Vol. 2 No. 1 Specials

An American in need of a new kidney can expect to wait two to three years for a transplant. If he had the means and the inclination, however, he could consider looking to China for a faster fix. For the right price, he might be able to buy himself the kidney of an executed prisoner. Although the notoriously opaque Chinese political and judicial systems make it difficult to compile reliable statistics on the practice of harvesting prisoners’ organs, human rights organizations agree that “China is the best known case of a country that uses organs obtained as a result of executions.”

While some organs are sold to foreigners, most go toward satisfying the enormous domestic pressure on authorities to procure extra organs, generated by China’s 1.3 billion people. For many years, the Chinese government denied that it met demand by transplanting organs from executed prisoners. However, “mounting evidence,” accumulated in 1991 by the international organization Human Rights Watch, “forced grudging admissions from Chinese government representatives that executed prisoners’ organs are in fact used.” To this day, China claims that organ harvesting from executed prisoners occurs only rarely. But independent investigations by Human Rights Watch, Amnesty International, and the UN have all concluded that executed prisoners are the “principle source of supply of body organs for medical transplantation purposes in China.” Indeed, Amnesty International estimates that fully 90 percent of China’s two to three thousand annually transplanted kidneys come from executed prisoners.

Officially, China is bound by the ethical principles of the World Medical Association (WMA), which has repeatedly condemned harvesting organs from prisoners. The WMA argues not only that the practice creates unethical incentives for executing prisoners, but also that physicians must violate accepted medical norms in facilitating the required surgeries. According to the British Medical Journal, in 1998 the WMA “reached an agreement with the Chinese Medical Association that these practices were undesirable and that they would investigate them jointly, with a view to stopping them.” In 2000, however, the Chinese Medical Association abandoned the investigation and refused to cooperate with the WMA. Physicians, though seemingly aware of international medical norms, often face extreme economic and political pressure not to complain.

The chief legal obstacle to a national voluntary donor program – like the ones that exist in places like Europe and the United States – is China’s refusal to abandon the heart-beat criterion for legal death. Whereas the international medical community overwhelmingly accepts brain death as the legal criterion for death, China uses the absence of a heart beat as its standard. According to Human Rights Watch, “Recognition of the brain death standard would clearly be beneficial to China’s organ supply situation, since it would allow broader access to non-prisoner sources of organs.” Examples of such non-prisoner sources abound. In large part, they consist of accidents involving severe head trauma, in which upper-level brain activity ceases even though the heart continues to beat. The narrower Chinese standard for death causes the loss of countless transplantable organs, exacerbating the country’s shortage. Nevertheless, Chinese cultural traditions about death and burial have so far resisted the brain-death concept.