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Preventing organ transplant abuse in China

Remarks prepared for delivery to a United Nations Conference, "Advance
Global Health"
31 August 2010
Melbourne, Australia
by David Matas

David Kilgour and I have concluded (first in a report released in July 2006 and updated in January 2007, and then in a book titled Bloody Harvest released in November 2009) that Falun Gong practitioners have been killed in China in the tens of thousands so that their organs could be sold to transplant patients. I invite you to take a look at our report, which is online , or read our book to see how we came to that conclusion. Falun Gong is a simple set of exercises with a spiritual foundation which started in China in 1992 and was banned in 1999.

This abuse in China has to be concern to the global community because it is a grave human rights violation which should concern all humanity, but also because the developed world has been complicit in the abuse. When China shifted from socialism to capitalism, the state withdrew funds from the health system.

Since 1980, government spending dropped from 36% of all health care expenditure to 17%, while patients' out of pocket spending rocketed up from 20% to 59%. A World Bank study reported that reductions in public health coverage were worsened by increases in costs by the private sector .

According to cardiovascular doctor Hu Weimin, the state funding for the hospital where he was working was not enough to even cover staff salaries for one month. He stated: "Under the current system, hospitals have to chase profit to survive." Human Rights in China reports: "Rural hospitals [have had] to invent ways to make money to generate sufficient revenue".

Hospitals needed to find private funding to replace state funding. Foreign sales of organs became the primary money maker. The Organ Transplant Centre of the Armed Police General Hospital in Beijing for instance stated on its website:

    "Our Organ Transplant Centre is our main department for making money. Its gross income in 2003 was 16,070,000 yuan. From January to June of 2004 income was 13,570,000 yuan. This year (2004) there is a chance to break through 30,000,000 yuan."

The Chinese health system began the organ transplant business by selling organs of prisoners sentenced to death. However, eventually, despite the large number of death sentences and executions in China, this supply became insufficient. So hospitals and prisons turned to another source, Falun Gong practitioners.

For years, patients from developed countries came over in the thousands to buy organs in China. The Government of China, in June 2007, ordered the hospitals to give priority to local patients . What before was a foreign flow became a trickle. Transplant volumes today are at traditional levels. So, with minor variations, are the sources. However, the patient composition has changed dramatically.

We can not nonetheless say that because the patient composition is now mostly local, Chinese organ transplant abuse has ceased to be an international problem. If a pusher gets a client addicted heroin, the pusher can not claim innocence because the client now grows his own opium. If a bartender plies a client nightly with drinks and the client becomes an alcoholic, the bartender can not later plead that the client now uses only his own home made moonshine.

Learning from the Chinese experience and reacting now is more than just shutting the barn door after the horses have escaped. Even the trickle of foreign patients now justifies concern. As well, learning from the experience helps us prevent its reoccurrence.

Moreover, there remains an international dimension of the problem in other forms. Drug companies continue trials in China of anti-rejection drugs. Chinese transplant professionals interact with their colleagues abroad. They continue, for instance, to show up at international conferences.

The contact Chinese transplant professionals have with their colleagues abroad presents opportunities as well as problems. The Chinese health system is now prepared to acknowledge that organ transplants come mainly from prisoners, though they contest the sourcing from Falun Gong prisoners.

Chinese health professionals also concede that sourcing organs from prisoners is wrong and should cease. Deputy Health Minister Huang JieFu, in a talk he gave in Madrid in March 2010, stated that executed prisoners is "a source that does not comply with international ethical and standard of practice".

This dual admission means the international community can press the end of transplant abuse in China without meeting with denials and intimidation, the typical Chinese government/party response to concerns about other forms of human rights abuse. Regrettably, all too many people are misled by Chinese party/state denials or cowed into silence by Chinese official political and economic bullying. It should in principle be possible to gather together a larger coalition in support of ending an abuse in China the government of China acknowledges exists and is wrongful than the abuses the party/state covers up.

