Amid Scandals, Can China’s New Organ Transplant System Work?

The now oft-derided Chinese Red Cross once again found itself in hot water in July, when it was reported that some branches have asked organ transplant hospitals to pay 100,000 RMB ($16,300) for each successful organ donation organized by them. In August, the People’s Daily reported that an organ donation coordinator for the Shaanxi branch of the Red Cross threatened to take away a critically injured patient’s breathing machine if the family continued to refuse to donate his organs in the event of a cardiac death. The coordinator, Liu Linjuan, said to the family that if they were willing to donate, “we can give you 100,000 RMB. No more than that.”

One Chinese netizen wrote on Sina Weibo, China’s version of Twitter, that she wanted to be an organ donor, but after finding out that she has to register with the Red Cross, she commented, “Through the Red Cross? Sigh… not trustworthy.” According to a poll conducted last year, among 1,012 Guangzhou residents interviewed, 79% of them think that “organ donation after death is noble,” but as many as 81% worry that “organ donation will lead to the organ trade.” The attitudes of everyday Chinese, no doubt influenced by scandals such as these, call into question how effective China’s newly introduced organ transplant system can be.

As long as organ transplants have been available in China, the vast majority of organs for transplantation have been taken from executed prisoners, often without their consent. The Chinese government has vowed to phase out this unethical and politically embarrassing practice by August 2015. A pilot organ donation program was launched three years ago. So far this year, according to official statistics, the portion of transplanted organs from executed prisoners has dipped to under 54%, and cadaver organ donations from the general population has risen to 23%. Now the government appears to be taking further steps to meet its goal.

On September 1, the Provisions on Human Organ Procurement and Allocation (interim) came into effect. Under the new law, every donated organ must be entered into the China Organ Transplant Response System, or COTRS. Hospitals that fail to do so will have their transplant licenses revoked. COTRS, modeled after that of the United States, is a computer system that allocates organs based on medical urgency and time spent on the waiting list. Theoretically speaking, doctors and hospitals will no longer have influence over who receives a specific donated organ. According to Huang Jiefu, head of the transplant office at the National Health and Family Planning Commission, the system is designed to allocate organs “equitably and transparently.” Meanwhile, the Chinese Red Cross and organ procurement organizations in each of the 165 accredited transplant hospitals have been charged with promoting organ donation, finding potential donors, and coordinating the donation process when actual donors become available.

Huang claims that the unique design of the system “provides confidence” that the donation program will be “widely implemented and accepted by Chinese society.” While only one-third of donated organs are allocated through the system at present, Huang believes the system will be fully implemented by early 2014. But if the recent spat of scandals and obvious shortcomings in COTRS are any indication, this will be easier said than done.

The current lack of transparency in COTRS is a cause for concern. Unlike in the United States, where anyone can log onto the Organ Procurement and Transplantation Network’s website to look for or request information regarding every organ donation and transplant event in the United States, COTRS is not open to the public. Details regarding matching methodology are not released, and information about donors and recipients are unknown to the public. A recent op-ed in the Guangming Daily asks, with everything being done behind closed doors, how can the public trust that the computer system won’t be tampered with by humans? Moreover, as Luo Gangqiang, Director of the Organ Donation Center at the Wuhan branch of the Red Cross, points out, with the lack of supervision from a third party, how can patients trust that their information is correctly entered into the system and is updated promptly?

Both the World Health Organization and the Transplant Society applaud the Chinese government’s effort in developing the organ donation system; however, the system may need to be much less opaque to ensure that organs are fairly allocated and to gain the public’s trust. Averting major scandals is also key to maintaining a system that depends on willing participants to work.