More than 90% of transplanted organs in China are obtained from executed prisoners, and the previously under-regulated growth of transplantation in China provided an atmosphere for other organ donors to get financial compensation. But the Chinese Government's Regulations on Human Organ Transplantation have banned financial reward by attaching stiff penalties to it, and introduced other safeguards. These regulations have been praised by WHO. The issues surrounding organ transplantation in China are discussed in a Comment in the Lancet Series on Health System Reform in China, written by Jiefu Huang, Vice-Minister of Health, China, and colleagues.

The new regulations have seen large decreases in transplants from dead donors and a more-than-doubling of transplants from living donors in 2007. The overall drop in transplantation in the last three years is a combination of these two factors. The authors say: "An organisational structure for transplantation must be established to oversee, implement, audit, and set up balance of authority between the central and provincial governments. A registry of recipients that uses robust methods of data-collection should be started. Donation, use of organs, and selection of patients are currently hospital based, without centralised standards, and a transparent system for organ procurement, equitable organ allocation, and selection of patients is needed."

China is planning regulations for the new phase of transplantation, which will largely conform to international standards, and incorporate cultural nuances, eg, the laws for brain death will incorporate language that respect the family's wishes, especially when they are based on religious belief that the whole body be buried. The authors conclude: "Despite a sharp decrease, capital punishment still exists in China. The long-term goal for social development is to abolish the death penalty but, until then, regulations need to protect prisoners' rights and desires and separate transplant programmes from the prison system."

Jiefu Huang, Vice-Minister of Health, China T) +86-10-68792005 E) liuyong@moh.gov.cn

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