AN UPDATE TO ‘BLOODY HARVEST’ & ‘THE SLAUGHTER’

China has 130 million hepatitis B carriers.¹⁷¹² China also has 40~50% of the world’s liver cancer patients,¹⁷¹³ in addition to over half the world’s new liver cancer patients about 350,000 cases per year.¹⁷¹⁴ For the 8 million end-stage liver patients (including those with liver failure, cirrhosis, and liver cancer), the most effective treatment is transplantation. ¹⁷¹⁵

The establishment of the “Hangzhou Criteria”¹⁷¹⁶ and “Shanghai Fudan Criteria”¹⁷¹⁷ removed the previous restrictions from Milan and other international standards, which required an individual tumor’s diameter to be 5 centimetres or less for the patient to qualify for a liver transplant. This requirement has now been loosened to 8 centimetres under the Hangzhou criteria and 9 centimetres by the Fudan criteria, which has expanded the potential liver recipient population by about 40%. China does not have an effective national organ donation and allocation network. According to expert estimates in 2010, over 300,000 people are waiting for liver transplants. ¹⁷¹⁸

According to China’s official transplantation website, China has the largest number of people with liver disease of any country. The World Health Organization puts the figure at about 100 million. ¹⁷¹⁹ Chinese researchers say that nearly 400,000 people die every year from liver cancer in China, making up nearly half of all deaths from liver cancer worldwide. And these researchers say that about 300 million in China suffer one or another form of liver disease. ¹⁷²⁰

In 2004, Chen Shi, chairman of the Chinese Medical Association’s Organ Transplantation Society and deputy director of Tongji Medical University’s Institute of Organ Transplantation, stated that there were millions of late-stage renal failure patients in mainland China, among whom about 500,000 were waiting to receive kidney transplants. This number would increase by 120,000 every year.¹⁷²¹ According to the current public data, over one million patients are waiting for kidney transplants in China each year. ¹⁷²²

China currently has more than 10 million patients with heart failure. Each year, more than 2 million die from end-stage heart failure.¹⁷²³

According to statistics from the World Transplant Games Federation, China has more than 4 million leukemia patients waiting for bone marrow transplants. ¹⁷²⁴ The country also has four million people suffering cornea disease.¹⁷²⁵ In 2012, Chen Jiaqi, founder of the Chinese Eye Bank and director of the Eye Bank of Guangdong Province, estimated that between 300,000 and 400,000 corneal transplants would be needed every year. ¹⁷²⁶

Organ transplantation has assumed a high priority in national strategy and receives great emphasis as a future emerging industry. The Government has invested heavily in research, development, and personnel training in transplantation technology. Liver and kidney transplants have become routine surgery in clinical practice. New techniques are emerging and spreading throughout China’s provinces. Not only are the major hospitals engaging in transplants; but small hospitals are unwilling to miss the opportunity.

The shift from socialism to capitalism in China meant withdrawal of government funding from the health system. Before the change, the Government owned, funded and ran all hospitals. All physicians were state employees.

With the transition to capitalism, this system was dismantled. From 1978 to 1999, the Beijing government’s share of national health care spending fell from 32 percent to 15 percent. Between 1990 and 2002, public funding as a proportion of local public health revenues went from almost 60 percent to 42 percent.

This led to privatization of most Chinese health care facilities. Hospitals were forced to rely on the sale of services to cover their expenses. David Blumenthal and William Hsiao wrote, “Public hospitals came to function much like for‑profit entities, focusing heavily on the bottom line.”¹⁷²⁷

According to cardiovascular doctor Hu Weimin, the state funding for the hospital where he worked was not enough to cover even staff salaries for one month. He stated, “Under the current system, hospitals have to chase profit to survive.” Human Rights in China reported, “Rural hospitals [have had] to invent ways to make money to generate sufficient revenue.”¹⁷²⁸

The Government, in addition to withdrawing funding, imposed price controls on basic health services. These price controls were not comprehensive and left new technologies and drugs untouched. In addition, hospital doctor salaries were changed to include a bonus component based on hospital revenue. Blumenthal and Hsiao wrote, “The result was an explosion in sales of expensive pharmaceuticals and high‑tech services.”

All these changes drove hospitals to transplants–a new technology not covered by price controls, which provided private revenue and which, afterwards, required anti-rejection drugs. Transplant surgery became a leading method for hospitals in China to make money. For example, the Organ Transplant Center of the Armed Police General Hospital in Beijing boldly stated, “Our Organ Transplant Center is our main department for making money. Its gross income in 2003 was 16,070,000 RMB. From January to June of 2004, income was 13,570,000 RMB. This year (2004) there is a chance to break through 30,000,000 RMB.”¹⁷²⁹

A report by World Journal in March 2015 quoted Huang Jiefu as saying thatTranslate from: Chinese a liver transplant costs at least 600,000 RMB (about $96,000 USD) and more than 300,000 RMB (about $48,000 USD) for a kidney transplant.¹⁷³⁰ At the end of 2006, Huang Jiefu stated to Caijing Magazine, “Organ transplantation has become a trend of being used as a tool for hospitals to make money.”¹⁷³¹

Because there were no guidelines for transplant fees in China, the prices for transplants ranged from tens of thousands to hundreds of thousands RMB. These included pharmaceuticals, surgery fees, organ acquisition, and preservation and transportation costs.¹⁷³² Before the Kilgour-Matas report on organ harvesting in 2006, the website of the International Transplant Network Support Center of the First Affiliated Hospital of China Medical University listed transplant prices for foreigners. Kidney transplants cost more than $60,000 USD, liver transplants were $100,000, and lung and heart transplants each cost more than $150,000.¹⁷³³

On February 26, 2013, Xinhua News published an article titled “China will officially launch three major principles for organ transplants and organ allocation to follow.” Huang Jiefu said, “A certain stimulus mechanism is to be introduced into China’s organ donation system by giving out certain humanitarian aid and economic compensation.”¹⁷³⁴ The Guangzhou Southern Weekend reported in March 2010 that since 2000, the sale of organs for transplants has become “a mine of high-grade ore that can’t be exhausted.” ¹⁷³⁵

On March 31, 2006, a senior military doctor of the General Logistics Department of the Shenyang Military Command wrote to the Epoch Times, “China is the center of international live organ trading, and has accounted for more than 85% of the total number of live organ transplants in the world since 2000. According to the data reported to the Central Military Commission, some people have been promoted and became Generals due to their ‘achievements’ in this field.”¹⁷³⁶

He also said, “The military acts as the organ transplantation management system. This type of management and organizational core belongs to the military system. This is something that the local government cannot match, because once it becomes a military secret, no one can acquire the information. We all understand how the military system works. There is a huge source of living organs, many military hospitals report their transplants to their supervising authorities, at the same time, they also carry out organ transplants on a large scale in private. This leads to the fact that actual numbers are much higher than the official statistics.”

