SAVING A LIFE: China ranks second in the world in the number of transplants after the United States. Doctors here prepare a liver for a transplant
Organ transplant represents a very sensitive and complicated issue. Experts say the temporary administrative regulations recently promulgated by the Central Government are an important step, but relevant laws and regulations must follow. Among these, the experts agree, legislation dealing with brain death is the most basic and urgent.
Since China has not instituted laws on brain death, people still accept the traditional standards for determining death: the cessation of breathing and heartbeat. However, there often is a time lapse between brain death and the cessation of heartbeat. If organs are removed only when the heart stops beating, many have lost their transplant value.
“Without legislation on brain death, there is no actual effect, however hard China advocates organ donation,” Chen Dazhi, Deputy Director of the Beijing Organ Transplant Center at Chaoyang Hospital, told Beijing Review.
Related Chinese government departments have realized the need for legislation to establish when a person is “brain dead,” that is, when the brain has ceased to function. In April 2000, the Ministry of Health carried out its initial research on the standards for brain death, because there were cases in which organ donations were made after a person was brain dead but before the death was determined by traditional standards, which aroused a lot of public controversy.
In 2003, the Ministry of Health issued a draft on Judging the Standards of Brain Death (Adults) for public opinion. In 2005, when the ministry was seeking views from the public on the Temporary Regulations on the Administration of Human Organ Transplants for Clinical Purposes, Vice Minister of Health Huang Jiefu said that the provisions might adopt the dual standards of the cessation of heartbeat and brain death, based on the family’s choice.
Later on, there were some reports that the Chinese Government would promulgate a law on brain death. But the temporary regulations make no mention of any standard for determining death, let alone the words “brain death.”
Sun Dongdong, professor at Peking University’s Law School who participated in the draft of the brain death law, said, “The greatest difficulty comes from people’s traditional concept. The standards for brain death will be drawn up, but not in the near future.”
Regulating the market
“The present regulations provide the access system but haven’t solved the problems of organ sources and donation,” said Chen Zhonghua, Deputy Director of the Organ Transplant Branch of the Chinese Medical Association.
Chen of Chaoyang Hospital said he is deeply aware of this problem. “The organ market is the foundation of the transplant industry. Only by regulating the source can we solve other problems,” he added. However, there are no related provisions in the present regulations, such as the procedures for donation, as well as the rights and obligations of related parties. The temporary regulations, issued by the Ministry of Health, only stipulate that human organs are not to be traded, that a donor’s written permission is required for medical institutions to use human organs in transplants and that the donor has the right to revoke that permission.
According to Chen, information is still not transparent in the market for organs and there are no nationwide networks. In the struggle to obtain limited resources, hospitals operate individually, which runs counter to the effective use of organ resources and may lead to a black market.
Therefore some experts hold that the government should establish special institutions responsible for publicity and the collection of donated organs, and a fair and transparent allocation network should be formed on this basis. At the same time, they say China should impose more serious penalties on illegally dealing in human organs by amending the Criminal Law.
Why do the newly issued regulations contain no provisions related to the market for organs? Wang Yanguang, professor at the Philosophy Institute of the Chinese Academy of Social Sciences, believes that health departments alone cannot solve the problem of regulating this market and that input from the justice and other ministries is required.
More organ sources needed
Expanding the sources of organs is another difficulty the Chinese organ transplant industry faces. On driver’s licenses in the United States, there is a choice of whether to donate organs. If the license holder chooses “yes,” hospitals can remove useful organs without the consent of the family after the person is judged brain dead. At present, more than 80 percent of transplanted organs come from victims of traffic and other accidents in the United States.
Noting the convenience of this channel, some local governments in China have begun to look into the matter. In February, deputies to the Shenzhen People’s Congress from the medical community handed in a proposal for similar regulations, promoting the donation of organs of people who die in car accidents. Rather than rejecting the proposal as expected, the local legislative body said it would research the proposal together with health, public security and other relevant departments.
Except for Shenzhen, no Red Cross societies in China, including the Red Cross Society of China (RCSC), have mechanisms to receive donated organs, and the Shenzhen Red Cross Society only accepts organs after the donors die. In a telephone interview with Beijing Review, an RCSC official said, “This is quite sensible and there is no law for us to apply to.”
Fu Yanhua, Deputy Chief Procurator of Zaozhuang People’s Procuratorate in Shandong Province, believes that, in addition to publicity and education on organ donations, the government should also encourage free organ donations through preferential policies, such as reducing or remitting the medical fees of donors or providing a long-term medical guarantee to the donors or their families.