Friday, September 30, 2011

Organs transplanted from executed Chinese prisoners

My good colleague Art Caplan and a number of co-authors published a piece in THE LANCET, arguing for a boycott of Chinese (that's mainland Chinese) transplant programs, specialists etc. They seems to have two bones to pick with the Chinese approach to organ transplantation:

1) the country has no ethical system in place to decide who gets an organ. They suggest in their piece that it is odd indeed that there's brisk transplant tourism (ie foreigners getting deceased Chinese people's organs for hard $$ while there ain't enough organs to go around  for Chinese folks who would need those very same organs to survive). So, they allege queue jumping by the rich. That's a pretty good reason, if true, for criticizing the current transplantation policy modus operandus in China. Whether  or not that's a good enough reason to boycott Chinese scientists working in the area is questionable as the opportunity is removed to influence policy development in this context constructively.

2) Their second reason is a tad bit weaker, I think. Caplan and colleagues are upset that organs from executed Chinese prisoners are being utilized for transplantation purposes (often without their consent, they allege, or with consent obtained under duress - ethically invalid is how they describe it ). They also claim that prisoners on death row 'might' be executed (ie they don't seem to know, but suggest anyway) in order to meet demand for a particular transplant organ. It goes without saying that they argue (well, claim) that these executed prisoners' human rights are being violated by this practice.

This second argument I don't find persuasive (it could be persuasive, but the data required to make it persuasive are nowhere to be found in Caplan and co-authors' comments). My thinking goes like this: given that China executes prisoners regardless of the organ transplantation issue, it makes sense to me that the organs of deceased prisoners are utilized to preserve human lives that otherwise would be lost. Just to be clear, I am against capital punishment. I think it's a barbaric form of punishment, the risk of wrongful convictions is plain too high,  and there are other sound arguments against the death penalty. However, as long as the number of convictions in a country that executes prisoners on death row (as eg Caplan's country, the USA does) does not increase as a result of demand for  transplant organs, I wonder why we should not use their organs to preserve human lives that otherwise would wither. This in no way condones capital punishment, it simply suggests that IF a country has capital punishment we should make the best of a bad situation.

There could be empirical evidence that the number of death penalty verdicts increases in China when there's increased pressure to generate transplant organs. That would be a very good reason for being against such a practice, but there's no evidence in the article to suggests that this is actually the case. I did not realize that there is such a thing as human right to be buried with all your organs (at least not in international human rights documents that I am aware of). If this right existed, many countries would be in violation of this right, as there's plenty of countries these days where people have to opt-out to avoid having their organs used for transplantation purposes. In other words, the organs of all those who have died, and who didn't care to opt-out, forgot, were too lazy, etc, are fair game in these countries (Austria being just one of them), even though they never explicitly consented to having their organs used for this purpose.

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