The People’s Liberation Army General Logistics Department is in charge of allocating organs sourced from prisoners in detention facilities. The Department receives cash (or foreign currency) when selling organs from hospitals, which pay for the organs. The bulk of the transplants are conducted in military hospitals, while the organs sold to civilian hospitals were just for extra profits. The purpose was to use these hospitals as shop windows and advertisements to overseas customers.¹⁷³⁷

Ever since the Deng Xiaoping era, the Chinese military has been given a high degree of latitude to raise funds through entrepreneurial schemes using military resources and infrastructure. The military hospitals are no exception to this long-standing arrangement. While the system responsible for providing organs for military hospitals is maintained by military expense, transplant profits do not fall under military oversight. Accordingly, the trafficking of organs has become a method for military hospitals to make direct profits.

Below are the average costs of kidney transplants in different regions between 2000 and 2004, as reported in academic papers:¹⁷³⁸

Table 9.1 Summary of kidney transplantation during 2000 to 2004

We found lower prices mentioned in various media reports:

The Qilu Evening News reported on July 28, 2003 that the General Hospital of Jinan Military Command charged 30,000 to 40,000 RMB for a kidney transplant and 20,000 to 40,000 RMB per year for immunosuppressive drugs thereafter.¹⁷³⁹

It was reported in April 2006, patients paid only 50,000 RMB for kidney transplants at the Second Hospital of Dalian Medical University.¹⁷⁴⁰

According to an archived webpage from 2008, Changhai Hospital of the Second Military Medical University advertised an average hospitalization fee of 50,000 RMB for kidney transplants.¹⁷⁴¹ The original page has since been removed.

According to a webpage dated in 2010, at the First People’s Hospital of Changde, the average cost for a kidney transplant between relatives was about 60,000 RMB with no complications, or about 80,000 RMB from a cadaveric donor.¹⁷⁴²

It was reported that in early September 2014, a patient paid 600,000 RMB in cash to the First Affiliated Hospital of Zhengzhou University, which was able to find a matching kidney for him in one day. The transplant surgery was done the following day.¹⁷⁴³

A people.cn report from November 16, 2015 indicated that that The First Affiliated Hospital of Xi’an Jiao Tong University Medical College requires “hundreds of thousands of RMB” for a kidney transplant.¹⁷⁴⁴

Between 1995 and 1999, liver transplant surgeries at Wuhan Tongji Hospital required 10 hours, and the cost averaged between 300,000 and 400,000 RMB and peaked at 800,000 RMB. By 2000, the cost had decreased to 190,000 RMB and surgery time to 7-8 hours.¹⁷⁴⁵ By 2001, the institute could usually keep the liver transplant cost below 150,000 RMB; the surgery took 4 hours, which represented the best in the country. In August 2011, the institute performed a liver transplant for 110,000 RMB, the lowest nationwide.¹⁷⁴⁶

In 2009, the cost of a liver transplant at Peking University First Hospital was around 160,000-200,000 RMB, including fees for surgery, monitoring, pharmaceutical, and examination fees for around three weeks after the operation.¹⁷⁴⁷

Lu Shichun, director of the Beijing YouAn Hospital transplant center, stated in a media interview in 2011 that the fee for liver transplants differs among transplant centers and averages around 400,000 to 500,000 RMB.¹⁷⁴⁸

In 2016, Wuhan Union Hospital, a sister institution of Tongji, advertised its liver transplant cost at around 150,000 RMB.¹⁷⁴⁹

At Fuwai Cardiovascular Disease Hospital, which is affiliated with the Chinese Academy of Medical Sciences, a heart transplant averages around 250,000 RMB. Fees for postoperative immunosuppressants average 3,000 to 5,000 RMB per month, as of 2016.¹⁷⁵⁰

Shanghai Chest Hospital of Shanghai Jiaotong University charges between 200,000 and 300,000 RMB for a lung transplant, as of 2016.¹⁷⁵¹

Organ transplant prices for foreigners are not fixed. Although it should be taken with a grain of salt as it is a source twice removed, in 2014 and 2015, Yang Guang, a China expert who resides in Denmark, claimed that his friend’s two affiliated hospitals with a medical university in northeastern China would often charge $500,000 to $1 million USD for transplant, and in several cases, rich foreign patients desperate for an organ have been charged up to $2 million USD for a transplant and hospital stay. A Japanese woman received a young girl’s liver with serial number 020014 and was charged $5 million USD.¹⁷⁵²

• In general, however, interviews with a group of international transplant recipients before 2006 reflected remarkably consistent prices:¹⁷⁵³
• In 2001, a group of 7 patients who went to China together for organ transplants were individually told to bring $200,000 HKD (about $26,000 USD)
• In 2004, an Asian patient paid $27,000 USD for a kidney transplant at the Economic and Technical Development Hospital of Guangzhou
• In 2005, a patient from Taiwan paid $29,000 USD (including “red envelope” money, airline tickets, and other extras) for a kidney transplant at Guangdong Province Border Patrol Armed Police Central Hospital in Shenzhen
• In 2006, a patient from Asia paid $26,000 USD in cash for a kidney transplant at the Land Force General Hospital of WuhanOther sources suggest the cost of a kidney transplant in China runs to $66,500 USD and a liver up to $157,000 USD¹⁷⁵⁴
• A heart transplant at the Zhongshan Hospital in Shanghai can be had for $119,000 USD, a fraction of the $860,000 USD such an operation would cost in North America¹⁷⁵⁵

Different hospitals charge different fees for transplants but they tend to follow a common trend. From a few examples of the main players in China’s organ transplant industry, we can see a decline in medical and pharmaceutical costs coinciding with an overall increase transplant fees. The main factors driving transplant costs are the treatment itself (including surgery and hospitalization costs), pharmaceuticals (including the ongoing regimen of anti-rejection drugs), and the donor organ source.

