渥太华公民报　格兰·麦克格雷格　2007年11月25日

　　因为受到滥用人权的指控，中国政府正严打器官走私。正如格兰·麦克格雷格来自北京的报道，新的规定使得器官更为稀有了，并引发了西式的教育、捐献者卡片及注册运动。

　　距离北京颐和园不远，上个月的一天早晨，一对农民夫妇坐在一家部队医院的大房间里，聆听一群身着白大褂的大夫讨论是否要动手术来挽救他们儿子的生命。

　　每周五，人民解放军医院第二附属医院道德委员会开会查看本院不断增加的器官移植病例单。这一天，委员会考虑是否允许27岁的高伟——这对农民夫妇的儿子，接受他妈妈的捐肾。

　　高伟因肾衰竭住院，正在接受常规治疗。中国和西方大多数国家一样，肾源稀少。仅这一家医院，就有300-400位患者需要肾源，而且，如果没有家庭捐献，大多数人要等五年之久。高伟能够存活下来的最好机会来自他妈妈。

　　有居民把这一病例提交给了人民解放军医院第二附属医院道德委员会，讲述了高伟和他妈妈雷永芳的情况，在大厅外面还有3个家庭排队等着递交自己的病例。

　　一位医生对高伟妈妈的身体状况表示担心，因为雷永芳曾患有肺结核。他问这是老毛病吗？雷永芳说：“我从来没有体检过，我第一次作检查是为了我儿子。”

　　主持会议的大夫转向高伟说：“我们会尽最大努力挽救你的生命”，“你必须珍惜你妈妈的肾，珍惜你妈妈的生命”。

　　雷和他的丈夫都忍不住哭了。

　　医院同意带领西方记者观看这样一个涉及个人的场景，以此说明中国是多么努力地在克服非道德做法引发的问题以及围绕器官移植引发的人权问题。

　　在过去的几年里，中国被指控允许黑市交易器官，并允许外国人从死刑犯那里购买器官。这些说法中国政府最终都承认了。有人称“法轮功”信徒被屠杀，为富有的外国人提供新鲜的肾脏、肝脏和眼角膜。对此，中国方面坚决否认。

　　但是，随着2008北京奥运会的临近，中国想要在器官移植和人权方面树立正面的形象。尤其是中国医生想要革新中国形象。中华医学会出资请我到中国，就是要展示一下在今年早些时候出台的新规章制度下，中国器官捐献机制正在正常运转。

　　北京解放军医院移植工作由石炳义（音译）博士负责，他是中国器官移植协会副主席。在石博士的指导下，医院每年做60例左右器官移植手术，大部分都是肾移植手术。

　　器官移植已在中国开展20多年了，而且近5年来，器官移植在外科手术中很盛行。西方评论认为，数字的增长证明了中国非道德器官移植做法的存在，也证明了中国曾过屠杀“法轮功”学员，并把器官卖给外国人。

　　但石博士认为数字增长原因与上述行为无关。他指出20世纪90年代末大批的中国外科医生去西方学习器官移植技术。超过100人到欧洲学习更先进的移植技术。现在那些医生回到了中国后，每年都做成千上万的手术。

　　石博士本人曾在剑桥学习，他承认死刑犯仍然是医院器官移植的重要来源。大约有一半的肾脏来自健在的亲属，很小一部分来自脑死亡者或者尸体。那么剩下的来自哪儿呢？

　　“被处决的犯人。”石博士说。

　　不清楚中国其他地方是否有着同样的比例。

　　他坚持说，在他做的所有手术中，处决犯都是自愿提供。“如果犯人坚持，我想我们不会违背他们的意愿。”他说。

　　把犯人当作捐献者仍然是一个敏感的、有争议的话题。中国政府表示新规定保证在争得犯人同意的情况下才进行移植手术。

　　但国际社会大多认为此做法需有书面同意证明才行。

　　9月份，中华医学会与世界医学会达成了一致立场，即：犯人和其他受监护个人的器官不能用作器官移植，为自己直系亲属的除外。

　　中华医学会的医生们是否会遵从组织的领导，停止使用私人器官，还不是很清楚。协会的立场对中国政府没有约束力，但与制定全国器官移植规定的中国卫生部的立场一致。

　　卫生部发言人毛群安说：“他们可以有自己的想法。”但是他说由卫生部制定规定，而不是医学会。

　　毛群安说，新规定明确了移植外国人的器官是非法的，除非极特殊的病例。规定要求健在的捐献者必须是有血缘的亲属，此规定旨在制止器官走私。但移植医院需由卫生部审定。曾经有400多家医院可以做移植手术，现在只有164家，如果违反新规定，他们将有被吊销营业执照的风险。

