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American should thank to the people of China.
Sunday November 11 09:04 AM EST
Doctors Worried as Americans Get Organs of Chinese
Inmates
By CRAIG S. SMITH The New York Times
An increasing number of Americans are traveling to
China to receive transplanted kidneys, livers, corneas
and other body parts from executed Chinese prisoners.
SHANGHAI, Nov. 8 Three years ago, in New York, one of
Dr. Thomas Diflo's patients on a long waiting list for
a kidney transplant showed up with a new problem: she
no longer needed a kidney, but suddenly needed
after-transplant care.
"She had just returned from a trip to China and, to my
surprise, had undergone a transplant while she was
there," said Dr. Diflo, of New York University Medical
Center, where he is director of kidney transplants.
The woman, a Chinese-American, was vague about where
the kidney had come from, but others who have come to
Dr. Diflo for treatment have been more forthcoming,
confiding that they got the organs of executed Chinese
prisoners.
Kidneys, livers, corneas and other body parts from
these prisoners are being transplanted into American
citizens or permanent residents who otherwise would
have to wait years for organs. Many of the patients
come back to the United States for follow-up care,
which Medicaid or other government programs pay for.
The transplants in China, which doctors in both
countries say are increasing, has presented the
American medical establishment with an ethical
quandary: Should American doctors treat patients who
have received organs from executed prisoners and, if
so, would they be tacitly condoning the practice and
encouraging more such transplants.
Or should they rebuke patients who, in desperation,
participate in a process that mainstream transplant
advocates condemn as morally wrong?
"That's a decision that has to be made by each
individual physician," said Dr. Thomas McCune, a
transplant physician in Norfolk, Va., and chairman of
the patient care and education committee of the
American Society of Transplantation.
Executed prisoners are China's primary source of
transplantable organs, though few of the condemned, if
any, consent to having their organs removed, people
involved with the process say. Some of the unwitting
donors may even be innocent, having been executed as
part of a surge of executions propelled by accelerated
trials and confessions that sometimes were extracted
through torture.
The American transplantation society says that
decisions to donate organs must be made freely and
without coercion or exploitation of any sort. It
opposes any organ donations by prisoners, even to
their relatives, because the circumstances of
incarceration make it impossible to ensure that the
decision is not colored by secondary benefits, like an
improved diet, that a prisoner may stand to gain.
Donations from death row inmates are even more
suspect.
Various initiatives are under way to protest the
harvesting of organs from China's prisoners. One bill
would bar entry to the United States of any doctors
from China who want American transplant training.
Chinese transplant specialists now travel freely to
the United States to take part in seminars and other
activities that help hone their skills.
But American doctors say there is little they can do
to stop the flow of prisoner organs to the United
States because the Chinese supply is growing just like
the American demand.
More transplantable organs are available in China
because more people are being executed. This year,
5,000 prisoners or more are likely to be put to death
during a nationwide anti-crime drive. Many of them
will be stripped of their vital organs, though there
is no available data to say how many. Government
policy allows the harvesting if the prisoner or the
prisoner's family has given written consent, or if the
body is not claimed after execution. In practice,
though, the rules are often ignored and illegal
harvesting tolerated.
Meanwhile, China has made great strides in transplant
techniques, having performed 35,000 kidney transplants
since its first successful one in 1961. As a result,
transplant centers have opened around the country,
some with special wards catering to high-paying
foreign patients.
Most of the organs are transplanted into Chinese
citizens, but a growing number are going into
foreigners, particularly Southeast Asians, Japanese
and Americans, who would otherwise face years of
illness or the risk of death if they were to wait for
transplants in their home countries.
Hospitals welcome foreign patients because they pay as
much as 10 times the price local patients pay for the
same operation. For an American patient, the Chinese
charges are somewhat below the comparative cost in the
United States.
It is hard to say how many Americans are receiving
such organs each year. Anecdotal evidence in both
countries suggests the number is small but growing and
cuts across various regions. I think this is pretty
widespread," said Dr. Diflo. "You'll see it anywhere
you have an Asian community."
All five hospitals that do kidney transplants in
Shanghai say they treat foreign patients.
"There was one from America in July or August," a
nurse in the urology department at Changhai Hospital,
affiliated with the Shanghai Second Military Medical
University, recalled this week. The doctor who
performed the transplant said the patient, a woman,
recently returned home to California.
More than 78,350 Americans are awaiting organ
transplants, according to the United Network for Organ
Sharing, a nonprofit group that matches donors to
transplant patients in the United States. Among them,
about 50,000 need a kidney and that number is expected
to double within the decade.
Most of those people must endure years of dialysis,
spending three hours three times a week at a clinic or
hospital where needles are inserted into an arm or leg
to drain their blood, clean it and return it to the
body.
The periodic buildup of toxins in the blood and the
stress of dialysis is debilitating over time. Between
5 percent and 10 percent of people undergoing dialysis
die each year.
With the wait for a kidney transplant stretching to
six years or more in parts of the United States, it is
little wonder that patients with the necessary money
and contacts opt for an ethically questionable
transplant.
China is not alone in using prisoner organs to meet
the demand for transplants. Taiwan also harvests
organs from executed prisoners, albeit with strict
consent requirements, as do some South American
countries. The idea has even gained currency with some
people in the United States. Last year, a state
lawmaker in Florida introduced a bill that would
facilitate the transplant of organs from death row
inmates after execution. The bill, which did spark
some debate, is unlikely ever to become law.
Doctors are divided about whether to treat patients
with transplanted organs from executed prisoners.
Dr. Stephen Tomlanovich, a kidney transplant
specialist at the University of California, San
Francisco, has several patients who traveled to
Shanghai or Guangzhou to receive kidneys that he
suspects came from executed prisoners. The patients
involved told him that they were not certain of their
organs' origins and Dr. Tomlanovich accepted that.
But if presented with a clear case in which an organ
came from an executed prisoner, he says he would
probably decline to treat the patient.
"I guess I would explain that it makes me
uncomfortable and might affect my care," he said by
telephone from San Francisco. "I would attempt to find
the patient care within some other medical system."
After Dr. Diflo was asked to monitor the level of
medication taken by patients who conceded that they
had been given organs from executed prisoners, he went
to his hospital's ethics board to discuss his
misgivings. The board supported his decision to
continue treating the patients.
"Certainly what they've done from my point of view is
ethically and morally wrong," Dr. Diflo said this
week. "But they're in need of medical care and we
can't punish them."
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