Second chances: A life in death situation

By Katrina Beikoff

August 27, 2008

EACH year in China about a million people die of organ failure, many of whom could be saved if donor organs were available. Sadly, in the world's most populous nation, there are far too few - which is why solving the dilemma has become Dr Huang Jiefu's life mission, writes Katrina Beikoff

Huang Jiefu had made his decision. With top marks in the sciences,physics and chemistry, the middle school student was going to be an engineer. But then, in his first year of high school, his father died.

He fell victim to Hepatitis B, a chronic infection of the liver that contributes to the death of up to 1 million people around the world every year.

Just before his death, the senior Huang altered his will. In it, he simply asked his son to become a doctor.

Death, it seems, can change lives.

Dr Huang, vice minister of China's Ministry of Health, instead has dedicated his life to understanding and treating the liver disease.

He has gone on to become a leading proponent and expert in liver transplant and the surgical treatment of malignant liver and gall tumors, gaining qualifications and prestigious academic titles from Chinese institutions, such as Sun Yat-sen University of Medical Sciences and Beijing Union Medical College, Australia's University of Sydney, Harvard University and Stanford University.

He now stands at the forefront of a push to get China in line with international standards - legally, scientifically and ethically - in conducting organ transplants.

Each year in China more than 1 million people die of organ failure. There are currently still more than 1.5 million on the waiting list for an organ transplant in the country. But only 10,000 of these people will be lucky enough to undergo life-saving operations.

The shortfall is largely due to a lack of organs. The massive discrepancy between supply and demand has created a legal, ethical and moral quagmire for the nation.

"The most important system we have to work on is donations. Without organs, there are no transplants," he says. "Clearly, it is our most urgent task."

It is a task that the softly spoken vice minister says cannot be achieved simply by rules and legislation, though an overhaul of the system governing organ transplants is being implemented.

A raft of new regulations were agreed in late 2006 and have been put in place gradually since May last year, he says. Under the regulations, the government declared it would ensure "human organ transplantation in China was healthily, systematically and legally developed protect the rights of the donors of human organs and the patients ensure the health and safety of the people and implement harmonious development of society."

The rules banned live organ donation by people under 18 years old, human organ trading and transplant tourism. The voluntary donation of organs was also stressed.

Those rules are still evolving, in line with international practices and laws, though with a distinctly Chinese perspective.

Primarily at issue is the Chinese view of death. Experts say that allowing organs to be taken from people who are "brain dead" would certainly increase organ supply.

However, the Chinese belief of living until the last breath has stopped them from donating organs. Waiting for the heart to stop to declare someone dead also means blood is not flowing through the organs, making them unfit to be used for transplants.

Huang says convincing the public that organ donation fits with Chinese beliefs - that it is compatible with the doctrines of Buddhism, Confucianism and Taoism - is complex, challenging and crucial.

It is, he says, his mission.

In the wreckage of the May 12 earthquake in Sichuan Province, rescuers discovered a woman, crushed to death by a fallen house.

Beneath her hunched and battered body was a baby, tucked carefully in a red quilt with yellow flowers, alive and sleeping peacefully.

A mobile phone was found in the quilt. It contained a text message: "My dear baby, if you survive, remember I love you."

Huang says the story, one of the most tragically poignant of the tales of love, hope and heroism from the quake disaster, is one of the reasons he believes Chinese people will begin to embrace the idea of organ donation.

Along with accounts from earthquake rescuers and survivors of teachers who saved scores of students yet who were themselves killed in the rubble comes the belief that even in our own death we can save a life, he says.

"We need to mobilize the spirit we have uncovered in China through these stories," he says. "We need to continue this idea that after death, you can carry on helping the living."

According to official statistics, more than 100,000 people die in traffic incidents in China each year.

A plan for people to declare on their driver's license consent to donate their organs in the event of their death would provide a huge boost to the number of lives that could be saved through transfers, Huang says.

The idea was planted when he was studying at the National Liver Transplant Unit in Australia between 1984 and 1987. At the time, as many as 80 percent of the Australian population declared on their driver's license that they were an organ donor, he says.

"I thought it was incredible," says Huang. "We can learn from the international experience. It can be done.

"Within five years, we can be carrying out the largest number of transplants in the world. That means more than 20,000 a year, maybe even 30,000 a year."

Huang will keep contributing his own skills to the transplant cause, keeping up surgical practice. He has performed more than 500 liver transplants.

"I'm an administrator and a surgeon," he says. "I still keep my identity as a surgeon. From the bottom of my heart, I prefer doing the surgery. It is my job. As a surgeon, I can save the life of the person in front of me."

Like the 23-year-old woman from whom he took a phone call recently.

In 2002, her mother donated the right half of her liver to the then 18-year-old who was in the terminal stage of Wilson's disease, a rare degenerative metabolic disorder in which excessive amounts of copper accumulate in the body. The daughter's call to Huang carried good news. She is well now and has a healthy two-month-old baby.

"That's what makes me very happy," he says, unable to contain his delight. "When we see what can be done, it is so important.

"We need more voluntary donations. It will be more ethical, the system will be better. We are facing a very big task. But I know the international community is standing behind me.

"I will try my best to make a difference," he concludes.

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This article posted November 16, 2008