Between 1995 and 1999, Wuhan Tongji Hospital charged an average of 300,000 to 400,000 RMB and a maximum of 800,000 RMB. In August 2001, surgery fees decreased significantly to around 150,000 RMB on average (the range was 110,000 to 190,000 RMB). The director of the hospital’s organ transplant research institute stated that the decrease in costs were due to the maturation of technology, decrease in operation times from 7-10 hours to 4-5 hours, reduced bleeding, lower cost of blood transfusions, shorter anesthesia times, fewer postoperative complications, and shorter hospitalization times. By 2002, Tongji Hospital had reduced its liver transplant operation time to 4 hours and the cost to below 150,000 RMB, the “lowest in the country.”¹⁷⁵⁶

As we observe, at the early stage after 2000, transplant prices steadily declined due to technological development and abundant organ sources. The dramatic decline of surgery costs and treatments made it affordable for a wider range of patients. The maturation of technology and increase in both domestic and international patients led to an exceptional growth in China’s organ transplant industry.

The decrease in medical costs due to improvements in technology and techniques is also reflected at Shanghai General Hospital, which in 2002 eliminated the need for blood transfusions in one-third of its liver transplant surgeries. The entire operation time was reduced to four and a half hours, and the lowest cost was 142,000 RMB.¹⁷⁵⁷

A 2003 investigation of liver transplant costs showed that early-stage recipients had an average pharmaceutical cost of 198,000 RMB every six months after surgery. The same cost for late-stage patients was more than 230,000 RMB. Recipients also need anti-rejection drugs, which cost more than 30,000 RMB per year.¹⁷⁵⁸

As of 2003, the surgery fee at Jiangsu Provincial People’s Hospital was one-tenth to one-eighth that of the same surgery in other countries.¹⁷⁵⁹

In 2004, Nanjing Drum Tower Hospital’s hepatobiliary department director Ding Yitao told a reporter that the hospital’s liver transplant fee averaged 150,000 RMB, the lowest in the country. Postoperative anti-rejection drugs cost around 3,000 RMB per month for domestically produced products and 5,000 RMB for imported drugs.¹⁷⁶⁰

In the same year, the People’s Liberation Army No. 309 Hospital charged 200,000 RMB for liver transplants and 300 RMB per day for anti-rejection drugs.¹⁷⁶¹ Early in the same year, the Oriental Organ Transplant Center charged around $32,000 USD (~250,000 RMB) for liver transplants. By 2006, the fee had increased to 400,000 RMB for international patients but remained at around 200,000 RMB for domestic patients.¹⁷⁶²

Since international patients are charged much more than domestic patients, organ tourism became a factor in driving up transplant prices. After the organ harvesting crimes were revealed in 2006, transplant prices generally stabilized due to the shrinking international market.

In recent years, along with the resurgence of the international market, both international and domestic demand have increased. According to a report by Jingchu Network in August 2015,¹⁷⁶³ liver transplants in China cost around 600,000 RMB, and kidney transplants cost around 300,000 RMB. From these descriptions of costs for liver and kidney transplants from different channels, we can see that the fees in the past few years have been significantly higher than those before 2006. However, medical and pharmaceutical costs have trended downward. Thus, organ sources may be representing an increasingly large portion of transplant fees and one may naturally wonder if the increase in fees is due to a shortage in the organ supply. While he is hardly a reliable source it is interesting that Huang Jiefu threw cold water on that notion, stating in the same year that the limiting factors of organ transplantation in China lie primarily in medical costs and availability of transplant hospitals and doctors: “Only the third [reason] is that there are not that many donor bodies; even though donor bodies are abundant right now, there aren’t that many hospitals and that many doctors that can [perform transplants].”¹⁷⁶⁴

Nevertheless, compared to the number of patients waiting for transplants, the transplant capacity of hospitals and organs available are still scarce resources. Despite an endless line of domestic patients in need of transplants, the profit-maximizing strategy for hospitals is to provide transplants to those most willing and able to pay. This can be seen in Huang Jiefu’s push to establish a platform to provide organ sources to Taiwan. Furthermore, we see international patients being charged more than domestic patients, to the tune of hundreds of thousands or even millions of USD–fees that are many times the treatment and pharmaceutical costs involved. This scheme takes advantage of the extremely inelastic nature of the market, given that these patients from other countries would otherwise have to wait years for a transplant.

The tissue type or HLA compatibility of the source and recipient impact the rate of rejection after a transplant operation. According to the U.S.-based National Marrow Donor Program (www.marrow.org), the compatibility ratio of recipient and source from a non-immediate family member is quite low—between 1% and 5%. In other words, it takes between 20 and 100 sources to find tissue type compatibility with a recipient; while media reports in China indicate a kidney tissue type matching percentage of between 20% and 30%.¹⁷⁶⁵

Immunosuppressant drugs can lessen rejection responses from tissue type incompatibility. Globally, sources and patients with six out of ten matching points are considered tissue-type compatible. The number of matching points has a direct impact on the rejection rate and the amount of immunosuppressants needed. In China, however, 4 matching points, or sometimes even fewer, are acceptable. As a result, patients would have to rely on large doses of immunosuppressants after receiving transplants. Patients who develop severe rejection responses would require second or even multiple additional transplants. These pharmaceuticals also provide doctors a source of kickbacks, which contribute to some doctors’ aggressive pursuit of even marginal recipient prospects.

