China has announced that it will cease using organs harvested from death row inmates as of January 2015, following an earlier, unfulfilled pledge to halt the practice by mid-2014. From that date, the 300,000-or-so people who require transplants annually will need to rely on organ donations from voluntary donors. Some figures for waiting lists are even longer, with over 500,000 believed to be on dialysis.
Even with the transplanted organs from prisoners, only roughly 10,000 of those people have received transplants in previous years. China has long relied on organs harvested from its many executed prisoners, which has generated heavy criticism internationally, ever since the practice was revealed in a damning Canadian report which involved extensive research that began in 2006. In 2009, the Chinese government admitted that most of the organs transplanted in the country came from executed prisoners, and doctors admitted that despite the fact written consent was required from prisoners, the system was prone to abuse. The Canadian report had concluded that much of the time, the organs simply ended up being sold by intermediaries.
Given the intense demand, there remain a whole host of reasons why it’s going to be incredibly tough to quit the practice cold turkey. The official in charge of organ donation reform told Reuters that even if the authorities attempt to stamp it out, the intense demand means there will be a black market for many years.
“The illegal trade of human organs will be inevitable in Chinese society in the years to come. The huge demand for organs is one of the causes. As long as there’s a gap between supply and demand, illegal organ trafficking won’t disappear, but the government will continue to crack down on it.”
The opacity of the prison system and the difficulty of preventing corruption within it mean that there is the possibility organs will continue to make their way out from prisons onto the market.
The problem is exacerbated by the fact that it’s not just locals, but also international buyers who are desperate to get their hands on organs, in what has become known as “transplant tourism” – a concept which has been well-researched in bioethics journals internationally, and generally always points toward China. A common theme is the difficulty in distinguishing between organs obtained voluntarily, and those that were either received from death row inmates, or from even darker origins.
The urban legend of the person who wakes up in a bathtub full of ice, missing a kidney, may be a myth, but it isn’t all that divorced from reality. There are myriad ways in which organs are coerced from people, but in the majority of cases, rather than partying tourists, victims tend to be the poor who are desperate for cash, such as migrant workers. Given the fact that demand is already high, the effect on the market if death-row organs are removed may or may not be significant, though it is unlikely those who would have received organs from death row inmates will give up searching for life-saving transplants. Perhaps they will simply look toward the people who need cash and are keen to sell their organs.
Desperate cases aside, the other side of the problem is the low rates of organ donation among the general public. Much of this can be attributed to traditional Confucian beliefs about the sanctity of the human body, even after death, which result in resistance to organ donation. This is one of the key reasons frequently cited by the authorities when explaining the difficulties of reform in organ donation. As the Wall Street Journal pointed out, results of surveys conducted by local media indicate low numbers of people willing to donate.
“According to an online survey done in May by the China Youth Daily newspaper and the website qq.com, fewer than half of more than 40,000 young Chinese people wanted to be organ donors. A 2012 online survey of all ages showed that 66% don’t want to donate.”
But there is also widespread skepticism about the safety and transparency of the hospital system, which means that people are often unwilling to risk the possibility organs will be taken from them under improper circumstances. One New York Times report outlined the problem via a case of an altruist who at first wanted to donate his organs, but was appalled at the greed he encountered.
“Then, Mr. Xu said, things turned ugly. The two representatives challenged each other over whose organization would have the rights to his corneas. ‘They started to argue,’ Mr. Xu said in a telephone interview. ‘They treated me as if I were just a commercial transaction. I said, ‘You people really have no conscience’.’
The experience soured him on the idea, and he decided not to donate, after all.”
The article highlighted the lack of trust in the Red Cross Society of China (not to be confused with the Red Cross in other countries, which it is not directly affiliated with) which often handles organ donations and has been struggling with a credibility crisis after a string of scandals.
Ultimately, while the ban on organs from death row inmates is a step in the right direction, it is unlikely to be a silver bullet that resolves the problem – after all, the use of organs from prisoners is just one part of a much larger, complicated organ-donation problem. It is an issue that will require a lot of time, dedication from the authorities, and increased transparency, before significant improvements are seen.