Minister wants humane stance on organ cases

PUBLISHED : Sunday, 25 March, 2012, 12:00am
UPDATED : Sunday, 25 March, 2012, 12:00am


Deputy Health Minister Huang Jiefu says he is a doctor first; official second. And it is this sensibility that has made him speak out boldly against perceived ills in the health system - starting with the practice of taking organs from dead inmates.

The 66-year-old Huang (pictured) has stood out among the central government's top officials for his sharp criticism of public-hospital reform and health policies.

'I speak with the consciousness of a doctor - and a doctor who has been working in the medical system for so many years,' Huang told the South China Morning Post.

At a conference in Hangzhou city on Thursday, Huang, an Australia-trained surgeon, said China would phase out within three to five years the practice of sourcing organs from executed inmates, Xinhua reported.

'The fact that most organs [for transplant] come from executed prisoners tarnishes the image of China,' Huang said. 'It needs to be replaced with a more ethical and sustainable system.'

In a paper published in The Lancet medical journal in March, Huang said China was the only country to systematically use organs from executed prisoners in transplants. It said 65 per cent of transplant operations done in China used organs from deceased donors, 90 per cent of whom were executed inmates.

Huang, who is also the chief of Peking Union Medical College Hospital's liver surgery unit, has himself performed more than 500 liver transplants and does 100 surgeries a year.

China is second globally in terms of the number of organ transplants performed each year, at more than 10,000. But the procedure's rapid development has been criticised as barbaric, since many of the organs are harvested from prisoners who had been forced to donate or whose consent was not nonexistent.

Despite this, doctors feel compelled to operate within the system to help their patients, Huang wrote in The Lancet paper. He also noted that most transplant doctors in China would avoid discussing organ procurement in international academic forums out of shame.

'I have been working to advance the establishment of [a] voluntary organ-donation system because I am a doctor, and that's what the patients need. Organ transplants are the last resort to save a patient,' Huang said.

The more humane system, similar to the United Network for Organ Sharing in the United States, will try to ensure a transparent, fair and need-based system to identify beneficiaries.

Huang acknowledges that some doctors who benefit from the old organ-sourcing system may resist the new scheme even if organs from patients who die of cardiac death, for instance, are of higher quality than those from prisoners.

'Doctors who are opposed to the [new] system must be trying to protect their own interests to profit from the involvement of the courts and army police. They won't be able to do that anymore with this open organ-donation system,' he said.

Voluntary donations are rare or virtually unheard of on the mainland, partly due to the traditional belief that a body should be buried or cremated intact. The lack of quality organs has also been exacerbated by a law that restricts organ sourcing from living donors to a patient's blood relatives. More than one million terminal kidney patients and 300,000 terminal patients with liver disease await transplants each year.

The gap between organ supply and demand has given rise to organ trafficking. Huang said the illegal trade resulted in six hospitals being disqualified last year from performing such transplants, and 16 doctors saw their licences revoked.

'We can't crack down on organ trade by banning living organ donations,' Huang said. 'We must build a voluntary donation system, and I believe that, once such a system is set up, such cases won't happen again.'

Huang's proposed system is currently being pilot-tested in 16 provinces and cities, and is expected to go national within the year. It will use a National Deceased Donor Database. 'The trial went very well and enabled around 200 organ donations. When the trial started in 2009, I expected only 100 surgeries,' Huang said.

The Red Cross Society of China is in charge of approaching the families of terminally ill patients and assigning organs to recipients.

Huang expects amendments to the 2007 Regulation on Human Organ Transplantation within this year, as the legal basis for the scheme.

Congruent to his fight for more ethical organ-donation policy is Huang's push for urgent reforms in China's 20,000 public hospitals, which he says 'are not public in the real sense'.

Huang says government financing comprises a meagre 10 per cent of each hospital's funds - barely enough for retired medical staff's pensions. Hospitals must find other sources of income, usually in the form of a 15 per cent surcharge they are allowed to place on prescribed drugs.

This, Huang says, has made hospitals profit-driven. 'Public hospitals will continue to pursue profits until the system is fixed.'

But the minister says the government cannot afford to increase public-hospital funding, so proposed allowing more private investment. He said the government could finance the operating costs of 1,000 provincial hospitals, 2,000 county hospitals and 100 major, high-quality hospitals. The rest could be run by private investors, he said.

'[Doctors] wouldn't worry about generating more income ... being able to choose the most reasonable and cheapest [treatments] rather than the most profitable ones.'