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Special Edition DAFOH report:
The debate over transplant ethics in China at The Transplantation Society's 26th Biennial Congress in Hong Kong 
September 2, 2016
In This Issue

China's ambitions to occupy center stage at The Transplantation Society's biennial congress in Hong Kong and to self-proclaim acceptance by the international transplant community turned into a nightmare when international criticism of its opaque transplant system reached fever pitch. What first appeared to be a certain home run for the host country soon met with the critical scrutiny of both the international press and the medical community. In response to China's self-praises, Prof. Philip O'Connell, President of The Transplantation Society (TTS), stated:

The controversy surrounding this particular congress revealed itself in different incidents. Liver surgeon Dr. Zheng Shusen was initially scheduled to speak. However, the organizer withdrew permission prior to the presentation, and replaced him with another speaker. Nonetheless, at the due time, Zheng Shusen presented anyway. This unprecedented breach of TTS Congress statutes triggered an unusual ad hoc statement of TTS' past-president Prof. Jeremy Chapman who said: 


Another incident, unusual for a medical conference, took place on the sidelines of the congress when a NTD TV film crew was interfered with by a small group of bodyguards while trying to interview Huang Jiefu.

China's attempt to annex the transplant congress is the result of TTS' previous failure to insist on systematic, independent and professional investigations. While international investigators and medical doctors have warned about transplant abuse in China 
for many years, in an open statement prior to the meeting, the Society's leadership responded to critical questions with vague, unscientific terms such as "we believe" and "our impression," not only unveiling gaps of knowledge of the organ procurement situation in China, but also exhibiting a lack of methodology to approach and thoroughly investigate this opaque organ procurement system. The objective remains: to obtain evidence from China that no prisoner is harvested for transplant organs whether executed criminals or prisoners of conscience. The Transplantation Society should not engage in making verifying statements about China's organ procurement system while simultaneously suggesting that it is not in the Society's realm of duties to conduct a comprehensive investigation. By not holding China to ethical standards, TTS helped create an environment where the controversial incidents at the congress could occur. No one can be blamed for not conducting investigations in China, because China has persistently evaded scrutiny and prohibited independent international investigations. However, one can be held accountable for not looking into the accessible, voluminous evidence that has been compiled over the past decade.

While China claims that it ended the practice of forced organ harvesting from prisoners in January of 2015, it has not provided any proof that the practice has indeed ended. In past years, China implemented several new actions, but none of them improved transparency in organ procurement. This lack of transparency has been discussed in the medical literature.
TTS leadership has misguidedly placed their trust in one man, Huang Jiefu, whose credibility is questionable, not only because he transplanted more than 500 livers during his career, but also because he lacks any official authority to lead reform. His pronouncements have only appeared in censored Chinese media and have never been endorsed by any government official or department. Huang Jiefu's 2014 announcement that the use of prisoner organs would end by January 2015 remained only that, an announcement. The 1984 provisions regulating and permitting the extraction of organs from executed prisoners have not been abolished, nor has any investigation revealed a new law prohibiting organ procurement from prisoners. In a March 2015 Phoenix TV interview, Huang expressed gratitude to the Chinese public security and judicial systems to whose cooperation in providing organs from executed prisoners he attributed the creation of the organ transplant industry in China. It requires confidence in a stable and abundant source of organs to call for an expansion of qualified transplant hospitals and doctors, as Huang did in an October 2015 interview. 

China has neither acknowledged nor announced an end to the forced organ harvesting from non-convicted prisoners of conscience. A Chinese official described allegations of forced organ harvesting from prisoners of conscience as "ridiculous," but a recent investigative report providing a large amount of thought-provoking evidence deserves a more sophisticated answer than just a one-word rebuttal.

China is boasting about its new China Organ Transplant Response System (COTRS), a computerized organ allocation system, and its new public organ donation program. However, both reforms come with their own controversies. While Huang Jiefu is quoted as saying, "Every figure is true and every case can be traced back," the reality is that all organs, regardless of how they are procured, are entered into the COTRS, effectively eliminating all traces of origin and risking a nationwide whitewash-system for all transplanted organs. The organ donation system is largely based on a professional recruiting system where local organ donation coordinators offer financial incentives equal to an annual salary to the families of deathbed patients in order to convince relatives to donate the deceased family member's organs. A presentation of the China Organ Donation Administration Center shows a steep increase in the number of these coordinators (page 6). The WHO Guiding Principles on organ transplantation prohibit any payments for organs, and the Declaration of Istanbul Custodian Group (DICG) states: "countries should not establish or allow public programs that pay money" for transplant organs. Surprisingly and incomprehensibly, officials from these organizations comment on China in a way that can only be described as a China-specific double standard: Jose Nunez, a WHO officer in charge of global organ transplantation, is quoted on the situation in China, "A transplantation reform on the basis of voluntary community-based deceased organ donation is the only legitimate source for deceased organ transplantation, aligned with the WHO guiding principles, consistent with the Declaration of Istanbul" ignoring that the so-called "voluntary community-based deceased organ donation" system in China is not based on voluntary organ donations, but instead based on practices that violate the principles of the organization for which Nunez works. A similar discrepancy applies to some members of the DICG who have praised China for its new organ donation system despite its violation of DICG's ethical standards on payments for organs.

