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News of the Day ... In Perspective

4/24/2007

Transplant tourism to China

Shortage of transplantable organs and the dissemination of technology is fueling a global commerce in body parts between rich and poor countries.

Recently, an Israeli man, Avraham Abelson, who was 127th on a heart transplant waiting list in Israel, flew to Shanghai to receive the heart of a 21-year-old man. After he sued his insurance company, it paid the $150,000 bill. Mr. Abelson is one of 150 patients that the Israeli company Medikt has referred to China for heart, liver, or kidney transplantation.

The Chinese Ministry of Health has recently instructed hospitals to stop performing transplants on wealthy foreigners because there aren’t enough organs for Chinese who need them. But it is not clear how rigorously the new rules will be enforced, as the transplants are highly lucrative.

China does not recognize brain death, but permits organ harvests only when the heart has stopped beating. Most donors for the 10,000 organs transplanted each year in China are executed prisoners.

While international medical groups condemn the practice, saying that prisoners cannot make truly voluntary donations, Chinese vice minister Huang said: “If some criminals become aware that they have done a disservice to society and want to atone by donating their organs after death, this is something that should be encouraged, not opposed.”

“The truth is, I don’t care where the heart comes from,” Mr. Abelson said (Wall Street Journal 4/6/07).

Between 1,770 and 8,000 executions took place in China in 2005, according to Amnesty International. In about 60 percent, a firing squad is used to shoot the prisoner in the back of the head. Death vans are being used with increasing frequency to administer lethal injections.

Some say that the lethal injection method allows doctors to extract organs more speedily and effectively. Others say that it renders organs unusable (Prison Legal News, March 2007, citing USA Today).

In the U.S., debate over organ donation currently concerns the ethics of “solicitation” websites such as www.matchingdonors.com. Some claim that recipients with an appealing story violate the “fairness” of the system by jumping the queue—even though the website inspires more people to become living donors (Sally Satel, “One Harsh Prescription,” nationalreview.com 4/3/07; Hanto DW, “Ethical Challenges Posed by the Solicitation of Deceased and Living Organ Donors,” N Engl J Med 2007;356:1062-1066).

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