Transplant tourism from the Middle East to China raises ethical issues

 

In a recent speech to the Middle East Society for Organ Transplantation in Istanbul, Canadian international human rights lawyer David Matas shed light on one of the hidden aspects of medical tourism. The focus was on transplant tourism from the Middle East into China.

Matas concluded, “ There is every reason to conclude that there is substantial transplant tourism from countries in the Middle East to countries where the patients are not nationals and to China in particular. Transplant tourism into China means receiving organs from prisoners of conscience killed for their organs. The efforts in the region to combat this transplant tourism are underdeveloped. There needs to be more of an effort in the Middle East to combat transplant tourism. National professional associations should require compliance with international standards.”

The key professional international standards on transplant tourism are:
•    The Transplantation Society Ethics Committee Policy Statement   Chinese Transplantation Program November 2006 and Mission Statement (TTS).
•    The Declaration of Istanbul on Organ Trafficking and Transplant Tourism May 2008 (Istanbul)
•    World Health Organization Guiding Principles on Human Cell, Tissue and Organ Transplantation, May 2008 (WHO)
•    World Medical Association Statement on Organ and Tissue Donation October 2012 (WMA)

Every national and regional professional association and society should develop a written ethics policy on the clinical practice of transplantation, including the subject of executed prisoners. (TTS)

There should be no recovery and no complicity in the recovery of organs or tissues from executed prisoners. (TTS and WMA)

Organ trafficking and transplant tourism violate the principles of equity, justice, and respect for human dignity. (Istanbul)

There should be no advertising (including electronic and print media), soliciting, or brokering for the purpose of transplant commercialism, organ trafficking, or transplant tourism. (Istanbul)

The practice of donation and transplantation requires oversight and accountability by health authorities in each country to ensure transparency and safety. (Istanbul)

Mechanisms for transparency of process and follow up should be established. (Istanbul).

The organization and execution of donation and transplantation activities, as well as their clinical results, must be transparent and open to scrutiny. (WHO)

Collaboration amongst transplant professionals in different countries must protect the vulnerable, promote equality between donor and recipient populations, and not violate other basic organ transplant principles. (Istanbul).

Matas used the Omar Healthcare Service to illustrate the problems. The website in Arabic and English dated from 2007 and targeted transplant tourists from the Middle East. Its opening page used both the Arabic and English languages at the same website, which explains the use of the name Omar. It promoted transplants in Tianjin, China with “We are here to assist you in getting a kidney, liver or heart transplant in China. We work with the most qualified two hospitals in China: Tianjin First Central Hospital and International Cardiovascular Hospital.”

The Transplantation Society write to President of China Xi Jinping “The Tianjin website continues to recruit international patients who are seeking organ transplants … the fact that foreign patients are still undergoing transplantation in China suggests that some hospitals are boldly and irresponsibly violating Chinese government regulations, thereby rendering the law a mere paper tiger. These hospitals are jeopardizing the public trust at home and tarnishing China’s reputation on the international stage.” The website vanished

Matas says, “While transplant tourism generally is a concern, transplant tourism into China has to be of particular concern because of compelling evidence that the bulk of organs for transplants comes from innocent prisoners of conscience in China detained arbitrarily because of their beliefs.”

It is easy to attack his evidence as outdated or generalistic, but his response to such attacks from China is, “ Investigators made calls to hospitals throughout China, claiming to be relatives of patients needing transplants, asking if the hospitals had organs for sale. We obtained answers on tape, transcribed and translated admissions throughout China.”

Matas and his research ream interviewed patients who went to China for transplants and found:
•    Waiting times for transplants of organs in China are days and weeks. Everywhere else in the world waiting times are months and years. A short waiting time for a deceased donor transplant means that someone is being killed for that transplant.
•    There is a heavy militarization of transplantation in China. Hospitals with a ready supply of available organs are often military hospitals. Even in civilian hospitals, the doctors performing operations are often military personnel. The military have access to prisoners as organ sources and the sale of organs is a prime source of funds.
•    The standards and mechanisms that should be in place to prevent the abuse are not in place, neither in China nor abroad.
•    The Government of China attributes the sourcing of the bulk of organs to prisoners sentenced to death and then executed but then refuses to provide death penalty statistics on the basis that they are state secrets.
•    China is the second largest transplant country in the world by volume after the US. Until this year, China did not have an organ distribution system. The organ distribution is limited to the relatively small donated organ numbers, and does not distribute organs from prisoners. The living donor sources are limited in law to relatives of donors and officially discouraged because live donors suffer health complications from giving up an organ.

Hospitals in Tianjin cater to Arabic speaking transplant tourists.  In Tianjin there have been 100 voluntary donations after cardiac death donors in the last four and a half years. There were 870 registered voluntary donors. Tianjin is a city with a population of 7.5 million. Tianjin has a 200-bed transplant centre that has done 6,000 transplants within the last 11 years. It is apparent that those 6,000 transplants did not come from donors.

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