World-leading Australian transplant doctors have come under fire from some of their medical colleagues for research links to China, which has long been accused of harvesting the organs of political prisoners.
Criticism is being leveled at clinicians from Sydney’s Westmead Institute for Medical Research, including Dr. Philip O’Connell and Professor Jeremy Chapman, the current and past presidents of The Transplantation Society – as the international body meets in Hong Kong for its 26th congress today.
Recently published research by author Ethan Gutmann, former Canadian politician David Kilgour and lawyer David Matas claims China is performing 60,000 to 100,000 organ transplants a year. They say this dwarfs the Communist regime’s estimates of about 10,000 and that it cannot be explained by China’s fledgling program for voluntary organ donors.
The investigators claim many of the organs are taken from prisoners of conscience, mainly the persecuted Falun Gong religious minority, but also Uyghurs, Tibetans and “House Christians” who congregate secretly in worshippers’ homes.
Professor Chapman, who has previously cast serious doubt on their numbers, told SBS that attacks on Westmead were “scurrilous” and that Falun Gong was making the most of the Hong Kong congress “to highlight the plight of their devotees”.
“We understand that motive but cannot permit such wild and false innuendo and allegations to pass without comment,” he said.
Professor Chapman was reacting to criticism of Westmead, a teaching hospital connected to Sydney University, co-operating with the Third Xiangya Hospital, a major transplant hospital in Hunan province, since at least 2008.
Medical specialists in Australia and overseas say they only became aware of the Westmead link to Xiangya - also spelt Changsha - in recent weeks, following disclosures made by a researcher based in Germany, Arne Schwarz.
Sydney University geriatrics professor Maria Fiatarone Singh and Macquarie University medical ethics expert Wendy Rogers question why the Westmead doctors have not disclosed the link on the research institute’s website or in journal articles about China’s transplant programs.
Under the NHRMC Code for Responsible Conduct of Research, researchers are required to disclose “actual or apparent conflicts of interest as soon as it becomes apparent.
Professor Rogers told SBS “the connection provides implicit endorsement of current and past transplant practices in China”.
“The relationship seems to extend back to at least 2008,” Professor Rogers said. “At that time, by China's own admission, over 95 per cent of transplants came from executed prisoners.”
Professor Rogers believed the Westmead doctors had “good intentions” but said: “No matter what the motives by Australian doctors for establishing the relationship, the reputation of Westmead has been used to lend credibility to unethical Chinese organ transplant practices.”
The Dui Hua Foundation, which monitors executions in China, estimates that approximately 2,400 people were put to death in 2013. Official figures on executions remain a state secret.
Dr O’Connell told the congress on Friday he welcomed China’s “cessation” of using organs from executed prisoners as of January 1, 2015, but he reminded those attending that foreign observers remained skeptical of the country’s commitment to reforms.
“Those of you from China will this week experience the reality of public scrutiny on the issue. I have to tell you that there remains, in many sectors, a deep sense of mistrust of your transplant programs which have been responsible for overt commercial trafficking of prisoner organs for transplantation to wealthy foreigners from the West and Middle East.”
While The Transplantation Society had campaigned for more than 10 years to stop prisoner executions, Dr O’Connell conceded: “Many people in the global community are not persuaded that China has changed.”
A longstanding dispute
The accusations come amidst a longstanding dispute between Chapman, his clinical partners and critics who say China’s organ donation system is ethically compromised.
At the centre of the debate is the commitment of Chinese authorities to ending the use of organs from executed prisoners, and the role of clinicians who have been working with both Australian institutions and hospitals in China that lack proper accountability procedures for organ procurement.
In 2013, the acrimony reached a climax after a surgeon who studied at the university now oversees China’s transplant programs, Dr Huang Jei Fu, admitted organs continued to be sourced from executed prisoners. The university quietly refrained from renewing his honorary professorship last year.
Professor Chapman has insisted that Dr. Huang is a reformer who is trying to bring China’s organ transplant system into a new era of transparency where organs are sourced only from consenting civilian donors.
In an open letter published on The Transplantation Society’s website, Chapman said the TTS “supports those in China who are agents for change” and is committed to the development of “an ethically based, transparent, deceased organ donor program, which must be free of corruption and financial incentives.”
Professor Fiatarone Singh, who led a campaign for Sydney University to revoke an honorary professorship awarded to Huang Jiefu, said Westmead had signed co-operative agreements with the hospital beginning in 2008 – which were supplemented in 2013 and 2014 - “apparently for the purpose of academic exchanges and research collaboration in the field of transplantation medicine”.