Dong Jiahong, director of the hepatobiliary surgery department at Beijing Tsinghua Chang Gung Hospital, revealed to Xinhua Net, “For a liver cancer patient, on average liver resection may cost 20,000 to 30,000 RMB. Liver transplantation may cost over 200,000 RMB, and there are follow-up costs. Most transplant patients will suffer from rejection issues and need to take immunosuppressants for life. Add in antiviral drugs preventing the recurrence of hepatitis B, and the cost is between 50,000 to 100,000 RMB a year.”¹⁷⁶⁶

Because immunosuppressant regimens are individualized, they vary among hospitals and patients. Our hospital survey shows that the annual cost for post-transplant immunosuppressants range from 10,000 to 60,000 RMB. The cost decreased over time as domestic immunosuppressants gained market share. We discuss immunosuppressants in more detail later in this chapter.

The experience and practice of the People’s Liberation Army No. 452 (Chengdu Air Force) hospital jumped from “township-scale” to that of a large-scale hospital in just a few years. Other military hospitals followed suit.

An article “Relying on the Market to Protect the Battlefield” by Xinhua Net and other domestic media in 2009 reported¹⁷⁶⁷ that, when Zhang Cong became the hospital’s president in 2000, the troubled hospital had more than 6 million RMB in debt. Its kidney transplant division used to be the hospital’s best-known department. However, due to the lack of funds needed to update its equipment, its number of patients decreased day by day.

In 2002, Zhang decided to “borrow a hen to lay eggs” and found an entrepreneur who invested 8 million RMB in the hospital. The investor and the hospital together managed the renal transplant division. After the capital and equipment were in place, its kidney transplantation operation soon “came back to life.”

Five years later, the hospital bought back the facilities, equipment, and management rights from the investor and embarked on a new entrepreneurial path. Very soon, the number of kidney transplants performed by the PLA No. 452 Hospital ranked first among all hospitals in Sichuan Province. After the hospital grew from its original 210 beds to more than 1,000 beds, Zhang became the president of the PLA No. 309 Hospital in 2013.

At No. 309 Hospital, the PLA Organ Transplantation Center’s revenue rose from 30 million RMB in 2006 to 230 million RMB in 2010, an increase of nearly 8-fold in 4 years.¹⁷⁶⁸

The annual income of Daping Hospital, affiliated with the Third Military Medical University, also increased from 36 million RMB at the end of the 1990s, when it began organ transplantation, to over 900 million RMB in 2009¹⁷⁶⁹—an increase of nearly 25-fold.

These examples show that the growth in organ transplantation continued after 2006.

Civilian hospitals have also profited from transplants. For example, the Second People’s Hospital of the Shanxi Occupational Disease Prevention and Control Center (in reality a kidney transplant center) charges around 100,000 RMB for a kidney transplant. Its revenue for 2005 was about 250 million RMB. There were at least 100 patients on its transplant waiting list.¹⁷⁷⁰

One aspect from our hospital survey that impressed us is that the vast majority of medical universities and their affiliated transplant centers, military and civilian, have received significant funding from all levels of government. The regime has prioritized organ transplantation in its national strategy and invested heavily in research, development, industrialization, and personnel training in transplantation technology.

The Five-Year Plan of China is a series of social and economic development initiatives.¹⁷⁷¹ It is shaped by the Chinese Communist Party through the plenary sessions of the Central Committee and national congresses.¹⁷⁷²

There have been twelve Five-Year Plans, with the first beginning in 1953. Although they are called Five-Year Plans, most of them are nothing more than long-term projects. Through macro environmental transformations every five years, these plans can be sustained and implemented. Since the advent of the persecution campaign against Falun Gong, the Government of China has continuously incorporated organ transplantation into its Five-Year Plans for multiple ministries–a rare occurrence.

In 2001, establishing organ transplantation regulations was listed as part of the Tenth Five-Year Plan for the Ministry of Health.¹⁷⁷³

In 2004, organ transplantation technology was added as a major research area and key technology in the Tenth Five-Year Plan for National Health, Science and Technology Development of the People’s Republic of China.¹⁷⁷⁴ In 2008, organ transplantation was included once again as a key project in the Eleventh Five-Year National Key Technology Research and Development Program.¹⁷⁷⁵

Since 2011, organ transplantation has been included again in the Twelfth Five-Year National Key Technology Research and Development Program and a number of other national special plans within that Twelfth Five-Year Plan.^{1776 1777}

China’s National Program on Key Basic Research Projects (973 Program) is a foundational research and major development project guided by national strategic demands. It is meant to be progressive, advanced, comprehensive, and to assume a leading role in China’s future development and advancement in scientific technology. Its orientation is to support significant scientific research.¹⁷⁷⁸

The High Technology Research and Development Program (863 Program) aims to address high-tech issues of national long-term development and national security; it is meant to be strategic, cutting-edge, and forward-looking. This program is intended to help develop high technology with independent intellectual property rights, to coordinate the integration and application of high technology, and to develop future emerging industries.¹⁷⁷⁹

Since 2000, these national plans and programs and other national funds have incorporated a large number of projects related to organ transplantation, one of the “comprehensive, leading future emerging industries” that is meant to drive China’s future global development.

The military central and local governments have invested heavily in domestic medical institutions to carry out basic research and development in the organ transplant field and promote its industrialization. These strategies are illustrated by the following examples:

The largest transplant center in Asia is located in Tianjin. The director of the Oriental Organ Transplant Center of Tianjin First Hospital, Shen Zhongyang (also director of the Institute of Organ Transplantation of the Chinese People’s Armed Police General Hospital), was named the “father of Chinese liver transplantation.” He was appointed as the chief expert of the organ transplant program under the national “863 Program” and an expert in biological and medical technology under the same program. ¹⁷⁸⁰ He claimed that organ transplantation is gospel in medicine and will change the world, that China has 130 million Hepatitis B carriers whose conditions are irreversible, and that the only solution is liver transplantation.

The First Affiliated Hospital of Zhejiang University has the largest transplant center in eastern China. The hepatobiliary and pancreatic surgery center and its affiliated liver transplant center have a team of 134 medical professionals, including Zhen Shusen, a member of the Chinese Academy of Engineering, and nearly 40 senior transplant experts. Among them, 60% have doctoral degrees. The center has 340 beds.

