In response to the “barbarous practice of obtaining organs from executed prisoners” in China, the prominent US bioethicist Arthur Caplan, together with other experts, proposed an international boycott of organ transplants in China in a recent issue of The Lancet. Chinese doctors and scientists would be excluded from conferences, journals, and collaborative research. BioEdge asked Professor Caplan to elaborate on the situation in China.
BioEdge: How dependent are Chinese transplant surgeons on the organs of executed prisoners?
Arthur Caplan: They are heavily dependent. While there are living donors of kidneys and once in a while a lobe of liver the Chinese have no cadaver organ procurement system. So the vast majority of transplanted organs according to their own numbers of transplants carried out must come from prisoners. For hearts and livers those certainly are executed prisoners.
Are Chinese doctors and hospitals actively marketing organ transplant services?
Yes, they are. They promote transplant tourism on the internet. And they are making plans to expand their ability to do transplants and to attract more non-Chinese cash customers by creating what they call “medical cities”.
How have doctors, journals, and scientists reacted to your proposal? Has there been any resistance?
It is too soon to tell. So far the reaction has been a bit disappointing--no ringing endorsements from any journals or professional societies.
How have the Chinese reacted?
No reaction at all.
The Chinese government has vowed to end the practice of using organs from executed prisoners. Why haven’t they stopped? Do you think that they will stop?
I think many Chinese health care professionals do want the practice to end. But they are sceptical about whether they can get the public to support cadaver organ donation. And I believe the military, which appears to play a key role in running prisons and some of the transplant hospitals, is less concerned about execution as a key source of transplantable organs.
As in other Asian countries, there is great resistance to organ donation in China. If they cannot rely upon executed prisoners, what would you advise them to do?
They must create a cadaver organ donor system. Period. There is always resistance when these programs are launched--there was in the USA decades ago and more recently in Denmark and Israel. A strong campaign with clear explanations of rights and safeguards is the key to public acceptance.
What if a prisoner did give his consent? A prisoner on Oregon’s death row recently published an op-ed in the New York Times volunteering his organs.
“Prisoners” in China come in all forms--political, religious, criminal. I doubt we can take 'consent' at face value. Nor do I think we can trust consent to donation from persons being executed in the USA. The hope of commutation of a death sentence is a hugely coercive factor even if it does not come to pass. See my just published article in the American Journal of Bioethics for more on using prisoners as sources of organs.
Arthur L. Caplan is the Director of the Center for Bioethics and the Sydney D Caplan Professor of Bioethics at the University of Pennsylvania. He is the author or editor of twenty-nine books and over 500 papers in refereed journals.