Transplant physicians express serious concern about organ procurement practices in China

Apr 22 2009

The globalization of health care and the growth of "transplant tourism" (traveling abroad to purchase donor organs and undergo organ transplantation) have outpaced the implementation of internationally accepted ethical standards for procurement of organs for transplantation.

A new article appearing in Clinical Transplantation finds that both U.S. and foreign transplant physicians expressed serious concern about organ procurement practices in China, and that this concern influenced their patient care decisions. The study is the first to assess how the perceptions of healthcare providers on transplant tourism may influence domestic patient care decisions.

Globalization of medical and surgical technology has increased the capacity for countries worldwide to perform organ transplantation. Unfortunately, dramatic geographic variation in the availability of organs for transplantation and a parallel discrepancy in financial resources for healthcare have increasingly led desperate patients to transplant tourism. Organ procurement in China has been especially criticized for its reliance on executed prisoners as donors.

An anonymous case-based questionnaire was used to survey a sample of healthcare professionals with affiliations to hepatology and transplantation professional societies. A strong majority believed procurement practices were ethically sound in the U.S. and Europe, but only 4 percent believed that procurement practices were ethically sound in China.

The majority of doctors surveyed said that they would provide post-transplantation care for patients who underwent liver transplantation at another domestic center, in a foreign country or in China. However, respondents who suspected unethical procurement practices in China were more reluctant to do so.

The practice of transplant tourism has been decried by numerous national and international healthcare organizations. These organizations cite serious concerns about clandestine international brokers, surreptitious payment, coercion of organ donors (and/ or donor families) and substandard medical and surgical practices that may lead to lower success rates and higher risk for transmission of infectious disease.

International ethical guidelines exist to ensure that the donation of organs is voluntary, both in life and after death. Not all countries adhere to these ethical guidelines. When traveling from one country to another country for organ transplant surgery, patients risk using an organ obtained in an unsafe or unethical manner.

In 2005, the World Health Organization (WHO) reported the transplantation of 66,000 kidneys, 21,000 livers and 6,000 hearts. Approximately 10 percent of these procedures occurred via transplant tourism. Leading destination countries for transplant tourism include China, India, the Philippines and Pakistan. The number of organ transplant procedures in China is surpassed only by the U.S. According to the WHO, in 2005 China had 348 transplant centers, which performed 8,204 kidney and 3,493 liver transplantations.

Transplant tourism to China has been isolated as particularly controversial. Organ procurement from executed prisoners in China has been reported by the U.S. Department of State, non-governmental investigative reports and in medical literature. These reports indicate that over 95 percent of organ donors in China are prisoners. China's use of prisoners, particularly those slated for execution, represents the use of a vulnerable population that is particularly susceptible to coercion. For this reason, both live and deceased donor organ procurement from prisoners violates U.S. professional guidelines and international standards ratified by the World Medical Association Statement on Human Organ Donation and Transplantation.

"Physicians caring for patients in need of organ transplantation must balance the duty to the individual patient vs. the duty to society," says Dr. Scott Biggins of the University of California San Francisco, lead author of the study. Acting as patient advocates, most transplant professionals were not opposed to patients seeking transplantation at alternative centers to shorten waiting times. Yet, respondents who suspected unethical organ procurement practices in China would discourage patients from transplant tourism to China.

"We aim to raise awareness of the need for adherence to international accepted ethical standards for procurement of organs and regulation of transplant tourism by international regulatory and credentialing bodies," says Biggins.