　　中国政府的审查使得中国器官源更紧缺了。政府正努力建立一个像西方国家那样的全国器官分配网络，正在努力制定脑死亡法律来帮助增加供给。但是在有13亿人的国家里，这些举措无法满足对器官的需求。

　　上海中山医院的一位移植外科医生，朱同玉博士说：“我认为这是一个大问题，国际性的问题。”

　　朱博士说服了中国人考虑由健在的家属捐献器官。他说他反对对器官捐献的固执的文化抵制。尤其是肾脏被认为是整个健康的钥匙，很多中国人反对捐献，甚至不给自己家人捐献。他翻译了一句中国谚语：“肾好，一切才好。”

　　男人尤其不愿意考虑捐肾，因为很多中国人把肾脏看作是男性性活力的源泉。

　　朱博士目前正在为上海电视台制作时长为一小时的纪录片，主要反映有多少患者从亲属那里获得了肾脏并且最终得救的情况。

　　去年，中国的器官移植生意就完全停滞了。

　　在访问中山市的那天，有几位中国病人，刚刚移植手术后就恢复了健康——他们都是从亲属那里得到器官的——但是外国人病房里的几位病人正在接受其他方式的治疗。

　　在快速查房中，朱博士查了查他的几位病人，其中包括一位24岁从他母亲那里获得肾脏的沈延平。大学毕业后，沈想成为一名翻译的计划被搁浅了，因为她要治疗肾病。现在，换了新肾，她希望回去工作。

　　被朱博士允许的器官接收者是幸运的。在他们医院里，300多名病人还在等着，很多人在还没有等到需要的器官的时候，就会死掉的。

　　朱博士是上海首批持器官捐献卡的人之一，试图产生新的器官源。器官捐献卡有点像金色信用卡，上面有持有人的手机号码。

　　另有10万人也许得到相应得帮助。

　　“在上海，我们需要100万张器官捐献卡，”他说，“那将是一个良好的开端。”

英文原文：

China buffs image with transplant rules

Not far from Beijing's fabled Summer Palace, a peasant couple sat in the boardroom of a military hospital one morning last month and listened as a group of white-coated doctors discussed whether they would approve surgery to save their son's life.

Every Friday, the ethics committee of the People's Liberation Army Hospital, 2nd Affiliate, meets to review its growing list of organ transplant cases. On this day, the committee considered whether 27-year-old Gao Wei, the son of a farmer, would be allowed to get a kidney from his mother.

Mr. Gao was hospitalized with kidney failure and was undergoing regular dialysis treatment. In China, as in much of the West, kidneys are scarce. At this hospital alone, between 300 and 400 patients need kidneys and, without a family donation, most face waits as long as five years. Mr. Gao's best chance for survival was his mother.

The resident presenting the case to the committee described the status of Mr. Gao and his mother, Lei Yongfang, as a PowerPoint presentation with CT-scan images of their kidneys flashed overhead. Outside in the hallway, three more families waited their turns to pitch their cases.

One doctor expressed concern about the mother's health and indications she had had tuberculosis at one point. Was this a long-standing problem, he asked.

I've never had my body checked before, Ms. Lei admitted. My first exam was for my son.

The doctor leading the meeting turned to face Mr. Gao. We will try our best to save your life, he said. You should cherish your mother's kidneys, your mother's life.

Overcome, Ms. Lei and her husband burst into tears.

That the hospital would allow a western journalist to watch this most private of proceedings indicates how strongly China is trying to overcome questions of unethical practices and human rights abuses surrounding organ transplantation.

In past years, China has been accused of allowing a black market trade in organs and allowing foreigners to purchase organs taken from executed prisoners -- allegations that the Chinese government eventually admitted. Some allege that followers of the banned spiritual movement Falun Gong were slaughtered to provide fresh kidneys, livers and corneas for wealthy foreigners -- charges the Chinese vehemently deny.

But with the 2008 Beijing Olympic Games approaching, China is eager to put a positive spin on its organ transplantation practices and mitigate concerns of human rights abuses.

Chinese doctors, in particular, want to see China's image reformed. The Chinese Medical Association has brought me here -- at their expense -- to show the machinery of Chinese organ donation at work under a new regulatory regime introduced earlier this year.

At the PLA hospital in Beijing, transplantations are overseen by Dr. Shi Bing Yi, vice-chairman of Chinese Transplantation Association and one of the heaviest hitters in China's transplantation community. Under Dr. Shi's direction, the hospital performs about 60 organ transplants a year, mostly kidneys.

While organ transplantation has been possible in China for more than 20 years, there has been a boom in surgeries over the last five years. Western critics have suggested that the surging numbers are evidence of unethical organ harvesting practices and prove that China slaughters practitioners of the banned spiritual movement Falun Gong to sell their organs to foreigners.