In recent years, the liver transplant center has completed over 40 national projects. Some of the projects have provided over ten million RMB in funding. It took the chief scientific position in leading two projects of the 973 Program: Foundational research in the application of immunological mechanisms of chronic graft dysfunction (2003~2008) and basic research on the application of organ transplantation immunology (2009~2013).¹⁷⁸¹ In addition, it took the lead in three projects of the 863 Program, three projects under the national Eleventh Five-Year National Key Technology Research and Development Program, and two projects supported by National Natural Science Foundation. Furthermore, the center had a project funded by Changjiang Scholars and Innovative Development Team Program, and another project supported by the Ministry of Health’s Professional Specialization Fund.¹⁷⁸²

The Organ Transplant Center of the First Affiliated Hospital of Guangzhou Sun Yat-sen University has engaged in more than 50 research projects, including the national “863 Program “, “Twelfth Five-Year National Key Technology Research and Development Program”, and a National Natural Science Foundation project during three recent years.

The academic leader of the center He Xiaoshun has presided over 17 research projects with funding of more than thirteen million yuan in total. From 1996 to 1998, he only got 80,000 RMB from the National Natural Science Foundation after he had worked in this area for over 10 years. During the seven years from 2001 to 2008, he received research funding of 850,000 RMB, a 10-fold increase from earlier. Since 2008, his team has obtained more projects amounting to 12 million RMB, a 14-fold increase in 7 years, including a national 863 Program on key technology of organ transplant (2.88 million RMB, from 2012 to 2015). ¹⁷⁸³

Liberation Daily, the official newspaper of the People’s Liberation Army, reported in 2004 that the Shanghai Municipal Science and Technology Commission established a major multiple organ transplantation research project in 2002. It invested 8 million RMB in five hospitals to conduct clinical research in heart, liver, and lung transplants. These five hospitals include Zhongshan Hospital of Fudan University, Ruijin Hospital and Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai First People’s Hospital, and Shanghai Lung Hospital. In 2003, the total number of organ transplants in Shanghai was more than 10 times that of 2001, and the hospitals achieved a few “national and even international first” titles in organ transplantation.¹⁷⁸⁴

People’s Daily Online reported in June 2014 that Renji Hospital’s liver transplant center at Shanghai Jiaotong University has become a key clinical specialization of a number of science and health programs under the National Health and Family Planning Commission, National “Project 211,” National Clinical Pharmacology Institute of Organ Transplantation, and the most important clinical key discipline of the Shanghai Health and Family Planning Commission. In recent years, the center received funding for seven projects by the National Natural Science Foundation of China; one project supported by the National Health and Family Planning Commission, a joint research project on major diseases supported by the Shanghai Health and Family Planning Commission, more than ten general programs, and key programs supported by the Shanghai Municipal Science and Technology Commission. The total research funding amounted to over 20 million RMB.¹⁷⁸⁵

We list here a few more organ transplant centers which have embarked on vast projects in recent years and their projects:

Dou Kefeng, the director of the PLA Institute of Organ Transplantation of Xijing Hospital, Affiliated to the Fourth Military Medical University, has taken the lead in the following projects: two sub-projects of national “863 Program”, one project in “Eleventh Five-Year National Key Technology Research and Development Program”, one major project and three projects in the National Natural Science Foundation, one military clinical high-tech major project, the military “Eleventh five-Year scientific and technological research disciplines, three military “2110” projects, and a special military discipline. The total ongoing research project funds reached over 20 million RMB.¹⁷⁸⁶

Recently, the Institute of Organ Transplantation Research of Xi’an Jiaotong University has taken the lead in 46 national and key department projects, including those under the “973 Program,” the “Eleventh Five-Year National Key Technology Research and Development Program,” “National Natural Science Funds,” and a provincial Key Discipline.¹⁷⁸⁷

The Liver Transplant Center of West China Hospital at Sichuan University is a teaching hospital, as well as a research and development institute. It has undertaken more than 30 projects supported by the National Natural Science Foundation of China, National Education Commission, the “973 Program” of the Ministry of Science, the Eleventh Five-Year National Key Technology Research and Development Program, the Ministry of Health, the Sichuan Province Health Department, and a provincial Key Discipline.¹⁷⁸⁸

The Organ Transplantation Research Institute of Wuhan Tongji Hospital affiliated with Huazhong University of Science and Technology, in the past decade, has undertaken over 30 science and technology research projects, including the national “863 Program “, “973 Program “, major projects funded by the National Natural Science Foundation of China, clinical key projects supported by the Ministry of Health, major projects by Hubei Province Natural Science Foundation, and other research projects commissioned by the Ministry of Health. In recent five years, this institute has published 410 papers, including 78 SCI papers and 11 books.¹⁷⁸⁹

In addition, other prestigious universities and affiliated hospitals, as well as almost all military and civilian medical universities and their affiliated hospitals, are rapidly developing their organ transplant research and receiving a large amount of national funding. These institutions include Tsinghua University, Peking University, Renmin University, Shanghai Tongji University, Wuhan University, Central South University, Jilin University, and Lanzhou University, etc.

These examples reflect that the Chinese Government has made organ transplantation a high priority in its national strategy, and have been stimulating and driving its development.

Many Communist Party and government officials at all levels have supported the hospitals’ transplant activities, by helping to remove the obstacles of development, providing financial aid, or playing a matchmaking role in establishing collaborative relationships between transplant centers. We give a few cases below as examples.

