Myth: Voluntary donors are the main source of organs in China

Lack of institutional and legal standards for brain death

For decades, brain-dead donors have been the main source of transplant organs outside of China. However, China has neither brain death legislation nor significant voluntary organ donation. Before 2010, there was no organ donation system in China.

Xinhua News Agency reported in August 2005 that China is the only transplant-capable country without brain death legislation.¹ As a result, 90% of Chinese doctors, as of August 22, 2014, were not aware of the criteria for verifying brain death.²

The number of organs sourced from brain-dead donors in China is negligible. In a July 2006 report, Dr. Chen Zhonghua said, “Ms. Yang, a 39-year-old woman, is the first voluntary brain-dead organ donor in our country … This is the first case that met international criteria for a brain-dead donor.”³

In April 2006, Sanlian Life Weekly reported,

“China currently has a voluntary organ donation rate from living relatives of 1.1%. The control of over 98% of organ sources originate from outside of the Ministry of Health system.”⁴

In December 2008, a report published online stated that almost all Chinese transplant doctors viewed voluntary organ donation as “unachievable.” Li Leishi, an academician at the Chinese Academy of Engineering and founder of the PLA Institute of Nephrology, wrote in a paper,

“In China, organ donation after a citizen’s death exists only theoretically. In actuality, it is not possible. There are no such conditions institutionally and legally.”⁵

The Organ Donation Management Commission of China was established on August 1, 2006. Dr. Chen Zhonghua was the first Executive Chairman of the Organ Donation Management Commission of China.⁶ In July 2010, an article in the Organ Transplantation journal stated, “since 2001, when Dr. Chen Zhonghua and his team began promoting organ sourcing for transplants from the brain dead, there have been over 60 successful organ donations after brain death in China.”⁷

Few donations after cardiac death (DCD)

Donations after cardiac death (DCD) were another organ source commonly listed by China’s transplant centers. However, very few DCD transplants have been performed despite pilot programs to expand this type of procurement.

The Red Cross stated that, in the two years after DCD pilot programs were launched, China completed 207 donations after cardiac death.⁸ Divided among the more than 147 participating hospitals, this is equivalent to fewer than one DCD case per year per hospital.

Although the Ministry of Health and the Chinese Red Cross launched the Human Organ Donation Pilot Program (DCD) on March 2, 2010, many regions have not received any actual donations over the years.

According to the official website of Health and Family Planning Commission of Heilongjiang Province, it was not until June 2015 that the province completed its first DCD donation.⁹

Fujian Province, a leader in heart transplantation in China, just completed its first DCD heart transplant in May 2015.¹⁰

The No. 81 Hospital of Nanjing Military Region stated on its website that it completed the first DCD donation in the Nanjing Military Region in April 2015 and that it was the second DCD donation in Jiangsu Province.¹¹

One of the biggest transplant centers in Hubei Province, Dongfeng General Hospital, completed the first DCD liver transplant in northwestern Hubei in July 2015.¹² However, as early as in August 2000, it conducted 10 kidney transplants, one thyroid transplant, and 3 corneal transplants in the same day.¹³ The hospital’s vice president Yuan Fangjun stated in 2009, “Kidney transplantation is now a routine surgery. Almost all surgeons at our hospital can independently complete kidney transplants.”¹⁴

Few voluntary donors as of the end of 2015

In March 2010, China piloted an organ donation program in Shanghai, Tianjin, Liaoning, Shandong, Zhejiang, Guangdong, Jiangxi, Fujian, Xiamen, Nanjing, Wuhan, and eventually in a total of 19 provinces and cities.¹⁵ This program was jointly run by the Ministry of Health and Chinese Red Cross.

A year after the launch of the Nanjing Organ Donation pilot program in March of 2010, not a single voluntary organ donation had been received. In the 20 years prior to that point, only three people had donated their organs in Nanjing.¹⁶

In Shanghai, the first organ donation from a deceased donor took place on August 21, 2013. Yet, there were 11 transplant centers in Shanghai approved by the Ministry of Health.¹⁷

Huang Jiefu stated in 2013 that he performed more than 500 liver transplants in 2012, one of which was “the first voluntary citizen donation meeting Chinese standards.”¹⁸

In a 2013 news report, organ coordinators stated that, among 100 potential organ donors, about half were ineligible because they could not meet the requirements for donation. Of the remaining donors, about 30 provided organs that were unusable because of delays in the availability of organs after death. Ten donations were overruled by relatives’ objections. In the end, there were fewer than five available donors.¹⁹

In November 2015, Huang Jiefu indicated that China’s trial organ donation and allocation systems still had not produced donations on any meaningful scale. He added that China’s organ donation system did not function in practice because the Red Cross and the National Planning Commission, the two most important organizations in organ donation, did not actually coordinate with each other:

“The two departments jointly established a national organ donation and transplantation committee on March 1, 2014, but it exists in name only. So far no meeting has been held yet.”²⁰

According to a 2006 Xinhua report, Jia Ruipeng, director of the Kidney Transplant Center at Nanjing Hospital No.1, said,

“Between the first living relative kidney transplant in 1972 and the end of last year, there were only 700 living relative kidney transplants in the country, accounting for only about 1.5% of all renal transplants.”²¹

China’s Ministry of Health has repeatedly proposed restrictions on living organ donations rather than encouraging the practice. According to a report published by China Network, Huang Jiefu indicated in March 2008 that the National Human Organ Transplantation Clinical Application Committee (OTC) would strictly regulate and manage living organ transplantation. He said, “So far, the main source of organs has been cadavers.”²² During the human organ donation pilot summary conference held by Chinese Red Cross and the Ministry of Health in Hangzhou, on March 22, 2012, Huang Jiefu again said the state would gradually restrict living relative transplants.²³

On March 27, 2012, the director of the Urologic Department of the People’s Hospital of Zhejiang Province, Xiao Jiaquan, said that the Ministry of Health was restricting relative donation due to adverse impact on donors’ health and to curb underground organ trafficking.²⁴

On March 26, 2012, JCRB.com (managed by the Supreme People’s Procuratorate) published a case report regarding an underground kidney broker, Cai Shaohua (defendant), who said that doctors told them that the matching rate between relatives was very low; even if there was a marginal match, it could result in complications after surgery, which would only cause bigger losses for the patient’s finances and health. Cai said,

“Now [among relative-donor] organ transplant surgeries, nine out of ten are fake relatives. Those in the hospitals are well aware of the things that we [brokers] do.”²⁵

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