Hospital of Sun Yat-sen University in Guangdong, complained about a requirement that the spouse, parents and adult children of a donor must sign an agreement before the organs are taken.

The requirement is understandable since the cause is still at a fledgling stage in the country. "But sometimes it just wastes precious time, which should have been used to save lives," he said.

He said donor registry in China "still has a very, very long way to go" In the United States, 48 percent of adults are registered organ donors while some 27,000 out of 1.3 billion Chinese people are on the registry, He said.

Li Qingsheng, head of the OPO office in the No. 1 people's hospital in Guangdong's Foshan City, said a successful method in foreign countries is asking new drivers if they want to register as donors when registering their license and mark their licenses with "Organ Donor" if they say yes.

"But it may not be viable here. Broaching the subject under that circumstance would be offensive to many Chinese who are uncomfortable talking about death," Li said.

In addition, given the fragile trust between doctors and patients, Li said, many may fear doctors would not try their best to save their lives if driving licenses show they are organ donors.

The government has launched an arduous fight against rampant illegal organ trafficking, as a result of organ scarcity. Last week, a Beijing court ruled on the country's largest case in kidney trading, with 51 kidneys and several doctors involved.