(Yicai Global) March 13 -- Despite 13,000 transplants being performed in China last year, the second-highest of any country, the waiting list for transplant surgery is 31,000 patients long. Yicai Global recently interviewed Huang Jiefu, former health minister and a member of the Chinese People's Political Consultative Conference, who has devoted himself to promoting organ transplants to save lives.
Yicai Global: Why is there such a large disparity between the number of patients waiting for a transplant and the number of transplants being performed in China?
Huang Jiefu: Every year in China, there are around 300,000 patients with failed organs, who need transplants. Medical research has proven that organ transplants can save lives and alleviate pain, but only 31,000 are registered and on the government's waiting list. There are several factors contributing to the large gap between the figures. Some people just can't afford it, others don't even know transplants are possible and China's capacity to carry out the surgery is limited. Very few Chinese hospitals and doctors can perform heart or lung transplants, and many organs were wasted last year.
Last year, China received organs donated by 4,080 deceased citizens, with surgeries transplanting 368 hearts, 204 lungs, over 3,000 livers and 9,000 kidneys. There was wastage across all four organs. Why? Our lungs have five lobes. A lung transplant patient may only need one lobe transplanted, which is called a combined heart-liver transplant. The lungs donated should be sufficient for 4,080 surgeries, but only 204 transplants were performed, the rest were wasted.
An important reason is a lack of services. Of the 204 transplants performed last year, more than 150 were performed by one doctor. It takes years to become an experienced transplant surgeon, and China doesn't have many. Such surgery has only been here since 2015, we still must wait about five years until we'll get more surgeons.
There's a huge shortage of surgeons. The US has 300 million people and nearly 300 transplant hospitals. The population here is 1.3 billion, but there are only 169 hospitals capable of carrying out a transplant. In the US, some 2,000 lung transplants were performed last year, but there were only a tenth of that number performed in China. If all patients could afford it, and China had the capacity to do so, it would have been easily possible to perform over 1,000 lung transplants last year.
Twenty hospitals will be qualified for organ transplants this year, and the total number of hospitals capable of carrying out the surgery will reach 300 in the next five years. The first group, made up of 10 hospitals, is under review. Successful candidate hospitals are those that have successfully performed kidney transplants in the past, have a leading researcher in the field, and have carried out more than 10 organ donation operations.
During the operations, they should have performed a liver or kidney transplant aided by a qualified hospital and have a one-year survival rate of 100 percent. There are additional requirements for joint heart-lung transplants, where a surgeon must have been trained abroad, and the hospital should have performed more than three organ transplants.
Yicai Global: How can China legislate for organ transplants?
Huang Jiefu: The Human Organ Transplant Regulations were enacted in 2007. It's the first such legislation in China. Guided by the legislation, regulations have made historical progress over the past decade, in terms of both organ donation and transplants. Major breakthroughs in the field were made in 2015 and last year.
Ethically, China is now indisputably the second-most advanced country for organ transplants, and ranks second in the number of organs donated, behind the US. Over 10,000 organs have been transplanted in China, with the success rate improving significantly. The one-year survival rate for liver transplants is now over 95 percent - this wasn't possible in the past.
As organ transportation has developed in China, especially after strong increases in the number of donations, the old regulations are outdated. Some provisions need urgent updates or amendments to provide a legal basis for the continuous development of organ transport.
Clauses should be inserted with respect to the role played by the Chinese Red Cross Society in organ donation activities, the duties and functions of the national donation and transplant commission including the responsibilities of the China Organ Transplant Response System, the organ procurement organization and organ donation coordinators. This way, donations can be conducted in accordance with a law, and lay the groundwork for the introduction of an organ transplant law in China.
Yicai Global: Some experts are looking for legislation on brain death. What's your opinion?
Huang Jiefu: Brain death and organ donation are different, and shouldn't be mixed up. The notion of brain death was first proposed by Harvard University in 1968. It can't be included in organ donation regulations, it is used to define death. Including brain death in the legislation wouldn't facilitate organ donation. The organs donated last year are not related to brain death.
Yicai Global: What's the current situation with organ donations in China?
Huang Jiefu: Some 4,080 people donated organs in China last year, with 13,000 organ transplants performed, making China the second largest performer of transplants and receiver of organs, second only to the US. Success rates have improved significantly. In early 2010, China's government started a voluntary registration for organ donation, but the number of volunteers has stayed small. As of March 6 this year, 219,365 people had volunteered to donate their organs after death by registering in writing or online.
In practice, becoming a volunteer is not the same thing as donating organs. Volunteers just need to make the choice, yes or no, and supply their identification details.
The purpose of the voluntary registration is to create a positive atmosphere in society, not turn everybody into a donor. It's an act of love and doesn't oblige you to donate, volunteers don't even need to contact hospitals themselves.
The actual donation is performed in an intensive care unit, and consent must be obtained from the patient's family. Some six million people die in ICUs every year in China. If just 0.1 percent of them agree to donate their organs, it would suffice to meet the demand for transplants. Through the volunteer program, it is hoped that organ transplants can become a public health service that is accessible to all people, so if a doctor finds a suitable patient at an ICU, he or she can talk with the family openly about organ donation, who may find the process more acceptable.