Shortage of Organ Donors in China? Blame Confucianism

[Clark]

http://www.bloomberg.com/news/2015-01-08/chinese-clinging-to-confucius-fuel-organ-donor-shortage.html

Shortage of Organ Donors in China? Blame Confucianism

Chinese organ transplant coordinator Gao Min spent hours on paperwork by the bedside of a comatose 81-year-old donor. Within minutes of her leaving the hospital, her work was scuttled by the man’s three nephews, who pressured his wife into withdrawing her consent.

“She said they scolded her and yelled, ‘how could you be so cruel? He’s dying and you want to cut up his body?’” said Gao. The man died, his wish to be a donor unfulfilled.

Between 6,000 and 9,000 transplants are conducted in China each year, a fraction of the roughly 300,000 needed, according to government data. The rising incidence of chronic diseases such as liver cancer along with a government drive to end a controversial practice of using executed prisoners’ organs may worsen the shortfall and make the work of coordinators like Gao more crucial.

Many Chinese believe that an intact body is needed in the afterlife, and medical workers and volunteers seeking donors usually face a protracted battle with extended families. “The body, hair and skin are received from the parents and one dares not harm them,” says one Confucian teaching.

Red Cross

A nationwide organ donation system was launched by China’s government as recently as February 2013, before which organs were donated through local programs or arranged case by case. In 2014, about 1,700 people contributed organs through that program, largely through the efforts of coordinators like Gao.

Gao, one of the first donation coordinators in the country, is an unpaid volunteer for the Red Cross Society of China. She keeps her phone on 24 hours a day, sometimes answering the questions of anxious family members at two in the morning. Clad in jeans and a Red Cross T-shirt, she often rushes to the bedside of dying donors.

Prior Consent

Her job is particularly hard because unlike in many other countries, prior consent by the donor doesn’t constitute legal permission in China. In practice, the system requires written consent from all living members of the immediate family, including parents, adult children and spouses, according to Gao Xinpu, deputy director of the medical affairs department at the China Organ Donation Management Center, which helps train coordinators and operates under the Red Cross Society of China. Gao Xinpu isn’t related to Gao Min, the coordinator.

The 81-year-old patient in southern China had signed up to be a donor four years ago and wished to donate his corneas for transplant and body for medical research. Only 1.2 out of every million Chinese became organ donors last year, said Gao Xinpu. The comparable number in the U.S. is over 20.

The Red Cross donation management center has certified 547 coordinators across the country, and is training thousands more. Even those efforts may not be enough to fill the shortfall, and experts say that gap may delay China’s efforts to move away from using the organs of executed prisoners, a practice that has drawn criticism from international groups.

Executed Prisoners

“I cannot see how they will take away their reliance on the use of executed prisoners’ organs if there is no robust infrastructure to make up that shortfall,” said Adnan Sharif, secretary for Doctors Against Forced Organ Harvesting, a nonprofit.

China reduced the use of prisoners’ organs to less than 20 percent of all transplants last year, and violations are punishable under the criminal code from Jan. 1 this year, said former Vice-Health Minister Huang Jiefu, who is also director of the government’s organ donation committee.

“I can’t say after Jan. 1 there isn’t even one single case, but we will certainly succeed,” said Huang. “It’s like how drug trafficking is punishable by the death sentence but there still are people who do it.”

China doesn’t disclose the number of executions each year. The Dui Hua Foundation, a non-profit organization, last year estimated that China executed about 2,400 people in 2013. Faxes to China’s Ministry of Justice and the Supreme People’s Court weren’t answered.

The government is counting on the national program it introduced in 2013 to attract more voluntary donors. They are up against citizens like Qian Haiyan, a 40-year-old Beijing resident, who accompanied her elderly mother out of a downtown hospital on a recent Wednesday. Qian said she might consider being an organ donor herself, but would be far more conservative if a decision had to be made on a family member.

“I am quite conservative about this,” she said. “Especially for my family, I’m not willing to. I hope they can pass away with an intact body. It’s an emotional issue.”

To contact Bloomberg News staff for this story: Li Hui in Beijing at hli355@bloomberg.net

To contact the editors responsible for this story: Anjali Cordeiro at acordeiro2@bloomberg.net Lena Lee