Hong Kong’s government is looking at ways to share transplant organs between the city’s hospitals and those in mainland China, sparking concerns over human rights protections, according to local media reports and healthcare advocates.
The government is in talks with Chinese officials to set up a regular organ transplant cooperation system, despite ongoing human rights concerns linked to organ harvesting in China, the Ming Pao, Wen Wei Po and Singtao Daily newspapers reported.
The move came as a bill seeking to impose sanctions on anyone involved in illegal organ-harvesting around the world passed in the U.S. House of Representatives on March 27.
Health secretary Lo Chung-mau told a recent transplant conference in Hong Kong that the city’s Hospital Authority is currently discussing setting up a common computer matching system for organs and donors, and is “hoping to implement it as soon as possible,” the papers reported.
Lo made a trip to Beijing earlier this month to talk about a common organ donor mechanism between Hong Kong and mainland China, and the Hospital Authority is currently talking with officials at the China Organ Transplant Response System, he told journalists on the same day that the bill passed in the House.
Lo said he was inspired to pursue the idea by a recent case in which four-month-old Cleo Lai had a successful transplant of a donor heart from an undisclosed location in mainland China, after being critically ill with dilated cardiomyopathy.
‘Clear and transparent mechanism’ needed
Simon Tang, Cluster Services Director at the Hospital Authority, praised China’s National Health Commission’s “robust mechanism” for helping to identify the right organ for Lai.
The case prompted Albert Chan, clinical professor at the department of surgery at the University of Hong Kong, to call for a system to be set up to share organs with mainland Chinese hospitals in future.
“Hong Kong’s organ donation rate is very low,” Chan said. “If the … government can set up a clear and transparent mechanism so more organs donated from the mainland could help people in Hong Kong, it’d be very encouraging news,” Chan told government broadcaster Radio Television Hong Kong at the time.
Alex Lam, chairman of the advocacy group Hong Kong Patients’ Voices, said organ donation rates are even lower in China than in Hong Kong.
“The proportion of donors in China is lower than that in Hong Kong, and the demand for organs is high,” Lam said. “My question is, even if there is an organ available in China, how likely is it that they will find no suitable recipient in mainland China, given that so many people are on the waiting list there?”
Data from the International Organ Donation and Transplantation Registration Organization shows that the organ donation rate from cadavers has slowed over the past decade in Hong Kong, but that it has consistently remained higher than the rate in mainland China, at 4.66 last year compared with mainland China’s 3.63.
Lam said there are concerns that organs could be taken from Hong Kong donors in future, who are given scant choice about where they end up, and who may not want their organs to go to mainland China.
“Has the government even listened to donors on this issue?” Lam said. “They need to respect their wishes if they are changing the plan.”
Willing donors or executed prisoners?
Song-Lih Huang, secretary-general of the Taiwan International Medical Alliance, said there are also issues around appropriate transportation facilities for organs, and legal differences between the two jurisdictions.
He cited concerns over where any organs donated from China had come from, and whether they had been harvested from executed prisoners or taken from willing donors.
“Where are the organs coming from?” Huang said. “From someone who had an accident, or prisoners on death row, including prisoners of conscience, political prisoners, or from live organ-harvesting?”
“None of us know the answer to that, and it’s very hard to verify,” he said. “We don’t know how many executions are carried out in China every year, nor any way of finding out who is a prisoner on death row.”
Huang said there are also differences in the way that brain death is declared in Hong Kong and mainland China.
The U.S. Stop Forced Organ Harvesting Act of 2023, if passed, will impose sanctions on individuals and entities involved in forced organ trafficking, and authorizes the Department of State to revoke the passports of individuals convicted of certain crimes related to organ trafficking.
China’s former organ transplant chief Huang Jiefu and colleagues reported in the U.K.-based medical journal The Lancet in 2011 that about 65% of transplants in China use organs from deceased donors, more than 90% of whom were executed prisoners.
And a 2022 study in the American Journal of Transplantation found evidence in 71 cases of “executions by organ removal” from prisoners, concluding that “the removal of the heart during organ procurement must have been the proximate cause of the donor’s death.”
China is believed to be one of the world’s top executioners, but the exact number of executions is regarded as a state secret by the ruling Chinese Communist Party.
Translated by Luisetta Mudie. Edited by Matt Reed.