Organs Extracted from Living Bodies

Living transplants in Mainland China differ from those in the rest of the world. In China, it is common practice to excise whole vital organs from living sources. Extracting a whole vital organ kills the donor.

For example, Chinese Medical University’s China International Transplantation Network Assistance Center (CITNAC) emphasized:

“In China we carry out living donor kidney transplants. It is completely different from cadaver kidney transplants you hear about in Japanese hospitals and dialysis centers…Compared to cadaver kidney transplants in Japan, what is offered here is much safer and more reliable.”¹

Chinese transplant hospitals claimed to have ample supplies of young, healthy organ donors. For example, the Liver Transplant Center at the People’s Liberation Army General Hospital of Beijing Military Command stated that they had established a fast and efficient supply channel from which to obtain excellent quality livers in the vicinity of Beijing as well as from other cities and provinces.²

In medical papers published by doctors from these hospitals, donors are often described as “free of hepatitis, fatty liver, malignant tumors and chronic disease with no long-term medication history or history of alcohol consumption.” Most of these papers cited warm ischemia times (WIT: the period of time from circulatory arrest to perfusion of the organ) of less than 10 minutes, with some even listed as 0 minutes, and the majority of organ sourced from “brain-dead donors,” “cadavers,” “non-heartbeat cadavers,” and “healthy young cadavers.” We list a few examples.

Table: Warm ischemia times for liver transplants reported in medical publications

Zhang Xiaodong, director of the Kidney Transplant Center at Beijing Chaoyang Hospital, said, “After the heart stops beating, the circulation stops, and this will cause organs to fail. The tolerable WIT is 3 to 4 minutes for hearts, 5 to 8 minutes for livers, and 30 minutes for kidneys.”⁷

Organs are transplantable only when the time and location of a donor’s death are known in advance and the organ procurement team is well prepared. Thus, vital organs from those who have died outside of a hospital (e.g. in car accidents) are not viable for transplantation. Regardless, organs with warm ischemia times of 0 to 5 minutes from “no-heartbeat cadavers” have become a common source of transplants in China.

For decades, brain-dead donors have been the main source of transplant organs outside of China as such organs have the shortest warm ischemia times possible. Because Chinese tradition requires bodies to be preserved intact after death, China has neither brain death legislation nor significant voluntary organ donation.

Xinhua News Agency reported in August 2005 that among countries capable of transplantation, China is the only country without brain death legislation.⁸ As a result, 90% of Chinese doctors, as of August 22, 2014, were not aware of the criteria for verifying brain death.⁹

The number of organs sourced from brain-dead donors in China is negligible. On July 25, 2006, Yangcheng Evening News published a report titled “The first successful lung transplant from a brain-dead donor.” 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.”¹⁰

The Organ Donation Management Commission of China was established on August 1, 2006. Dr. Chen Zhonghua served as the first Executive Chairman of the Organ Donation Management Commission of China.¹¹ 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.”¹²

Donations after cardiac death (DCD) were another commonly listed organ source in China’s transplant centers. Warm ischemia times of 0 to 5 minutes with “no-heartbeat cadavers”¹³ have become a standard practice of Chinese transplant doctors. However, there have been few recorded DCD donors despite pilot programs to expand this type of procurement.

Although the Ministry of Health and the Chinese Red Cross launched the Human Organ Donation Pilot Program (DCD) in March 2010, many regions have not actually received any donations over the years. The Red Cross stated that, in the two years after DCD pilot program was launched, China completed 207 donations after cardiac death.¹⁴ Divided among the more than 147 participating hospitals, this is equivalent to less than one DCD case per year per hospital.

Heilongjiang Province did not complete its first DCD donation until June 2015.¹⁵ Fujian Province, a leader in heart transplantation in China, just completed its first DCD heart transplant in May 2015.¹⁶ The No. 81 Hospital of Nanjing Military Region completed the first DCD donation in the Nanjing Military Region in April 2015. It was also the second DCD donation in Jiangsu Province.¹⁷ One of the biggest transplant centers in Hubei Province, Dongfeng General Hospital, completed the first DCD liver transplant in northwestern Hubei in July 2015.¹⁸

Chinese transplant doctors have developed their own standard procedures for excising organs in order to achieve the desired short warm ischemia times. Because it is not possible to achieve a warm ischemia time of 5 minutes or less sourcing organs from cadavers, living people are killed with this type of organ extraction and turned into “no-heartbeat cadavers.”

Tianjin Medical Journal published a study in 2009 that analyzed 1,600 liver procurements performed between 2004 and 2008 at the Tianjin Organ Transplant Center.¹⁹ Among these 1,600 cases, most livers were taken from young, healthy males with an average age of 34.5 years. Based on this study, Shen Zhongyang, director of the Center, created a surgical procedure for extracting livers from “no-heartbeat cadavers” that could keep the warm ischemia time to 5 minutes or less. This procedure has been adopted widely in China.²⁰

Other well-known transplant centers have also developed organ excision procedures to minimize warm ischemia times. Liu Yongfeng, director of China Medical University’s Institute of Organ Transplantation, created a technique for rapid extraction of an abdominal organ by excising surrounding organs simultaneously, which he claimed could reduce both organ damage and warm ischemic time. Currently, this explantation procedure is widely used in many hospitals throughout China.²¹

Between 2003 and August 2009, only 130 citizens successfully donated their organs after death in Mainland China.²² This translates to fewer than 30 donations per year.²³ The number of livers used by the Tianjin Organ Transplant Center alone has exceeded the number of citizen organ donations in all of China.

References