When asked whether organs are still harvested from prisoners, officials said it might still occur due to an uncontrollable black market. Yet, how can prisoners under constant surveillance by the state be part of black market organ trafficking? Such claims are evasive and do not address the issue at hand. 

China tirelessly implements an endless array of reforms in order to earn international recognition, but there is only one reform that China is not willing to implement: unconditional transparency of its organ procurement pathways, the step that the international medical community should continually demand without rest from China.
Events Preceding Hong Kong Congress

DAFOH released a PRNewswire statement requesting TTS to reconsider its plans to gather the world's transplant professionals in Hong Kong, given newly released evidence that Chinese prisoners of conscience are still being used as organ sources and strongly objected to TTS inviting China's transplant expert, Huang Jiefu, to be a plenary speaker due to his use of prisoner organs for liver transplants. DAFOH maintained, "TTS has the professional and ethical obligation of due diligence, and a moral responsibility to...establish, beyond doubt, that no prisoners of conscience are being killed for their organs in China."

TTS then posted a statement on its website affirming its stance against the use of organs from executed prisoners for transplantation and reiterating the high ethical standards demanded of its membership. With respect to China, TTS leaders stated that because of their impression, belief and perception that organs from executed prisoners are no longer being used in China, they are engaging with selected transplant programs inside China and supporting those agents for change.

One day before TTS Congress opened in Hong Kong, the American Journal of Transplantation published an article co-authored by DAFOH members from around the world detailing the need for ongoing international scrutiny of transplant medicine in China.  Significant ethical concerns over organ sourcing were voiced regarding ten Chinese abstracts already accepted for presentation. The authors felt that the inclusion of China in the international transplant community should depend upon strict independent verification of the complete cessation of prisoner organs. With the recent allegations of ongoing organ sourcing from living prisoners of conscience, primarily Falun Gong practitioners, by the government of China, full transparency is essential.  

While answering questions from the press, TTS leaders expressed new doubts that organ sourcing reform is actually taking place in China. Dr. O'Connell acknowledged widespread, ongoing distrust of Chinese transplant programs, global disbelief that China has changed, and longstanding disgust of their past practices. Dr. Chapman was particularly angry over the presentation of research data that used prisoner organs, stating that surgeon will never be allowed to present at a TTS conference again. It is DAFOH's hope that these events will encourage the TTS leadership to perform their own due diligence by examining the critical evidence demonstrating China's ongoing use of prisoner organs for transplantation.
News Media Reports on TTS Congress

On the eve of the TTS 2016 conference, the American Journal of Transplantation published an article criticizing the choice of Hong Kong to showcase China's purportedly sanitized transplant achievements. Citing lack of transparency and validity, any acceptance of China as a partner in the international transplant community is premature while lifting academic and professional embargoes on Chinese transplant professionals is unethical.

TTS leaders claim that holding their meeting in Hong Kong in no way signified acceptance of China's transplant practices, calling organ donation reform in China a major global issue while reinforcing their position opposing the use of executed prisoner organs. The Society reiterated that all scientific papers presented in Hong Kong would be carefully vetted to ensure no studies using organs sourced from executed prisoners would be accepted. 

TTS president, Dr. Philip O'Connell, told Chinese surgeons at a special session during the Hong Kong transplant conference that the global community has "long been horrified" by China's harvesting of prisoner organs and that violations of its ethical standards will be met with sanctions such as exclusion from Society membership, future meeting attendance and from publication in all TTS journals. Dr. O'Connell also denied Chinese media reports that the presence of TTS 2016 in Hong Kong denoted global acceptance by the medical community of China's transplant system.

What if the allegations are proved to be true?
NYT correspondent Didi Kirsten Tatlow was harassed on the sidewalk outside TTS conference in Hong Kong simply for interviewing members of a peaceful demonstration against forced organ harvesting. Amidst headed debate on the topic and outright denial by Chinese officials, Tatlow writes "What if, one day, the allegations were proved to be true, as accusations of Nazi genocide against the Jews were?"
Why have TTS officials largely ignored the recent damning research revealing "secret industrialized slaughter of prisoners of conscience for their organs" in China? Why, after being made aware of the dubious and duplicitous background of their Chinese colleagues, did TTS not change the conference's program? Dr. Lavee, president of the Israel Transplant Society and member of TTS Ethics Committee, boycotted the congress in Hong Kong calling it "a moral stain on TTS' moral code" to ignore reports of organ harvesting of prisoners of conscience while accepting Chinese transplant professionals to the meeting with open arms. 