Vice Chairman of Standing Committee of National People’s Congress Guides Establishment of Peking University Organ Transplant Center

In October 2001, the Peking University Organ Transplant Center was established under the guidance of Han Qide, Vice Chairman of the Standing Committee of the National People’s Congress.¹⁷⁹⁰ It incorporated related departments from five medical institutions, including Peking University First Hospital, Peking University People’s Hospital, and Peking University Third Hospital. The center specializes in transplantation of liver, kidney, pancreas, heart, cornea, bone marrow, and other organs. It claims to be the largest and most academically advanced in China, with its liver transplant capabilities in a leading position in the Beijing region.¹⁷⁹¹ The Peking University Organ Transplant Center was the predecessor of the Peking University Organ Transplantation Research Institute. In 2013, Zhu Jiye, director of the Institute, revealed to the media that it conducted 4,000 liver and kidney transplants within a particular year.¹⁷⁹²

Jiangxi Provincial Party Secretary Assists Transplantation at Nanchang University

The First Affiliated Hospital of Nanchang University is the only hospital in Jiangxi Province with an independent organ transplant center. It is also the best equipped in the province. In 1991, this hospital became the first in the province to perform kidney transplants, followed by heart, liver, combined liver-kidney, combined pancreas-kidney, bone marrow, and corneal transplants. Within the first four months since its official opening, the center was able to perform 6 vital-organ transplants in one day.¹⁷⁹³

Meng Jianzhu, former Jiangxi Provincial Party Secretary and current Party Secretary of the CCP Central Political and Legal Affairs Committee, has historically supported this hospital’s transplantation activity. He personally played a matchmaking role in establishing a collaborative relationship between this hospital and the Shanghai Organ Transplant Center (Shanghai General Hospital).¹⁷⁹⁴

Promotion of Organ Transplantation by Hubei Provincial Party Secretary

Since December 2007, Li Hongzhong has sequentially held the roles of governor of Hubei Province and provincial Party Secretary. On February 25, 2014, he attended the “2013 Hubei Province Science and Technology Awards Conference” held in Wuhan. He gave Tongji Hospital a “special award for scientific and technological progress” for its research program in “new technology for combined transplants and treatment of major diseases.” Since then, these capabilities have been propagated to organ transplant centers at ten 3A hospitals in Beijing, Shanghai, Guangzhou, and other regions.¹⁷⁹⁵

Prior to the above, Li Xiansheng, the Deputy Party Secretary of Wuhan and mayor of Wuhan between April 2002 and December 2007, enthusiastically supported and promoted the city’s development in organ transplantation. In mid-November 2003, after listening to a report by the city’s science and technology bureau, he raised the need to advance the city’s transplantation technical base and facilities.¹⁷⁹⁶

According to a Sina Global News report dated in November 2011, Wuhan, the capital of Hubei Province, is said to be China’s largest organ transplant center. Among its hospitals, Tongji Hospital of Huazhong University of Science & Technology is the best known; it is also one of China’s first and most authoritative hospitals for living kidney transplants. It conducts thousands of kidney transplants each year and has China’s largest pool of kidney recipients.¹⁷⁹⁷

Organ transplantation in Shenzhen grew extremely quickly between June 2003 and November 2007, when Li Hongzhong was the city’s mayor and Party Secretary. In July 2006, authorities in Shenzhen became the first in the country to add heart and liver transplants to local subsidized health insurance programs. This reflects the speed at which the organ transplant industry developed in Shenzhen.¹⁷⁹⁸

Organ transplantation in China began when Wu Jieping, a member of Chinese Academy of Sciences and Chinese Academy of Engineering, completed the country’s first kidney transplant in March 1960.¹⁷⁹⁹ Kidney transplantation experiments were expanded nationwide in the 1970s. Since 1990, more than 1,000 kidney transplants were being performed each year. By the late 1990s, around 80 kidney transplant facilities had been opened nationwide, each averaging less than 20 annual operations.

According to Zheng Shusen in March 2006, liver transplantation in China went through three stages of development.¹⁸⁰⁰ The 1970s was a period of experimental and clinical exploration: Tongji Hospital in Wuhan and Ruijin Hospital in Shanghai first carried out clinical liver transplants in 1977. Liver transplantation soon peaked before declining and coming to a standstill in the mid-to-late 1980s. It rose to 78 cases between 1990 and 1998, reaching 16 in 1997 and 27 in 1998. The volume then jumped to 115 cases in 1999 before surging. Each facility has also gradually matured in its clinical experience.

Since 2000, a large number of national and military transplantation medical technology research centers and key research laboratories have been established, incubated new transplant technologies, and led the rapid development of the transplant industry. After nearly 40 years of preparation and then relying on a living organ bank, transplantation in China saw a unique explosive growth from sporadic cases to the large-scale transplant industry it has now.

Case Study: Establishing Industry Standards and Routine Procedures

Shen Zhongyang, the director of both Tianjin Oriental Organ Transplant Center and the Liver Transplant Institute of the Armed Police General Hospital, is known as the founder of China’s modern clinical liver transplantation. He is the first in China to establish a multidisciplinary liver transplant standard and procedures. With surgery as the central link, he standardized a process for liver transplantation with multidisciplinary collaboration. As a result, liver transplants have become part of routine clinical practice in China.

According to the 2009 edition of the Tianjin Medical Journal, between January 2004 and August 2008, Shen participated in 1,600 liver graft procurements.¹⁸⁰¹ The now-standard procedure for excising the liver from a donor lowered the time necessary for the organ to remain at body temperature to under five minutes and reduced the time for procurement operations to thirty minutes.¹⁸⁰²

Shen pioneered and improved a variety of liver transplant surgical procedures. He developed an integrated prevention system that reduced the recurrence rate of the hepatitis B virus (HBV) after liver transplants from over 80% to under 5%.¹⁸⁰³ This advancement resolved a major obstacle in liver transplantation in China.

He wrote books including Clinical Liver Transplantation, Modern Clinical Liver Transplantation, China Liver Transplantation, and Liver Transplantation Manual to address continuously emerging theories and technologies.

He helped 66 medical facilities in 22 regions to carry out clinical liver transplants, training 200 transplant professional personal and spreading the “pinnacle of transplantation technology.” In July 2006, the center was sponsored by the China Medical Board (CMB, a private foundation based in the U.S.) and became a “National Liver Transplant Training Center.” It has trained 385 doctors, who have become the backbone of organ transplant departments in other hospitals, where huge numbers of transplants are performed on the front lines.

