On March 19, the website for voluntary organ donation registration was official launched in China, after successful pilots programs in recent years. As a critical part of a national donation system, this website will continue to increase the public’s awareness of the urgent needs of organ donor, break down the Chinese cultural barrier towards organ donation, and depart from the dark past of organ harvesting from prisoners.
There is a worldwide organ shortage but it is particularly acute in China. According to the estimation of China’s National Health and Family Planning Commission, there are at least 300,000 people in need of organ transplantation but only about 10,000 can get the organ needed. The supply and demand ratio in U.K. is 1:3 and in U.S. is 1:5 in comparison. A lack of donors and a national program to organize donations has been the main reason for this grieve mismatch in China.
Filial piety, a key principle in Confucianism, is the primary reason holding Chinese back from organ donation. Confucianism is a philosophical and quasi-religious system based on the teachings of Confucius (Kǒng Fūzǐ, 551–478 BC) in China, strongly influencing Mainland China, Taiwan and Korea, among other countries. The Confucian teaching instructs children to obey parents, serve them diligently, bury them respectfully and worship them afterwards. It says that body, hair and skin are gifts from parents and no one shall damage them. Children are taught to treasure even a single hair from their parents and to keep their bodies safe.
Even though the modern Confucian scholars believe the life-saving power of organ donation is valued more in Confucianism than preserving the integrity of the dead body, it is not unusual for relatives, particularly children, of the willing donor to not accept that their loved ones go to another world blind or with other missing parts of the body.
Lack of a national donation system, most of the organ transplantations in China since 1980s are organ harvested from executed prisoners. A 1984 regulation made such practices legal if the prior consent of the criminal or permission of relatives was obtained. Human rights groups have reported many abuses in this prison system. Some prisoners who were not on death row were executed just because their organs were good matches for certain waiting patients. One executor shot the prisoner in the chest not to kill but to send the body into deep shock, to avoid squirming and contractions making organ harvesting problematic, and then a live surgical extraction of the organs was performed. Canadian human rights lawyers David Kilgour and David Matas were the leading human rights watchers involved in disclosing such abuses. In 2009, a few years after some initiatives to depart from this dark past, it was estimated that 65 percent of organ donations in China were still from prisoners.
Chinese government acknowledged the reliance on executed prisoners for organs must end and set the goal to build a strong national system for fully voluntary donation by 2017. The effort first started in 2007 when The Regulation on Human Organ Transplantation went into effect, making organ trading illegal and requiring a person’s prior written consent to remove any organs. The number of hospitals certified to perform organ transplants was reduced significantly due to this regulation. Since then, multiple regulations and various pilot programs in different areas and with different formats took effect to reduce dependence on organs from executed prisoners and increase the pool from voluntary donors. In 2009, a fatally ill 16-year-old boy in Shenzhen made national news in China when he signed with China Red Cross to become the youngest organ donor. Examples such as this boy are helping more and more people to break the traditional cultural barriers of organ donation.
The data on the newly launched website for voluntary organ donor registration is only accessible by certified organ procurement organizations and workers. China Red Cross monitors the process of confirming the death of the donor and the relatives must give consent before the organ harvest operation can be proceed in the 169 hospitals approved for such procedure. China’s Association of Organ Procurement Organization (OPO) was established in Guangzhou on March 20, chaired by Huang Jiefu, the former vice-minister of the Ministry of Health. This non-profit organization will focus on policing the organ harvesting and transplanting process and writing standards.
The system in China still has a lot of work to do to be transparent and match international standards, but its dark past of organ donation must be left behind.
By Tina Zhang