On the eve of the conference formerly undisclosed ties between an Australian teaching hospital where TTS leaders preside and a similar hospital in China were revealed that have shocked many, including members of TTS Ethics Committee. The hospitals have agreements for regular academic exchanges, personnel exchanges, joint conferences, advance study, remote education, surgical demonstrations, medical consultations and for research that could generate profitable patents but that is illegal to perform in Australia. 

Controversy and change of sentiment marked the end of TTS Congress in Hong Kong. Conflict arose during a special session about China's 'new era' in transplantation. TTS former president denounced one Chinese presentation for including data from executed prisoners. As Chinese state media was boasting of acceptance by the international transplant community and vehemently denying allegations of forced organ harvesting of Falun Gong prisoners of conscience, TTS leadership was changing their belief that organ transplant reform in China is actually occurring. TTS president admitted, "Many people in the global community are not persuaded that China has changed."

Western media is reporting on the lack of credibility in China's announced transplant medicine reform and on the persuasive evidence that prisoners of conscience are still being harvested for their organs. From American "straight talk" on ethics and human rights to Chinese "sweet talk" that covers up the realities of a multi-million dollar transplant tourism industry, distrust continues to grow. China's failing public voluntary organ donation system, and its reclassification of prisoner organs as voluntarily donated, have caught global media attention in recent months.

According to New York journalist Heng He, Beijing's point man for selling China's murderous organ transplantation system to the world, surgeon Dr. Huang Jiefu, has been on a roll. And in his wake, The Transplantation Society past-president Francis Delmonico, MD, has shared an optimistic message about China's transplantation, a naive hopefulness that hangs heavily on the credibility of this one person: Huang, a bureaucrat with a trail of broken promises who lacks the authority to be more than a front man for one of the worst, and most profitable, human rights atrocities in history. 

"The entire development of transplantation in China has depended solely on the public security and judicial systems. It has never been an issue governed by the medical profession. It has always been a political and economic issue," writes Heng. Shifting the focus from credible accusations of human rights atrocities, and with no disclosure of organ sources, Huang now says the goals for 2016 are to expand the number of hospitals qualified to perform transplants and to train more young doctors. 
Dear Friends and Colleagues,

More than ten years of independent and thorough investigations on China's forced organ harvesting practices can no longer be ignored. The list of researchers and investigators, as well as the amount of data and evidence are growing month after month. The recent report by David Kilgour, Ethan Gutmann, and David Matas, Bloody Harvest/The Slaughter - An Update, added another milestone to the already extensive existing evidence. We are at a critical crossroads. While "pro-China" physicians and experts accept data and statements provided by Chinese officials, there appears to exist a resistance within the same group to accept other data that has also been compiled from Chinese sources. The only difference is, in the latter case, the data and statements have been collected by the aforementioned investigators, and not by the "pro-China" faction or Chinese officials. A biased selection of information, the acceptance or denial of data from the same overall source, will certainly skew the view of the current and past organ procurement situation in China.

There is another misconception circulating among those who wish to defend the recent developments in China: the purpose of the collected evidence, data and discrepancies compiled by investigators is to raise awareness, concerns and to demand more transparency and inspections. The compiled evidence is meant to justify the initiation of prosecution, but not meant to satisfy the legal requirements for a verdict or judgment. The latter would require investigation and inspection of China's detention camps and hospitals. In contrast, the voices of those who support the developments in China use limited knowledge and information to rule out any abuse. This approach is unreasonable, because, to completely rule out abuse, scrutiny must yield evidence that in none of the 169 transplant centers, and in none of the other hospitals in China, are prisoners being forcibly organ harvested. Limited data and limited evidence can never completely rule out abuse, but it can be sufficient to raise concerns that result in the need for further investigation and prosecution.

Sincerely,

Torsten Trey, MD, PhD
Executive Director, DAFOH 
  
  

  

  
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Doctors Against Forced Organ Harvesting (DAFOH) aims to provide the medical community and society with objective findings of unethical and illegal organ harvesting. Organ harvesting, the removal of organs from a donor, without free and voluntary consent, is considered a crime against humanity, as well as a threat to the integrity of medical science in general. This edition of our newsletter offers up-to-date information on international efforts to stop unethical organ harvesting.

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