Case Study: From Research to Industrialization

The Third Xiangya Hospital of Central South University is a national research base in central and southern China for transplantation technologies on organ, tissue and cellular levels. The hospital has the capacity to conduct major organ transplants on a large scale and now leads the country in the total number of solid organ transplants performed, including liver, kidney, combined liver-kidney, combined heart-lung, and intestinal transplants.^18041805

In August 2001, the hospital invested nearly one billion RMB to build the Hunan Transplant Medical Center, including laboratories, laminar flow operating rooms, an ICU ward, and 150 transplantation beds.¹⁸⁰⁶

In 2005, the Transplant Medicine Engineering and Technology Research Center affiliated with the Ministry of Health was officially established in this hospital. Its mission was to build an important national base specializing in clinical transplantation medical research and related industry development. The center also collaborated with the World Health Organization and the International Xenotransplantation Association to develop xenograft international norms (the Changsha Standard).¹⁸⁰⁷

The center received funding from the National Natural Science Foundation and other key projects in clinical disciplines from the Ministry of Health. The hospital also concentrated manpower, material, and financial resources to industrialize related research results.

The center has carried out liver, kidney, small intestine, spleen, heart, nerve, ovarian, testicular, and multi-organ transplantation. Its clinical work includes transplantation of islet cells, bone tissue, bone marrow, stem cells, liver cells, and spleen cells. The center also cooperated with the Human Disease Genes Research Center of Peking University under the national 863 Program’s Human Genome Study to research immunosuppressant drugs, pharmacogenomics, and its personalized medicine.¹⁸⁰⁸

The hospital experienced tremendous growth. Its new 1,000-bed, 98-metre-tall surgery building became operational on April 9, 2008 and represented 600 million RMB in investment.¹⁸⁰⁹

The Ministry of Health guides some military and civilian medical institutions with strong technical capability, as well as large organ transplant centers, to conduct clinical teaching and practice, establish technical training bases for transplantation, and promote new transplantation technologies. A large number of transplant doctors have been trained in a short time to meet the rapid growth of China’s transplant industry.

Case Studies

Mobile Heart Transplant Hospital

Zhongshan Hospital of Xiamen University’s Heart Center was established in 2001 and began to operate independently on April 28, 2011.¹⁸¹⁰ In 2014, it became the Xiamen Cardiovascular Hospital. Its new site has 600 beds.¹⁸¹¹

Liao Chongxian, the founder of the heart center, has been named “China’s top person in heart transplantation.”¹⁸¹² On August 21, 1995, he performed the first heart transplant in Fujian Province and the first pediatric heart transplant and first heart-kidney transplant in China.

Based on his experience in the United States, Liao created the “mobile heart transplant hospital” model and travelled around the country to instruct and personally participate in heart transplants.¹⁸¹³

In 2001, he established the Xiamen Heart Center Cardiovascular Surgery Department at Zhongshan Hospital and started his mobile heart transplant hospital model.¹⁸¹⁴ Its website says that the department performs heart transplants on a large scale and has helped more than 20 Class 3 Grade A hospitals to perform heart transplants in the past 10 years.

Liao revealed to the media that as of 2004, more than 75 heart transplant recipients had received their transplants from his hospital. ¹⁸¹⁵

A “New Era” of Lung Transplants

The lung transplant center at Wuxi People’s Hospital claims to be among the top three in the world,¹⁸¹⁶ and claims to have completed more than half of all lung transplant surgeries in the country.¹⁸¹⁷ Its founder, Chen Jingyu, is thus renowned as the “No. 1 Lung Transplant Surgeon in China.” As reported in July 2014, Chen’s team often completed four or five lung transplants a day.

He led his team to spread its advanced techniques to more than thirty 3A hospitals in more than ten cities and provinces, including Beijing, Guangzhou, Nanjing, Hangzhou, Wuhan, and Jilin.¹⁸¹⁸ A new era of lung transplantation in China has begun, and Chen’s team has filled in many gaps in this area.¹⁸¹⁹

Spreading Advances in Liver Transplantation

Zheng Shusen served as the academic lead of the transplant center at the First Affiliated Hospital of Medical School of Zhejiang University. He was one of the pioneers of liver and multi-organ transplantation. The hospital has helped develop transplantation at Peking Union Medical College Hospital, Huashan Hospital of Fudan University, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, the First Affiliated Hospital of Xinjiang Medical University, Zhongshan Hospital of Xiamen University, and other institutions.

It has also established remote diagnostic systems with the First Hospital of Zhejiang Province and other hospitals in Zhejiang, Fujian, Guizhou, Xinjiang, and other areas. Its transplant capabilities radiate to more than 20 provinces and cities in China and have propelled the development of the country’s organ transplant industry.

Zheng was among the first in China to use a non-venous bypass technique to reduce bleeding, transfusions, surgery time, ICU time, and cost. His award-winning innovations in liver and multi-organ transplants have been put into use all over the country.¹⁸²⁰

Building a Remote Medical Network Through Military Satellites

No. 181 Hospital of Guangzhou Military Command serves as the organ transplant center for Guangzhou Military Command. It has a number of PLA medical centers, clinical bases, research institutes, and key specialties under the Guangzhou Military Command.

In early 2005, it spent 250,000 RMB to build a remote medical network through military satellites, connecting over 200 military hospitals and more than 1,000 experts. This remote treatment model provides patients with a platform for accessing high-end medical resources.¹⁸²¹

Its PLA Kidney Transplant Center performed 8 transplant surgeries on December 30, 2012, including heart, lung, kidney, liver, corneal, and islet cell transplants. Although this hospital is not qualified to conduct heart transplants, conducted experiments and clinical research in heart transplantation using a “partially continuous beating technique”, a technique that is internationally advanced and has been applied in other hospitals.¹⁸²²

Sharing Organ Sources and Technical Support

On August 12, 2003, the Xiamen Evening News published a report titled “New Breakthrough at Xiamen First Hospital: Two Liver Transplants in One Day:” In the morning of August 12, the hospital simultaneously completed liver transplants for two patients. Li Bin, director of the vascular hepatopancreatobiliary surgery department, revealed that if there are sufficient organ sources and recipients, they can perform three liver transplants in one day. However, the fact that the First Xiamen hospital’s newly detached vascular hepatobiliary surgery department can perform three liver transplants per day was beyond one’s expectation.

