Tuesday, July 2, 2013

Deceased organ donation in China, and Hong Kong

I just arrived in Hong Kong (via a fast train from Guangzhou).

On Friday I spoke in Beijing about organ donation and allocation with officials of the Ministry of Health, and today (Tuesday) I'll be speaking with people in Hong Kong who are active in trying to reform the Chinese organ transplant system. Here's some background material (and here):

       Report on the Cooperation of the Chinese Ministry of Health and
           RID 3450 in the Promotion of Organ Donation in China

The Milestone on 26 December 2012

       A Letter of Intent was signed on 26 December 2012 between the Chinese Ministry of Health (MoH) and Rotary International District 3450 (D3450) whereby the two parties, together with the China Organ Transplant Response System Research Center at the University of Hong Kong and the No. 1 Hospital Affiliated to the Sun Yat-sen University in Guangzhou, will cooperate in the promotion of organ donation and international exchanges in this field.


2.   Many major transplant countries used the organs from executed prisoners in the course of developing their organ transplant services.  As this unethical practice was abandoned with social progress, many countries have developed national donation systems to address the need for transplant organs.  In 2007, the State Council of China passed the human organ transplant regulation, a crucial piece of legislation for the development of an organ transplantation system for Chinese people.  The MoH plans to start implementing the new national system in 2013.  This will mark the start of the phasing out of the old practice of relying on organs from executed convicts, who have the right to decide whether or not to donate their organs after death as any other people in the community.  The law is being revised in China to establish the new national system for transplant, including the definition of the role of national accountable organizations and their responsibilities in line with the guidelines of the World Health Organization (WHO).  Apart from scientific issues, the plan also includes addressing cultural and societal issues, i.e. non-scientific aspects of organ donation to gain public confidence and support.

The New National System of China on Organ Transplant

3.     A research team of the MoH at the University of Hong Kong has developed a national organ computer system, which allocates organs according to national policy that reflects urgency, compatibility and patient need, known as the China Organ Transplant Response System (COTRS), which is free of human intervention and monitored by many bodies to ensure the transparency, fairness and traceability of organ procurement and allocation.  The Red Cross Society of China has been commissioned by the MoH to run the organ donation system, and to ensure that organ donation, procurement and allocation within the medical system are in accordance with the law.  These measures provide the basis for public trust in organ donation.

4.     The new system will ensure donors not only that they can donate their organs to save people as they wish, but also that their organs will not be traded.  Furthermore, deliberations are being made on how to provide social support for the disadvantaged donor and recipient families, such as using China’s existing social support mechanism to cover their expenses but not to be a form of payment for the organs.  While this is not necessarily reflected in the regulations, it has to be decided and built into policies governing the process as a whole.

Cultural and Societal Issues

5.    One major cultural and societal difference between western countries and China relates to the definition of death.  Brain death, as defined in law, is used to determine death in many countries and is often taken as the basis for the surgical removal of organs for transplant.  Without such legislation on brain death, China makes reference to current cultural and societal norms in its deceased organ donation criteria which provide three options for the Chinese people who want to donate organs after death: (i) organ donation after brain death; (ii) organ donation after circulatory death (heart stop) and (iii) organ donation after brain death followed by circulatory death.  Data from a pilot study in China reveal that only 9% of organ donations were on the basis of brain death, while the rest were based on brain death with circulatory death or just on circulatory death.  It is possible that as China makes progress with the new organ donation system, its cultural and societal norms regarding death will shift.

Future Plan

6.    Based on the results of a two year pilot program, the MoH and the Red Cross Society of China decided to implement the new system on a national scale.  The national organ procurement and allocation system, the centerpiece of the new national organ donation system in China, has been launched in September 2012.  Time and coordination will be needed for the new system to be carried out among hospitals in China.  It is planned that the new system will be implemented in the Guangdong Province as a start, and the experience gained will help improve the system which will ultimately be implemented throughout the nation.   

