Transplants in China performed before proving donor brain death

Dozens of Chinese medical journal articles published between 1980 and 2015, when the Chinese government said it would stop procuring organs from executed prisoners, describe doctors in China performing organ transplants without following standard procedures for establishing brain death, according to new research published in a top U.S. medical journal.

Why it matters: “This shows, in the words of the physicians themselves, that they prioritized organ procurement over adhering to the most basic medical oath — first do no harm,” said research co-author Jacob Lavee, director of the heart transplantation unit at Sheba Medical Center in Tel Aviv.

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The big picture: For decades, the Chinese government permitted organ procurement from executed prisoners, a practice widely condemned in medical ethics because prisoners on death row cannot offer true consent for organ donation.

• In 2013, Huang Jiefu, the head of the Chinese Health Ministry’s organ transplant office, told Reuters, “I am confident that before long all accredited hospitals will forfeit the use of prisoner organs.”

• By 2015, the Chinese government claimed it had ended the practice and established a voluntary organ donation system, though researchers have since questioned that claim due to problems with Chinese government data on organ donation since then.

• In 2017, Huang said it was possible some organs from executed prisoners were still being used.

Details: Researchers identified 71 articles published in Chinese medical journals between 1980 and 2015 in which physicians describe procuring an organ from a donor without first performing a test that is key to establishing brain death, according to an article published on April 4 in the peer-reviewed American Journal of Transplantation.

• The declaration of brain death, the standard prerequisite before removing organs from a donor to ensure the organ removal is not itself the cause of death, involves a list of medical tests that must be performed and that may take several hours.

• The key final step involves an apnea test, which requires intubation of the donor patient.

• In the 71 journal articles identified by Lavee and his co-author Matthew Robertson of the Victims of Communism Memorial Foundation, doctors describe intubating the patient only after brain death had already been declared, meaning the apnea test could not have been performed.

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What they’re saying: “Procuring vital organs from prisoners demands close cooperation between the executioner and the transplant team,” the researchers state.

• “The state’s role is to administer death, while the physician’s role is to procure a viable organ. If the execution is carried out without heed to the clinical demands of the transplant, the organs may be spoiled. Yet if the transplant team becomes too involved, they risk becoming the executioners.”

Between the lines: Organ procurement from executed prisoners in China is well-documented but received with skepticism among some China watchers.

• That’s because the most prominent activist on this issue is the exiled Chinese religious group Falun Gong, which has long claimed that the Chinese government has specifically targeted their members in China for organ trafficking without presenting sufficient evidence for that claim.

Backstory: Lavee first learned of China’s use of executed prisoners for organ procurement in 2005, when one of his patients in Israel flew to China for a heart transplant scheduled two weeks in advance.

• “I said, how can anyone promise you a heart on an exact date? Someone has to die on that exact day,” Lavee recalled. The patient then “went to China and got his heart transplant on the exact day he was promised two weeks earlier.”

• The experience shook Lavee, who then worked with Israeli lawmakers to help pass a law prohibiting Israeli insurance companies from covering the costs of transplant procedures in countries that did not meet international ethics standards for transplants.

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