To deal with international organ transplant abuse in China, and learning from the China experience, I propose these fifteen steps:

1. Parliaments should pass extraterritorial legislation banning transplant tourism. Belgian senator Patrik Vankrunkelsven and Canadian Member of Parliament Borys Wrzesnewskyj has each introduced into the Parliament of his country extraterritorial legislation banning transplant tourism. The proposed legislation would, when enacted, penalise any transplant patient who receives an organ without consent of the donor where the patient knew or ought to have known of the absence of consent.

2. State health funding systems should not fund abusive organ transplants abroad. Parliaments should prohibit private insurance from funding abusive organ transplants abroad. Israel has passed legislation which prevents private insurance companies for paying for black market organ transplants.

3. International brokerage of organs should be prohibited. Israel has such a law .

4. Doctors should not prescribe drugs which will be used during the transplantation of a purchased organ. The Canadian Society of Transplantation and Canadian Society of Nephrology released a policy Statement on August 17, 2010 on organ trafficking and transplant tourism containing that policy.

5. Doctors should have the right to choose not to provide medical records to patients if they believe the information will be used in support of an illegal transplant performed in an unregulated system and that there is a significant risk of harm to the patient or organ vendor. This is another element of the Canadian policy.

6. In non-emergency situations, doctors should have the right to choose to defer care to another physician for a patient who may have obtained an organ through transplant tourism. This is a third element of the Canadian policy.

7. Pharmaceutical companies should not support directly or indirectly the harvesting of organs from prisoners as part of the research and marketing of anti-rejection drugs. The Swiss section of Amnesty International on August 13, 2010 issued a statement stating that position.

8. Pharmaceutical companies should adopt common guidelines approved by independent experts to avoid complicity in abuse. This is another element of the Amnesty International August statement.

9. Pharmaceutical companies should adopt a moratorium on clinical testing of organ anti-rejection drugs in China. The global drug company Novartis announced, according to a newspaper report published August 15, 2010 , that it was adopting such a moratorium and would work to unite all pharmaceutical companies on the issue.

10. Presentations of studies involving patient data or samples from recipients of organs or tissues should not be accepted unless the presenter can satisfy the host beyond a reasonable doubt that the sourcing of the organ is not abusive. The Transplantation Society has a policy like that, but which does not address directly the issue of onus.

11. Collaboration with experimental studies should not be considered unless the foreign collaborator can satisfy the local collaborator beyond a reasonable doubt that no material is derived from abusive organ sourcing. The Transplantation Society has a policy like that too, but without reference to onus.

12. Local hospitals should not be training foreign transplant surgeons unless the local hospitals are satisfied beyond a reasonable doubt that the foreign doctors have not participated in and will not participate in abusive organ transplant surgery. The major transplant hospitals in Queensland, Australia have banned training Chinese surgeons .

13. The Government of China should make transplant data publicly accessible. The Chinese health system runs four transplant registries, one each for liver, kidney, heart and lung. Three are located in mainland China - kidney and heart in Beijing and lung in Wuxi. The Liver Transplant Registry is located in Hong Kong. The data on the Hong Kong registry used to be publicly accessible but is no longer. The data on all sites is accessible only to those who have registry issued login names and passwords.

14. The Government of China should make public death penalty statistics. Right now China does not publish official death penalty statistics and refuses to do so. At the United Nations Human Rights Council Universal Periodic Review for China in February 2009, six different countries - Canada, Switzerland, United Kingdom, France, Austria, Italy - recommended that China publish these statistics. The Government of China publicly and explicitly rejected this recommendation.

From unofficial Amnesty International death penalty statistics, there appears to be a massive discrepancy between sources of organs and volumes of transplants. Publication of death penalty and transplant statistics would either dissipate the appearance of discrepancy or require an explanation for it.

15. The international transplant community should press China to end abusive organ transplantation now, not sometime in the future. Chinese government health officials indicate that, through the spread of donations and an eventual enactment of a law allowing for sourcing of organs from the brain dead cardiac alive, the practice of sourcing organs from prisoners will cease. But in this area, ending the abuse tomorrow is not good enough. The abuse should end immediately.

David Matas is an international human rights lawyer based in Winnipeg, Manitoba Canada.

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