“These agreements have been publicized on Chinese websites, but never before disclosed in TTS or Australian or international context to our knowledge,” she said.
“The ethical concern is that there is convincing evidence from this Chinese hospital's reports that large volumes of transplants were performed in this hospital at a time when virtually no voluntary organ donation system existed, and when the Vice-Minister of Health at the time, Huang Jiefu, has admitted that virtually all organs were sourced from executed prisoners.”
Professors Fiatarone Singh and Rogers were concerned that another doctor at the Westmead Institute, Shounan Yi, collaborated in research with Third Xiangya on a clinical xenotransplantation study that involved injecting pig pancreatic cells, or islet cells, into humans with diabetes
While this research was in China, Tthere had been a moratorium on such research in Australia at the time.
“It therefore violated the spirit of this moratorium”, Professor Fiatarone Singh said.
However, Professor Chapman said there had been no collaborative research projects, or grants, with the Chinese hospital “and thus no papers to co-author”.
Dr Yi’s name does, however, appear on that research paper, which states he is from the Westmead Institute.
But Professor Chapman said: “Dr Yi was in Australia and he was employed at Westmead in our research laboratories.
“In recent years he has been part-time at Westmead and has a separate appointment to Changsha – his home town – where he has worked to support their research and was an author on one of their publications on xenotransplantation.
“We would not be a party to such premature xenotransplantation research in Australia, even though the NHMRC embargo, which had been instituted partly through our lobbying, was revoked in 2009.”
“No relevant disclosures”
Professor Chapman said there was a memorandum of understanding between the Western Sydney Local Health District, Westmead and Xiangya Hospital.
“This was derived originally from a capacity building program in laboratory research whereby standard research methodologies were taught at our laboratories at Westmead, to inexperienced researchers in their radiology and endocrinology departments, and specifically excluded clinical transplantation.”
Xiangya had sought “to extend this to clinical programs in cardiology, endocrinology and intensive care, but we specifically excluded the transplant program”.
The arrangement had been signed by the health district chief executive “and was of course a matter of record and declared”.
“Each party to the MOU met its own costs and there were no fees or honoraria. The relationship was of course known to colleagues in the TTS council.”
In December 2013, Professor Chapman himself expressed grave doubts about China’s transplant program in the Medical Journal of Australia, stating that “China cannot enter the global community of civil societies while current practice continues in its prisons and hospitals”.
Dr Chapman also quoted a physician in Australia who was allegedly told by a patient of Chinese origin: “I cannot come in for dialysis tomorrow. I have to fly tonight because they are shooting my donor tomorrow.”
While there is no suggestion this incident occurred at Third Xiangya, by then, the Westmead Institute had already had a long relationship with the Chinese hospital
The article was followed by the line: “Competing interests: No relevant disclosures.”
SBS has asked the Westmead doctors whether they believe China has so radically improved its position since that article that it now derives all its organs from genuine donors.
At time of writing, none of the clinicians had addressed this overarching concern.
While China says it has stopped harvesting organs from executed prisoners, honorary professor Dr Huang Jiefu defended the practice during a rare news conference in May 2013. The ABC reported he told a small group of journalists why a death-row prisoner might choose to give up his organs:
“Before he (the prisoner) died he found his conscience, and found he needed to do something to repay society. So why do you object.”
Professor Rogers told SBS she accepted the research of Gutmann, Kilgour and Matas, which – despite China’s secrecy – she said “examined data from multiple sources including transplant bed counts, bed occupancy rates, staffing levels, revenue from transplants, records of individual doctors etc”.
It was not possible so many transplants could have sourced voluntary donations from Chinese citizens, she said.
“The most likely source of organs is from executed non-consenting prisoners of conscience … This fact is consistently denied by the Chinese government and largely discounted by The Transplant Society.”
Based on the same researchers’ claims, Professor Fiatarone Singh agrees Third Xiangya Hospital must also be involved in unethical organ harvesting.
“Thus, it would expressly violate the very nature of our calling as physicians to collaborate in any way with these doctors who have been involved in such organ harvesting and possibly crimes against humanity,” she said.
Doctor Chapman told SBS that the Chinese practice of organ donation had markedly improved since the publication of his 2013 article.
Dr O’Connell told The Transplant Society congress there were “political undertones” to “some of the media on this topic which TTS is aware of and makes no judgements on”.
“There are some sectors both inside and outside of China who, for different reasons, want you to fail,” he warned. “Many people in the global community are not persuaded that China has changed. It is up to you to demonstrate clearly and transparently that you are no longer using executed prisoner organs and are not selling Chinese organs.”
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