By staff reporters Liu Jingjing, Li Hujun and He Xin, and intern reporter Wang Xuan

Related article: Part II -- Legal Shortcomings 
                       Part III: Ethical Issues

(Caijing Magazine) It's no secret that millions of people in China desperately need liver and kidney transplants. But it took a brutal murder for many to realize how bloody the transplant business can be – and the benefits of a new and hopefully fair system for organ donations.

In mid-June, the mutilated body of a murdered homeless man was found in a small town in Guizhou Province. His internal organs had been removed.

A police investigation later found the organs were purchased by doctors at a major hospital far away in the city of Guangzhou. Liver transplants at the hospital were subsequently halted in July, and doctors suspected of involvement were detained. Now, police are investigating whether the doctors were aware of -- or even participated in -- the man's murder.

The criminal probe was still under way when health experts gathered August 25 and 26 in Shanghai for a national human organ donation conference – a meeting that set the stage for a national organ donation system in China based on international ethical standards.

Huang Jiefu, vice minister of health, called the conference "a life and death matter" for the nation's organ transplant system.

With participation by more than 130 senior surgeons, medical administrators and officials from the Red Cross Society of China (RCSC), the meeting was the first of its kind since China started offering human organ transplantation services in 1966.

A November 2006 meeting called the National Summit of Clinical Application and Management of Human Organ Transplantation had led to enactment of six, major ethical principles for medical institutions and medical practitioners. Some were incorporated in the country's first comprehensive Human Organ Transplantation Regulations, which took effect May 1, 2007.

One regulation says, "Human organ transactions, as well as cross-border activities for organ transplants in the name of travel, are strictly prohibited."

Another says, "Written consent must be obtained from a human organ donor before an organ removal, and the removal must be done according to procedures prescribed by law. When a donor is unable to give consent, written consent must be obtained from his or her family."

RCSC has handled cadaver donations in China for quite some time. According to Jiang Yiman, RCSC executive vice president, these donations have "limitations" since they are largely used for academic purposes, and most donors are elderly.

By comparison, organ donations are technically more complicated; certain procedures, such as donor selection and organ collection, cannot be accomplished by RCSC alone.

Without the assistance of medical institutions and medical workers, it is simply impossible to find organ donors, said Song Ruliang, Guangzhou lawyer and deputy director of the Medical Disputes Commission at the Guangzhou Lawyers Association. Experts are also needed for organ data matching, donation services, collection, transportation, preservation and surgical procedures.

Organ shortages are a problem in most countries, but some are better off than others. For example, Spain has a three-tier system at national, regional and hospital levels that has effectively increased the number of organ donations.

In the United States, organ distribution management policies are based on medical and scientific standards that do not differentiate by race, gender, economic or political conditions. Statistics for each donor are transmitted to the country's United Network for Organ Sharing (UNOS) for matching with potential recipients. UNOS and the Organ Procurement and Transplant Network scientifically evaluate each organ and remove unqualified applicants from a database.

In Britain, all patients that need organ transplants have to register with a national transplant organ database. Blood type, age and other physical data from donors and recipients help determine matches.

Thus, many developed countries operate comprehensive organ transplant systems that include nationwide administration networks, donor registrations, donation and distribution networks, clinical services and transplant databases. The public is offered 24-hour access to databases or networks, except for personal donor data. Information about recipients and applicants is strictly protected to prevent them from directly contacting each other, and to ensure fair distribution of organs.

Such a system does not exist in China, however, despite skyrocketing demand for organ transplants spurred by the country's economic growth.

Thus, establishing a framework for voluntary donations and fair distribution has risen to the top of the nation's health care agenda.

An initial step was, under the leadership of RCSC and Ministry of Health, to form the Chinese Human Organ Donation Committee. The committee will supervise a two-tier administration system overseen by a donation committee, donation office, collection agency and groups of experts at national, provincial and municipal levels.

Starting in 2010, pilot programs will be launched in 10 locations including the cities of Shanghai, Tianjin, Xiamen, Nanjing and Wuhan, as well as in the provinces of Liaoning, Shandong, Zhejiang, Guangdong and Jiangxi. If all goes as planned, the system will be rolled out on a nationwide scale in 2011.

Under the program, provincial RCSC offices will set up donation offices and dispatch coordinators to local hospitals to seek potential donors, such as patients in intensive care wards. Patients will be consulted with and potential donors registered. After each donation, the donation office and collection agency will follow specific guidelines for distributing organs.

Organ distribution should be fair, open and impartial, said Shi Weixing, a professor of public health at Zhejiang University Medical School. Priority should be based on medical standards, including levels of urgency and necessity, the potential for surgical success, and the life expectancy of transplant recipients. Yet decisions would not be based on financial or political considerations.

Medical researchers argue that the success of China's fledgling organ donation program will hinge on the use of a neutral, objective third party with strong organizational and management skills, as well as on open and transparent information flow in an improved legal environment.

The vice minister of health said the ministry entrusted RCSC to play a leading role in setting up the organ donation and distribution system mainly because it is a non-governmental organization. "Establishing a human organ donation and distribution network that's independent of medical institutions is also a target of China's medical reform."
 
Huang said the planned donation system would significantly lower transplantation costs and improve transplant quality.

Lately, transplant surgery effectiveness around the country has fallen for reasons that include organ contamination and ischemia, according to Huang.
 
China's new system can provide financial compensation for donations without turning organ donation into a business. Huang said there are internationally accepted standards for compensating voluntary organ donations.

"As opposed to trading organs as a commodity, voluntary organ donations are not for pay," Huang said. "But that does not mean it can't be rewarded financially."
 
For example, he said, a donor who dies in a traffic accident may leave aged parents and young children behind who can benefit from compensation. "Should their organs be able to save other lives, the Red Cross can provide subsidies for donor families in an open and transparent way," Huang said.
 
"The needs of the country could largely be satisfied if 10 to 20 percent of those who die from cerebrovascular disease, brain tumors or traffic accidents donate their organs," he added.

Donors and families should not be paid for organs, said Zhai Xiaomei, a bioethicist at Peking Union Medical College and a member of the Committee on Clinical Application of Human Organ Transplantation of China. But they can receive letters of gratitude and memorials.