Due to the scarcity of donated organs patients around the world regularly die while waiting for life-saving transplants. The prospects for those on a transplant waiting list in China are particularly gloomy as at least 150 people scramble for every donated organ.
　　According to the Ministry of Health, about 1.5 million people in China need transplants every year, but only around 10,000 transplants are performed due to the lack of available organs.
　　Vice Minister of Health Huang Jiefu said in March that within three to five years China plans to create a transparent national organ donation system and ban organ donations from death row. According to a paper published by Huang in 2011, more than 65 percent of the organs used in transplants in China had been taken from executed prisoners as of 2009.
　　According to a 1984 regulation, organs can be taken from an executed inmate only when nobody collects the corpse, the inmate has expressed his or her willingness to donate organs or the inmate’s family members consent to the harvesting.
　　The practice of harvesting organs from executed prisoners not only is ethically controversial but also raises safety concerns. Huang, who worked as a transplant surgeon for a long time, said that the rates of fungal and bacterial infections in organs taken from executed inmates are often high, which explained why the long-term survival rates of organ transplant recipients in China are below those of the most advanced countries.
　　 Huge demand, low supply
　　In China, the quality of donated organs rather than the skill of surgeons is seen to be the major cause of post-transplant deaths. Chinese surgeons can perform a wide range of trans- plant surgeries and according to the World Health Organization, the number of organ transplant procedures in China is surpassed only by the number performed in the United States.
　　Zheng Shusun, one of China’s top liver transplant surgeons, said that the success rate of China’s liver transplant surgeries is above 99 percent and the post-transplant survival rates of recipients in one year, five years and 10 years are 90 percent, 80 percent and 70 percent, respectively.
　　Fu Shaojie, a seasoned kidney surgeon from Nanfang Hospital in southern Guangdong Province, said that the survival rate of patients undergoing kidney transplants 10 years after the operation has reached 80 percent.
　　According to official statistics, China has around 1 million patients suffering from end-stage kidney disease who can be cured by a transplant and about 300,000 patients of end-stage liver disease who need transplants. However, less than 4,000 kidney transplants and less than 1,500 liver transplants were conducted in China in 2011.
　　Fu said that the majority of his uremia patients are in need of a donated kidney that is a match. “Many of them die while waiting for a donated kidney,” Fu said.
　　Chinese customs call for people to be buried or cremated with the body intact. One die-hard superstition has it that if an organ is taken from a body after death, the person in question will be reborn with a handicap in that organ in his or her next life.
　　China didn’t have a publicized case of cadaver organ donation until 2003 when the parents of nine-year-old Tian Jin donated his kidneys after the boy was killed in a traffic accident. Despite some pubic awareness campaigns in recent years, the rate of cadaver organ donation in China is a negligible 0.03 per 1 million people, which lags far behind that of other countries.
　　Though China’s current regulation states that citizens can become organ donors if they write a will of donation, such a desire is not always honored. Shen Weixing, Vice Dean of the Law School of Tsinghua University, said that in practice if family members oppose organs being taken away from the cadaver, no medical professional will insist on harvesting the organs.
　　Unlike many other countries, applicants for a driver’s license in China are not asked whether they want to be organ donors in the event of death. During an online survey about the possibility of introducing such a system in China at news portal Xinhuanet. com, 74.8 percent or 5,177 respondents said they wouldn’t accept such a system as it is too inauspicious while only 21.8 percent were supportive.
　　The acute shortage of donated organs has driven the development of underground networks that profit from illicit organ deals and transplants.
　　In February 2011, the Standing Committee of the National People’s Congress, China’s top legislature, adopted an amendment to the Criminal Law, which for the first time singles out criminal activity related to transactions involving human organs. It states that those convicted of “forced organ removal, forced organ donation or organ removal from juveniles” could face homicide charges.
　　Despite this, the black-market organ trade is still a problem. Last June, a 17-year-old high school student from east China’s Anhui Province sold one of his kidneys for 22,000 yuan ($3,492) through an underground dealer without telling his parents and used the money to buy an iPad2 and a laptop computer. The news caused an online furor with thousands of comments lamenting the poor enforcement of laws.
　　In March, a Beijing court prosecuted 16 people for organizing the illegal sale of 51 human kidneys worth about 10 million yuan($1.6 million) in what is China’s biggest organ trafficking case to date.
　　The ring is accused of deceiving scores of young and poor people to sell kidneys by paying them approximately 25,000 yuan ($3,970) each. The kidneys were then sold to transplant patients for about 200,000 yuan ($31,750) each. Those involved in the scam include doctors from public hospitals.
　　 Needing further regulations
　　In 2007, the State Council, China’s cabinet, promulgated the Regulation on Human Organ Transplantation, the first national regulation in this field. It explicitly bans the sale of organs and limits recipients of organs donated by living donors to the donor’s spouse, lineal relatives by blood, collateral relatives within the third degree of kinship and people who have developed family-like relationship with donors by aiding them. The regulation also requires any transplant surgeries to be conducted in medical institutions with qualified staff, sufficient equipment, a clinical and medical ethics committee and a registration at the provincial-level health authorities. In the ethics committee, transplant surgeons should not constitute more than a quarter of the total membership.
　　The regulation also requires every case of organ harvesting from cadavers to be reviewed by the ethics committee in order to rule out the possibility of organ sales. An application for a transfer can only be ratified if more than two thirds of committee members give their approval.
　　Shen at Tsinghua University, who is participating in the revision of the regulation, told Beijing Review that in light of the revised draft, organs donated by living persons can no longer be used by people who are emotionally related to donors through aid since the clause has been abused to facilitate organ sales. He said that another major change is to clearly identify the responsibilities and duties of Red Cross organizations in promoting organ donation.
