Transborder transplants

By Koichi Furuya and Tatsuyuki Kobori

The Asahi Shimbun

February 25, 2006

SHANGHAI -- One rainy evening at a Shanghai hospital in January, an unlikely stranger could be found: a 62-year-old pajama-clad Japanese man from Kyushu.

He was in pajamas because he was about to have a kidney transplant; he was in China because that's the only place he could get one.

"A doctor in Japan told me that medicine in China is scary," he said. "But I heard that I could quickly receive a transplant, so I hurried here."

The man is part of a throng of Japanese unhappy with the shortage of organ donors in their home country.

In China, getting an organ is relatively easy, and the level of medical care is rapidly modernizing -- two excellent incentives for the now hundreds of Japanese who have decided to come here for kidney or liver transplants.

The practice raises some troubling concerns, not least of which being how, exactly, China gets so many organ donors. Many organs, in fact, are from executed criminals. Critics also say that the legality of organ transplants in China is murky, at best.

For the man from Kyushu, though, the whole process was so easy he couldn't refuse.

He applied for and was granted a passport at short notice, only nine days before his flight.

Upon arrival in China, he was examined by a doctor, then scheduled for an operation that very evening.

An interpreter helped him talk to the Chinese surgeon, who put his mind at ease. And the large general hospital, with more than 1,200 beds, was a pleasant surprise. "It is cleaner than I expected," he said.

The man had been undergoing dialysis treatment in Japan for four years and two months, the whole time unable to have a transplant.

Then, via the Internet, he found out about transplants in China.

He was helped in his journey by the China International Transplantation Network Assistance Center in Shenyang, Liaoning province.

The center helps Japanese, primarily, with the administrative help they need to get transplants. It has both Chinese and Japanese employees, and also provides interpreters.

A kidney transplant costs between 6 million and 7.5 million yen and a liver transplant between 13 million and 18 million yen, according to the network.

The cost is about the same in Japan, where insurance usually covers almost half the amount but the waiting list is much longer.

The center has helped more than 100 Japanese get kidney or liver transplants over the past two years. In total, the number of Japanese to have received transplants in China is estimated to be as high as several hundreds.

"If one selects doctors and hospitals in China, the medical level is extremely high," said an official at the center. "A major plus for patients is that it is possible to receive transplants without waiting very long."

According to China's state-run Xinhua News Agency, 2,600 liver and 6,000 kidney transplants were conducted in China during 2004.

The technical progress is certainly state-of-the-art. The ethics and legality are much more in doubt.

Caijing Magazine, a biweekly, said Vice Minister of Health Huang Jiefu had indicated that 95 percent of transplanted organs in China are taken from dead people, mostly prisoners.

Amnesty International estimates China conducted at least 3,400 state executions in 2004, far more than any other country.

Regulations that went into effect in 1984 allow the use of such corpses for transplants if the prisoner and his or her family agree, or if nobody is prepared to receive the body.

There have been reports, however, of families suing judicial authorities for using organs in this manner without prior consent.

And from the beginning, China has had no laws regulating the organ transplant process, although sources say that hospitals must apply to local public security and health authorities to receive executed corpses, and that the government is moving quickly to put rules in place.

To get a handle on the situation, the research unit of Japan's Ministry of Health, Labor and Welfare, and the Japan Society for Transplantation, are embarking on a joint survey.

Many aspects about Japanese traveling to China or the Philippines for transplants remain unclear, including actual numbers, general safety issues, and the circumstances relating to organ donations.

The unit will ask the society's doctors to contact Japanese who received transplants overseas to learn about their experiences and the conditions of the transplanted organs.

It hopes to compile the results by the end of March.

One doctor in Tokyo who has examined nine people after their return home from getting kidney transplants in China expressed some concerns about the process.

"There is no accurate information about organ donors, and the patients did not receive proper explanations concerning the use of immunosuppressants," he said.

Within two years of the transplants, he noted, four men had died, some from cancer.

"My impression is that survival rates are lower than those for transplants conducted in Japan," he said.

Human rights issues are also a concern. It appears that most patients obtain information either via Web sites operated by overseas middlemen, who match Japanese patients with Chinese doctors, or through word-of-mouth. It is also suspected that monetary transactions may sometimes be involved.

The head of the ministry's research unit, Eiji Kobayashi, is a professor of transplant and regenerative medicine at Jichi Medical School in Tochigi Prefecture.

"While being suitably concerned about the people who received transplants, we would first of all like to grasp the actual situation, including the process followed after transplants," he said.

For many Japanese, though, there is simply no time to wait around.

Since organ transplant legislation came into effect in 1997 in Japan, there have been only 41 cases of organs being donated from patients after brain death.

The Kyushu man was one of the ones who was willing to take the overseas risk -- and the operation was, at least apparently, a success.

"I believe it went well," he said after the procedure. "In Japan, I probably wouldn't have been able to undergo a transplant, no matter how long I had waited."

Copyright © 2006 The Asahi Shimbun Company.

This article posted March 18, 2006.