But Dr. Shi says the reason for the rising numbers is far less nefarious. He points to the large number of Chinese surgeons who went to study organ transplantation in the West in the late 1990s.

More than 100 travelled to Europe to learn more advanced transplantation techniques.

Dr. Shi himself studied at Cambridge. Now those doctors are back in China and performing thousands of surgeries every year.

Dr. Shi admits, however, that criminals who receive death sentences are still an important source of organs transplanted in his hospital. About half of kidneys come from living relatives and a very small number are from brain-dead bodies or cadavers. The rest?

"Executed prisoners," Dr. Shi says.

It is unclear if the same ratio exists elsewhere in China. Dr. Shi says tracking of both the number of executions and transplants across China has been spotty.

In all the surgeries he performs, he insists, the executed criminals voluntarily consented and the documentation of their consent is rigorous.

A condemned prisoner should be able to donate an order in a bid for redemption, should he choose, Dr. Shi says.

"If criminals insist, I don't think we should betray them," he says.

The use of prisoners as donors remains a sensitive and contentious point. The Chinese government says that the new rules adopted over the past two years ensure that prisoners who agree to be organ donation have given full and informed consent. Prisoners agree as a way of showing remorse for the crimes, it claims.

But to much of the international community, the practice remains abhorrent -- with or without written consent. Even the Chinese Medical Association this fall adopted a new policy on organ donation, agreeing that no prisoner's consent could be truly free of coercion.

In September, the association said it agreed with the World Medical Association's position that "the organs of prisoners and other individuals in custody must not be used for transplantation except for members of their immediate family."

Less clear is whether Chinese Medical Association doctors will follow the organization's lead and stop using organs obtained from death row. The association's position is in no way binding on the Chinese government, but it has put the organization at odds with the Chinese ministry of health, which sets national regulations for organ transplant.

"They are able to have their own opinion," said ministry of health spokesman Mao Qunan. But the ministry sets the rules, not the medical association, he said.

Mr. Mao says the new government regulations codified this year make transplants for foreigners illegal in all but the rarest of cases. Regulations requiring that living donors be blood relatives are designed to stop the trafficking in organs. And transplant hospitals must now be accredited by the ministry of health. Where once there were more than 400 hospitals performing transplants, today there are only 164, and they all risk losing their licenses if they violate any of the new rules.

The overhaul has left China with an even greater shortage of organs. The government is trying to set up a national organ allocation network similar to those in western countries and is still trying to develop a law on brain-death to help increase the supply. But in a country of 1.3 billion people, these fledgling initiatives can't come close to meeting the demand for organs.

"I think it's a big problem, an international problem," says Dr. Zhu Tongyu, a transplant surgeon in the department of urology at the Zhongshan Hospital in Shanghai.

Dr. Zhu is helping lead a drive to convince Chinese to consider donations of organs from living family members. He says he's up against a stubborn cultural resistance to organ donation. Kidneys, in particular, are seen as a key to overall health and many Chinese are averse to donation, even to family members. He translates a Chinese saying, "If kidney is good, everything will be fine."

Men are particularly reticent to consider kidney donation, as many Chinese see the kidney as the root of male sexual vitality.

Dr. Zhu is currently producing an hour-long documentary for Shanghai television that chronicles how many of his patients have saved from death or dialysis by kidney donation from relatives.

Dr. Zhu and the Zhongshan hospital are still featured on the website of Meditours, a Kelowna, B.C., company offering medical tourism.

The site describes the organ-transplant facilities at Zhonghan and says foreigners can get a new kidney for $75,000. But Shaz Pendharkar, Meditours owner, says the webpage is out of date.

The transplant business in China has completely shut down in the past year, he says.

On the day the Citizen visited Zhongshan, there were several Chinese patients recovering from transplant surgery -- all received organs from relatives -- but the few patients in the foreigners' ward were there for other types of treatment.

In a quick tour of the post-op wards, Dr. Zhu checked in on his patients, including Shen Yanping, a 24-year-old who received a kidney from her mother.

Ms. Shen's plan to become a Japanese-Mandarin translator was put on hold after university as she tried to manage her kidney disease. Now, with her new kidney, she hopes to go back to work.

The organ recipients he treats, Dr. Zhu allows, are the lucky ones. At his hospital more than 300 patients are on the waiting list and many will die before they get the organs they need.

Dr. Zhu is among of the first in Shanghai to carry an organ donor card, in an attempt to generate a new source of organs. It looks a bit like a gold credit card and has the cellphone numbers of the bearer's next of kin.

His is one of the first batch of 10,000 printed -- a number he admits will be useless. Another 100,000 might help.

"We need one million cards in Shanghai," he says. "That would be a good start."

(The Ottawa Citizen, Sunday, November 25, 2007)