　　According to the Red Cross Society of China, under a pilot program in 16 provinciallevel regions across the country, 207 deceased donors donated 546 life-saving organs and 15,379 people registered as organ donors in the past two years.
　　Hao Linna, Vice President of the Red Cross Society of China, who led the twoyear pilot program, said that proposed additions to the organ donation regulation include “Red Cross organizations around the country shall participate in awareness campaigns for organ donation, donor registration, organ allocation, remembrance of organ donors and distributing humanitarian benefits to their surviving families,” and “the country encourages citizens to donate their organs after death.”
　　“Encouraging public donations and widening the available legal sources of organs is the only solution to the transplant organs shortage in China,” Hao said.
　　But promoting organ donation is a very complicated process, requiring clear guidelines on procedures for determining death, harvesting organs and allocating organs. Hao said that only by establishing an independent national-level institution can the work of drafting organ donor laws and regulations, collecting suggestions from various professionals and training personnel in this field be effectively conducted.
　　Zhao Baige, Executive Vice President of the Red Cross Society of China, said that the efforts to promote deceased organ donation demand coordinated efforts and support from different government departments. “Crossdepartment coordination is badly needed when donors are traffic accident victims or die in a place other than their permanent residences,” she said.
　　Also badly needed are laws and regulations defining the compensation standards for the families of deceased organ donors. Under the two-year pilot program, relatives of 90 percent of the 207 deceased donors successfully applied for subsistence benefits, spurring public worries that monetary rewards could become disguised forms of payment for donated organs.
　　“Organ donation is a fair cause and we are totally against the routine where the poor sell organs for money and the rich simply benefit,” Huang said.
　　However, Hao said that it is an international norm to provide donors’ families with financial aid, which was distinct from organ trading.
　　Experts suggest that the compensation amount should be set according to the financial need of the family and not based on how many organs a donor has donated, to avoid money-driven donation. A national regulation on managing an organ donors’aid fund is reportedly at its drafting stage.
　　


　　 Transparent procedures
　　China’s future national cadaver organ donation system, which has taken shape in the 16 provincial-level regions that participate in the pilot program, will be composed of eight databases that are still being fine-tuned by the Ministry of Health.
　　When the system is set in place nationwide, after an organ donor dies, all the donated organs will be registered in a database to prevent sales. Their availability and testing information will be immediately uploaded to a national network for organ sharing, which can be accessed by transplant surgeons from all qualified hospitals. Doctors of patients on the waiting list will be informed of the availability of organs through a cell phone text message.
　　Information of all organ transplant surgeries will also be put in a data pool. Therefore, when a patient with an illegally transplanted organ visits a hospital for post-transplant check-ups, doctors can confirm the nature of the transplant and report the case to health authorities through another system. Then health authorities can investigate the source of the organs and punish medical facilities that conduct illegal surgeries.
　　Through the two-year pilot program, a breakthrough has been made on making organ allocation more transparent.
　　The organ allocation network on trial has prioritized the urgency of patients’ conditions and geographic proximity in a unified national waiting list. Under the trial system, when a donor dies in a hospital, patients hospitalized in the same facility will be first considered as recipients. If there is more than one candidate, the sickest patient will get the organ. When there is no candidate, the recipient search will be expanded to medical facilities in the same city, and then in the same province and finally around the country. Last year, a donated liver harvested in a hospital in Guangzhou, Guangdong Province, traveled more than 2,000 km to save a person’s life in north China’s Tianjin, which was impossible before the adoption of the national sharing platform.
　　Designers of the organ sharing network argue that the proximity-based rules ensure that organs spend the shortest possible period of time out of a body, which guarantee the highest success rate for the transplant. The only exception is when the donor’s close relatives need an organ, in which case they will be granted priority.
　　Li Peng is a surgeon at a hospital in Guangzhou. He said that without the ground-breaking national organ sharing network, medical facilities used to compile their own waiting lists according to different criteria. While some prioritized patients with the longest waiting time, others thought the survival rate was the most important gauge.
　　An anonymous surgeon told the The Beijing News that in the past with no clear system, donated organs were often handed out to those with professional connections to the harvesting surgeon. It was also reported that some doctors would favor their acquaintances or even patients who were willing to bribe them.
　　“Only when the organ allocation is fair, will more people be willing to become donors,” Li said.
　　During the two-year pilot program, an unexpected hindrance to the organ donor enlistment has come from hospitals and clinics, which are reluctant to turn off life-sustaining equipment for fear of litigation from families.
　　The Beijing News reported a case in a province covered by the pilot program where family members of a brain-dead patient had agreed to donate the person’s organs when the president of the hospital opposed removing life support for fear of malpractice litigation. Eventually, the family had to give up their altruistic act. An anonymous organ donation coordinator who worked on this case blamed the lack of public awareness of organ donation for the hospital’s fear.
　　Hao said that many hospitals don’t want to get involved in organ donation at all due to legal risks.
　　In countries like the Netherlands, education programs enabling teenagers to make an informed decision about organ donation have proved effective in increasing the number of potential donors. In China, such programs have yet to be conducted.
　　A recent survey conducted by the Red Cross Society of China on 1,000 people in 12 provincial-level regions revealed that 72.4 percent respondents expressed their willingness to become organ donors after knowing that their bodies can save lives. About 70 percent of those who support organ donation were teenagers and young adults.
　　“It is a surprise for us to know that there are so many people supporting this cause out there,” Hao said.