The Role of D3450

7.    Rotary is no stranger to the MoH with its significant efforts over the years in conducting various humanitarian programs in China.   In particular, the success of the Hepatitis B Vaccination Program conducted for over a million children in China by D3450 has probably engendered trust and confidence of MoH in the professionalism, dedication and capability of Rotary in rendering assistance in this important and nation-wide project of promoting organ donation.  Furthermore, the vast international network available through Rotary connections among its 1.2 million members from 33,000 clubs distributed in more than 200 countries will be an invaluable asset to the project team which would need close and continuous exchange with the international community.

8.    DG Kenneth and his team met Minister Chen Zhu in end August, and Deputy Minister Huang Jiefu in October, to discuss prospective Rotary projects in China.  In December 2012, MoH formally invited D3450 to participate in this project of promotion of organ donation, through the Director of the COTRS Research Center, Dr. Wang Haibo, and proposed that a letter of intent be signed between MoH and D3450 on 26 December 2012.   

9.     The major areas of work in which D3450, through rotary clubs in Hong Kong and Macau, will be engaged according to the letter of intent will include the following:

(i) to support the construction and enhancement of the management system on Organ Donation and Allocation in the Mainland;
(ii) to promote organ donation through publicity and advocacy programs in the Mainland; and
(iii) to promote international cooperation and exchange in organ donation between China and members of the World Health Organization (WHO).

10.     While Rotary Clubs in Hong Kong and Macau will participate in the above work on voluntary basis and provide suitable professional input/advice where appropriate, the MoH will oversee the implementation of the new organ donation and transplant system by the two universities and the hospitals in the Mainland, provide the necessary financing and support to the parties concerned and give due attention and response to the views, assessment and suggestions provided by the Rotary team appointed by the Governor of D3450.  All the above will take place in the Guangdong Province as a start.  It is expected that experience gained from the Guangdong Province will help in further improving the system which will eventually be implemented in all other provinces of China.

The Signing Ceremony and Press Conference

11.     A Delegation of 46 Rotarians led by DG Kenneth attended the Signing Ceremony held on 26 December 2012 at the International Conference Center of the Guangdong Hotel in Guangzhou, including DGE Eugene, 6 PDGs, Presidents, Past Presidents, District Officers and their family members.  Dr. KO Wing-man, Secretary of Food and Health of the HKSAR Government, and Dr. CH Leong, Chairman of the Council of the University of Hong Kong, also attended and addressed the audience.  The Deputy Minister of Health, the Chairlady of the Red Cross of China and representatives of the HKMAO, the two universities and the No. 1 Hospital Affiliated to the Sun Yat-sen University in Guangzhou represented the Chinese Government.  The Letter of Intent was signed by DG Kenneth Wong and Director General Wang Liji of the MoH and witnessed by all present.  A press conference chaired by the Deputy Minister of Health was held immediately after the signing ceremony.

12.      The subject was widely reported by the media in China, notably by the China Daily and the Phoenix TV Channel.  The presence of RID 3450 as a key party in ensuring the openness and fairness in the promotion and implementation of the new organ donation and allocation system was succinctly presented by the speakers and reflected in the media reporting.  For the easy reference of readers of this report, copy of the full script of the China Daily’s article on the subject is at Appendix 1.  The video script of the Phoenix TV Channel on the subject can be accessed through this link: http://news.ifeng.com/mainland/detail_2012_12/27/20560185_0.shtml.  Some pictures taken on the occasion are also attached.

What Next

13.      No doubt promotion of organ donation is a highly worthwhile project to which Rotarians are expected to be fully prepared to make their contributions.  It will bring significant benefits to people in China which is the country ranked second in the number of organ transplant but with a significant shortfall in organs donated vis-a-vis organs needed for transplant.  Successful promotion of knowledge in and advocacy for organ donation in the Mainland will likely lead to significant increase in the number of organ donors and hence the number of organ recipients (the beneficiaries).   

14.     D3450 will soon initiate programs and activities through which Rotary Clubs in Hong Kong and Macau will be able to contribute to the areas of work mentioned above.  The views of Rotary Clubs will be consulted in drawing up the programs and planning the activities.  Committees for overseeing the implementation of the project will be set up as necessary and appropriate.

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