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Zhang Xinyou was one of the lucky ones.”If you don’t do a liver transplant, you’ll die,” doctors told the cirrhosis sufferer, recalled his wife Gao Li.
Zhang, 59, got his liver, but where it came from is something he doesn’t want to ask.
“Most of the organs here come from executed prisoners,” Gao, 57, says in hushed tones inside a transplant ward at the Tianjin First centre Hospital, the country’s largest transplant facility. “I haven’t considered whether it’s right or wrong. All we want is a good liver.”
As cultural taboos restrict voluntary organ donation, the systematic harvesting of organs from freshly executed prisoners provides almost two thirds of China’s very limited supply of livers, kidneys, hearts, lungs and corneas, says vice health minister Huang Jiefu.
Last month, Huang announced Beijing will abolish the practice within the next three to five years and replace this controversial source with a new donation system that encourages donations of organs and regulates where they go.
That’s a welcome promise but tough to realise, say analysts, who doubt Chinese authorities can quickly shift social attitudes and sweep aside a practice in which some people profit from collusion between medical staff, judicial officers and the police.
Some 10,000 transplants are performed here each year, second only to the United States. But 1.5 million Chinese are waiting for organ transplants, said state news agency Xinhua, leaving just a 1 in 150 chance. In the USA, there are about five patients for every organ, according to the United Network for Organ Sharing, a non-profit agency.
In China, overwhelming demand for organs and little supply has given rise to to underground networks that deal in organs and transplants. Doctors who oppose a new system “must be trying to protect their own interests to profit from the involvement of the courts and armed police,” Huang Jiefu told the South China Morning Post newspaper.
In one recent case, a 17-year-old boy sold one of his kidneys for $3,500 to buy an iPad and iPhone.
To stop the illegal trafficking, China is testing a new system in half of the country’s provinces, to be expanded nationwide this year. The new system includes computerized allocation procedures to provide faster, fairer and more transparent organ allocation.
Liu Changqiu, a legal expert at the Shanghai Academy of Social Sciences, says the new system should reduce cases of the rich and powerful jumping the line.
From March 2010 to March 2012, pilot programs persuaded just 207 people to donate their organs after death, according to the Red Cross Society of China, which operates the transplant system. Those donors were mostly from the rural poor, and 90 per cent of them, or their families, asked for “financial aid” in return for their organs.
Distrust of the new system may be one reason why there are so few donors. In a survey of residents in Guangzhou, one of China’s richest cities, 81 per cent of respondents worried that donated organs could be bought and sold, reported the Canton Public Opinion Research centre.
Another reason is Chinese social tradition, which says the bodyshould be whole in death to show respect to the parents who gave one that body and to ensure a complete body in the next, spiritual life. Such beliefs “still have a great influence in China, and these concepts will take decades to change,” says Liu Changqiu.
Despite public pressure to donate, hundreds of organ donor coordinators employed by the new system are having little luck.
In China’s eastern Shandong province, none of the coordinators managed a successful case in 18 months, reported the local Life Daily newspaper. The most striking refusal came from the parents of a 21 year-old single woman. They planned to bury her beside a dead bachelor, and thus marry them off in the next life, coordinator Liu Hong said. In Tianjin, a port city of 13 million people east of Beijing, a total of 19 donations since 2010 placed it second among all the pilot schemes.
The publicity drive to spur donations hardly appears aggressive: No organ donor materials were on display at the large Tianjin No. 2 Hospital.
Liu, the legal expert, supports the use of prisoner organs given the difficulties of getting organs elsewhere, provided the prisoners consent. Beijing says death row prisoners, or their relatives, do consent to donate organs. Rights activists disagree.
“Prisoners can never give meaningful consent,” says Sarah Schafer, a Hong Kong-based China researcher for Amnesty International.
Beside the issue of consent, there is the matter of who is being executed to provide organs. The Dui Hua Foundation, a U.S.-based human rights group, estimates that China executes 4,000 people a year, more than all other countries in the world combined (The USA carried out 43 executions in 2011).
While only the most heinous of murderers are eligible for capital punishment in the U.S., the banned spiritual group Falungong has long alleged that many of its adherents have been executed for their organs.
Without addressing such accusations, Huang, the health official, said it is not for moral reasons that China should stop using prisoner organs, but for practical ones. Prisoner organs, he says, are less desirable because of high rates of fungal and bacterial infection that result in lower long-term survival rates than in other countries.
Meanwhile, the black market is thriving and operates in a fairly open manner. “Underground” dealers are found quickly on the Internet. Buyers in need of organs pay between $32,000 to $63,000, say these illegal brokers, who insist they are merely helping people and are professional.
In China’s biggest organ-trafficking case, 16 people, including medical professionals, were charged in February with crimes relating to the removal of over 50 kidneys in 2010, earning $1.6 million, reported the Procuratorial Daily. The doctors operated out of a four-story house turned makeshift clinic in a northwest suburb of Beijing.
“We never knew that was going on in our neighbourhood, but I know the high profits are worth the risks for the middlemen,” says Wang Yanxia, a doctor at a nearby health clinic.
In Shanxi province, Li Lidan and her parents have moved into a simple cave house for $16 a month to be near the Changzhi county hospital where Li undergoes dialysis to keep her alive.
“I envy people who had transplants, they can live longer, get a job and live a normal life,” says Li, 25, who needs a kidney to live and doesn’t care if it comes from a prisoner or the black market.
Despite a less than 1 per cent chance of a kidney becoming available, Li is hopeful.
“I’m already a lucky person,” she says. “There are still many good people out there. In the future, there will be a donor for me.”
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