China’s new Regulation on Donation and Transplantation of Human Organs takes effect May 1, 2024. The sweeping changes include wording designed to meet some of the established standards for organ transplant like those set forth in the WHO Guiding Principles On Human Cell, Tissue and Organ Transplantation and the Declaration of Istanbul On Organ Trafficking and Transplant Tourism. However, experts suggest the regulatory change will not lead to transparency, bring an end to China’s transplant tourism business, or protect prisoners of conscience and ethnic groups from crimes in organ transplantation, including forced organ harvesting. This post calls for bioethicists to remain vigilant in calling attention to forced organ harvesting and other violations of human rights in the global organ transplant ecosystem.
Towards Legitimacy
The regulation purports to prohibit the trade in organs, ensure all organ donation is voluntary, codify the dead donor rule, establish that all organ donation must go through the State Council, and impose professional requirements for those participating in organ transplantation surgeries. It also has provisions relating to living donors and recipients. If enforced, the regulation sounds like a move toward a legitimate donation system.
Organs and Abuse
Organ transplant abuses in China include forced organ harvesting, which is the practice of killing people for the sake of organ removal. Evidence of biometric data collection, disappearances of Falun Gong practitioners and Uyghurs, large numbers of transplants, and transplant tourism support those questioning the sincerity, transparency, and effectiveness of the new regulation. A doctor now practicing in the United States suggests that half of organ transplants in China take place in military hospitals. That is a red flag in that the military runs prisons and labor camps targeting Falun Gong and Uyghurs. He notes that party insiders and the wealthy have increased access to organ transplants. He further confirmed that transplant tourism continues in China with a market geared toward wealthy patients. In fact, transplant tourism is a billion-dollar industry in China. The China Tribunal collected testimony and evidence of forced organ harvesting and released a 562-page judgment in 2020. The tribunal found that China engaged in forced organ harvesting beyond a reasonable doubt.
“It’s all cover-up”
Researchers suggest that China’s center for managing organ donations is not transparent, provides inflated donation numbers, and is somewhat a ruse and part of a cover-up. David Matas, a human rights lawyer and expert, suggests that, “It’s all cover-up: obfuscation, denial of accusations, counter narratives[,]” “It’s unverifiable,” and “The number looks as if it was made up using a mathematical calculation formula.” Ethan Gutmann recently testified in a hearing held by the Congressional-Executive Commission on China that China began sweeping biometric testing of Uyghurs beginning in 2014, possibly due to exhausting the supply of Falun Gong practitioners of the optimal age for organ retrieval. He also attributes some of the incentive and profitability to improvements in Western technology that China then purchased to enable more organ transplants. Torsten Trey, of the international organization Doctors Against Forced Organ Harvesting, also is skeptical of the new regulation. He anticipates that the changes will not lead to any improvement in eliminating forced organ harvesting or transplant tourism.
American Complicity
Bioethics and “health and human rights” have significant overlap, and perhaps sometimes compete for subject matter. Organ transplantation is clearly medical and many doctors participate in organ transplants without proper verification of the source of the organs. The global organ trade is violent and exploitative. This transnational crime calls for attention from within the bioethics community. Those engaged in debating which systems ought to be in place and the doctors and scientists creating more economical, sophisticated, and accessible methods to harvest, preserve, and transplant organs must ensure a safe medical environment. When there is no way to ensure organ traceability and to account for each organ in a foreign system, the lack of transparency should at least call for disengagement by businesses and academic and clinical research partners. Institutions and corporations may find themselves complicit in human rights abuses if they continue to engage in collaborations, supply chains, and educational trainings. Furthermore, governments must take steps to ensure that transplant tourists are not purchasing organs abroad in countries that fail to prohibit forced organ harvesting, organ brokering and selling, and the exploitation of those in poverty. Changing laws may lead to improvements. If passed, the Stop Forced Organ Harvesting Act would address any organization or individual that “funds, sponsors, or facilitates” forced organ harvesting and would provide for sanctions, property-blocking, and visa revocation.
Role of States in Prevention
States can also address human rights. For example, Texas recently passed legislation that makes it difficult to seek a transplant in China by forbidding insurers to cover transplants there or transplants of organs acquired there. This itself may create ethical dilemmas of interest to the bioethics community — for example, if a resident does have a transplant that violates the law, banning the person from coverage for expensive follow-up care may feel wrong and punitive. The bioethics community should examine what ought to be done as many of the oughts operate outside of law.
Complicity in human rights violations is not merely a legal matter from which one should protect oneself. It is a matter for bioethicists to actively consider.
Anne Zimmerman, JD, MS is the Founder and President of Modern Bioethics, Chair of the New York City Bar Association Bioethical Issues Committee, and Editor-in-Chief of Voices in Bioethics.