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Print Edition> Nation
UPDATED: April 2, 2011 NO. 14 APRIL 7, 2011
A Matter of Life and Death
Cultural beliefs and a flawed donation system stem the flow of in-demand organs for operations



RECOVERY: A patient talks to a doctor on December 28, 2010 about the progress of his recovery. He received a bone marrow transplant in Beijing's Anzhen Hospital last August (TANG ZHAOMING) 

The huge gap between supply and demand is due primarily to Chinese people's traditional beliefs and the flawed donation and transplant management system, said Gu Guorong, an executive of the Red Cross Society of Zhengzhou, capital of Henan Province.

"For instance, Chinese people traditionally believe corpses should be kept intact, even if they would be cremated later. It is also considered inauspicious if an applicant for driving license is asked about whether he or she would like to donate organs if they die in a traffic accident," Gu said.

Besides, he said, obscurity in relevant laws and regulations sometimes left organ donors' wishes unfulfilled.

In China, any family member could obstruct doctors from removing a donor's organs, even if the donor has completed all required legal documents while alive, Gu said. He said he felt envious that in some Western countries, after a registered organ donor dies, doctors can remove the organs without obtaining authorization from his or her family.

For successful transplants, organs from the deceased are best transferred from a donor to a recipient within 20 minutes after death, medical experts say. Some organs such as hearts, livers and kidneys are best if they are removed soon after the donors are brain dead, but other organs are still functioning.

How to define death is a delicate issue. In some countries, a brain dead person can be pronounced legally dead.

In China, legal death is still defined as the cessation of heartbeat and breathing. When that happens, some organs will deteriorate quickly and become unfit for transplanting later, medical experts say.

"If China can adopt brain death as the criteria for death, and remove the organs of brain dead organ donors for transplantation, more people will be given another chance to live," said the late Qiu Fazu, one of the founders of organ transplantation in China.

"Determining brain death is quite complicated, because several criteria must be met simultaneously," said He Yudong, a lawyer with the Beijing-based Zhongce Law Firm. Currently, brain death is prevalently defined as irreversible loss of all functions of the brain, which is caused by brain diseases or severe brain damage, he said.

"Brain death is different from a vegetative state,"said Chen Zhonghua, Director of the Key Laboratory for Organ Transplants under the MOH. "Although a brain dead person can breathe with the assistance of a ventilator and appear alive, he or she has completely lost cerebral functions and a recovery is impossible, whereas a person in a vegetative state may recover."

"Since the 1980s, some medical experts have called for legislation setting brain death as the legal standard for death," Zhang said.

But many people in China still believe brain death to be a deep coma, and even an estimated 90 percent of the doctors in the country do not have a good understanding of brain death.

"Traditionally, Chinese people think as long as a person breathes, he or she is still alive, so the general public usually cannot accept removing organs from those who are brain dead," said Huang Jiefu, Vice Minister of Health.

Huang said he hoped the current regulation on organ donation would be revised so Chinese citizens would be allowed to choose between heartbeat cessation and brain death as the legal criteria for death.

Poor Management

China's current regulations on organ donation took effect in May 2007. "The regulations and a series of follow-up measures taken by the government set organ transplantation in China on the right track," Huang said.

But he says he agrees with some medical experts who argue the management system for organ donation and distribution in China is underdeveloped.

Critics say although the regulations outline the principles for voluntary and uncompensated organ donation, they do not spell out detailed rules about organ donation and distribution management.

Huang said that the government should set up an efficient donation registration system, guarantee donors' rights, and ensure the quality of donated organs as well as their equal distribution and rational use.

"The draft for the amendment to the regulations on human organ transplantation has been finished and submitted to the Legislative Affairs Office of the State Council," Huang told Shanghai-based China Business News in early March. He predicted the amendment would be promulgated in the first half of this year.

Huang said around September 2011, a comprehensive organ donation management system would be launched in China. The system will handle organ donation according to information relating to recipients, organs in need, donors and matching.

"Health authorities are considering giving financial assistance to donors and their families to encourage donation," Huang said.

Donors and their families might receive a reduction in the cost of medical care and funerals, as well as preferential policies for health insurance and taxation, he said.

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