A dream comes true and a new journey begins

In 2005, I myself started to learn transplant medicine as a post-graduate student. Every day I am facing a moral dilemma of using prisoner’s organ and watching patients with end-stage liver diseases in dire needs of a transplant surgery. We dreamed someday we could recover organs in the operation room rather than in elsewhere. In the same year, our government had officially admitted that transplant practice relies on death-row inmate’s organs and demonstrated China’s political will to reform the system.

There is an old saying in China that “it takes decade to forge a good sword”. China’s effort to establish an organ donation system is truly a long and arduous journey. Due to extreme demand but limited supply, China used to rely on organs from executed prisoners as a source for organ transplantation. The interim provision on the administration of clinical Application of Human Transplant Techniques was issued by the Ministry of Health following “Guangzhou declaration” in November 14^th 2006. In 2007, the State Council put the Regulation on Human Organ Transplantation into action, with the aim of creating a legal and sustainable voluntary organ donation system. In 2010, a pilot on civilian organ donation was launched in ten provinces and cities. And in 2013, Hangzhou Resolution, promulgated by the Chinese National Health and Family Planning Commission, banned the sale or purchase of human organs, prevents organ trafficking and transplant tourism. All major Chinese transplant centers are complying with the Hangzhou Resolution and are mandatory to the use of COTRS (China’s Organ Transplant Response System) computer system for organ allocation to ensure transparency and fairness.

With these and other efforts, we can see that from 2011, the number of civilian organ donation cases doubled or tripled annually and achieved almost 1,700 cases in 2014 (data from COTRS). We are now doing the best in Asia. With this expansion speed, we will exceed the United States as the country with the largest transplant volume within three years. Undoubtedly, it is one of the greatest successes in the history of organ donation. From January 1^st 2015, China officially puts its reliance on the organs of executed prisoners to history and implements a new organ donation system which is in line with international ethical principles.

Yes, our dream comes true finally. We can speak loudly around our medical colleagues that we are transplant surgeons and we solely use organs donated from deceased civilians or related living donors. However, it is far from the end and we have to start a new journey.

In the administrative aspects, we should make sure the transparency and fairness of the new system, which will further increase the donation rate. Most importantly, a legal framework has to be constructed to promote organ donation and simultaneously protect human rights. For instance, we are still waiting for legislation for brain death. The Regulation on Human Organ Transplantation needs to be amended and a related law should be legislated. A number of organ procurement organizations (OPOs) have been set up. However, a more powerful national administration network of OPOs is required to reinforce their running efficacy and quality. Particularly, a national or regional guideline for the financial administration of OPOs is yet to be drawn to avoid economic affairs related to organ donation. Accordingly, the social insurance should cover the fees of organ donation and transplantation. With this, we can guarantee the public that every donation is only good-will motivated and citizens have an equal right to receive a transplant.

In the academic aspects, efforts should be made to answer the key clinical and scientific questions concerning organ donation and transplantation, with the aim to improve transplant outcomes. Although several clinical guidelines or consensuses have been published, training courses should be held to help our first-line doctors to understand and practice these guidelines. In addition, as separated from the international academic society for a long time, the Chinese doctors usually lacks of ability to conduct high-quality multicenter, prospective clinical trials. It is time for our transplant physicians, particularly our young doctors to learn more knowledge and skills in conducting clinical trials. Besides, a number of national and hospital-based tissue banks and databases should be established. Involvement of international experts or domestic experts from other fields is required to shorten the learning curve. Since promotion of organ donation is one of the crucial national strategic demand in medical field, our government should provide more funding supports in related clinical and animal studies. Researchers should focus on solving the key scientific and technological problems in organ donation.

In summary, with a decade of efforts, the dream of conducting organ donation in the way complying with the international standard has become true. China will be the largest transplant country in the near future. And we are on the road to be the best one in the world.