Regulation of lung transplantation in China

Abstract

To the Editor: We read with great interest the article by Lavee and colleagues, who presented and reviewed the current status of heart and lung transplantation in China. The authors provided insights into the controversial issues of transplant programs that have existed for a long time. Although acute criticisms of organ donation were conducted by professional societies and other organizations, some advances have been recently achieved. As we represent the Chinese management unit for the lung transplant registry, we highlight some positive developments with regard to the transplant profession and present some guidelines for addressing the future growth of lung transplant programs in China. It is well known that there is a lack of wide acceptance of the concept of brain death in China, because, in traditional Chinese culture, death only occurs after cardiac death with cessation of respiration. Second, legislation regarding brain death has not yet fully come into effect. With organ donation after brain death (DBD) considered unacceptable by most citizens, there was an increase in under-regulated transplant practices, given that, in a country of 1.3 billion people, there is a large population of patients requiring organ transplantation to extend life expectancy. Despite that unfortunate development, much success has also been achieved. In 2003, the Chinese Ministry of Health (CMH) published official criteria for brain death, which indirectly promoted transplantation from brain-dead donors. Then, the CMH established a government policy in 2007 to oversee organ transplantation so as to limit the growth of inadequately regulated transplantation. A total of 282 organs from 63 brain-dead donors had been utilized for transplantation until 2007, and the number of qualifying hospitals had largely decreased. In April 2008, however, the CMH organized a symposium to discuss the effect of brain death criteria in China. The CMH has since aimed to widely promote the brain death criterion and enact legislation for brain death when the concept finally becomes widely accepted. Lavee et al commented on those “whose consent is either non-existent or ethically invalid, and whose demise may be timed for the convenience of the waiting recipient—that is,