How had they achieved that? The hospital obtained two donors at the same time from the largest organ transplant center in eastern China–the affiliated hospital of Zhejiang University. It also received technical support from academician Zheng Shusen. According to the report, the department had reached an organ sourcing and technology sharing agreement with the affiliated hospital of Zhejiang University. The affiliated Zhejiang hospital has a nationwide system of organ sources and basic research in key laboratories, both of which could be borrowed by the First Xiamen hospital.¹⁸²³

The First People’s Hospital of Yueyang collaborated with Tongji Hospital and many other hospitals to provide remote consultation for patients with complicated diseases. Meanwhile, the hospital has set up an organ information sharing network with many hospitals inside and outside the province, enabling the sharing of organ resources and complementing of transplant capabilities. ¹⁸²⁴

Similarly, Rui Jin Hospital in Shanghai has equipped its transplantation pathology laboratory with a remote consultation system connected to the University of Pittsburgh Thomas E. Starzl Transplantation Institute, enhancing the diagnosis of difficult cases.¹⁸²⁵

The Second Hospital of Dalian Medical University collaborated with the Hepatobiliary and Pancreatic (HPB) Surgery Department of the First Affiliated Hospital of Zhejiang Medical University to conduct remote medical consultation. It established a communication platform with University of Heidelberg in Germany to further develop the discipline.¹⁸²⁶

A media report in 2005 stated that the Second Xiangya Hospital of Central South University’s “…donor organ network has gradually extended to the north and south, and has established resource sharing relationships with more than 10 domestic organ transplant centers.”¹⁸²⁷

Training Transplant Specialists to Keep Up with Demand

We found that many leading institutions have been selected by the Ministry of Health to train a large number of transplant specialists for hospitals nationwide, allowing the industry’s work force to better keep up with demand.

In June 2006, Huang Jiefu cooperated with the China Medical Board (CMB) in New York to provide one million USD to assist in the establishment of transplant standard and registration systems, domestic laws and regulations regarding transplantation in China, strengthening professional training, and expanding liver transplant-related research achievements. The project established three liver transplant training centers in China, at the Peking Union Medical College Hospital, the First Affiliated Hospital of Sun Yat-sen University, and Tianjin First Center Hospital.¹⁸²⁸

Two doctors from the Department of Kidney Transplantation at Nanfang Hospital of Guangzhou’s First Military Medical University wrote in a published paper, Experience of Guiding Graduate Internship in renal transplant clinical work, in November 2003:

“With the growing number of kidney transplants in recent years, our department attracted many young military and civilian medical students attending Master’s and Doctoral programs in renal transplantation. These intern students stayed with our department for 6 to 8 months … Donor nephrectomy technique is an important part of kidney transplantation … the requirement is to minimize warm ischemia time, to avoid damage during excision in complicated environments…Graduate students increasingly participated in nephrectomies under the guidance of teachers … from initially inexperienced in renal transplant to the end of the internship, these students became more skilled specialists in renal transplantation. Most graduates are assigned to various work units after training, where they become the backbone of their renal transplantation teams.”¹⁸²⁹

On these hospitals’ websites, a large number of young “associate experts” claim to have “skilled donor organ excision techniques and rich experience in handling donor organs.”

The Department of Hepatobiliary Surgery at Southwest Hospital, which is affiliated with the Third Military Medical University, was the first major liver transplant laboratory and transplant center in the military. With world-class equipment and many functional laboratories, it is one of the largest hepatobiliary and pancreatic surgery departments, both domestically and internationally. It guided 21 medical institutions to carry out liver transplants in Jiangsu, Shandong, Guangdong, Shaanxi, Henan, Yunnan, Sichuan, Xinjiang, Guizhou, Fujian provinces, etc. It has graduated 50 PhD students, 75 Master’s students, and 762 internship doctors in the major of Hepatopancreaticobiliary Surgery. These graduates have become the backbone and academic leaders in their facilities all over the country and in the military. ¹⁸³⁰

The First Affiliated Hospital of Zhejiang University has a multi-organ transplantation research laboratory under the Ministry of Health. It claims to be the largest transplant center in the east of China and one of largest transplant centers in the whole country. It assisted Peking Union Medical College Hospital, Huashan Hospital of Fudan University, First Affiliated Hospital of Xinjiang Medical University, and other domestic and international hospitals in carrying out liver transplants, and extending technical support to more than 20 provinces and cities nationwide.¹⁸³¹

The organ transplantation center of the First Affiliated Hospital of Sun Yat-sen University claimed to offer the most variety of transplants nationwide and is among the top in transplant volume.¹⁸³² The hospital performed China’s first successful kidney transplant in 1972. Since Huang Jiefu in 1993 successfully implemented China’s first liver transplant in vitro blood bypass, the hospital is known as the birthplace of the second peak in China’s liver transplantation. In 2006, this center was approved by the Ministry of Health as a national kidney transplant technical training base. It has also become one of the three largest liver transplantation training centers sponsored by the China Medical Board (a private foundation based in the U.S.).

“The Institute of Organ Transplantation Research at Xi’an Jiaotong University is one of the largest transplant centers in the country and includes all functions of medicine, teaching, and research. Its researchers include 9 professors in their doctoral program, and has trained 85 PhD graduates, and 156 Master’s degree holders.”¹⁸³³

In 2003, it incorporated with Terasaki laboratory of the United States and jointly established the Organ Transplants Tissue Typing Technology Training Center in Northwest China. By December 2012, this center had guided more than 10,000 kidney transplants for 23 hospitals in 13 provinces. It guided other hospitals in liver, kidney, heart, lung, and small intestine transplants in western China.¹⁸³⁴ It trained more than 500 medical professionals for other domestic institutions, with some of them having become academic leaders. Since 2000, this center has held annual programs for continued education in kidney transplantation, with students from large general hospitals from 14 provinces and autonomous regions. “After learning from this program, the students started or carried out a greater number of high quality clinical kidney transplants and achieved a remarkable degree of continuing medical education.

Unccessful research and trials that proved the feasibility of transplant technology were followed by a nationwide effort to make the technology readily accessible throughout China.

In the past decade, these hospitals and individuals have achieved many innovations that enabled the growth of the transplant industry and made it possible to achieve its present-day scale. These achievements include lower rejection rates, shortened operation times, increased collaboration, and other advances.

Case Study: “Father of Chinese Hepatobiliary Surgery” Awarded 1 Million RMB

According to Chinese state media, former president Jiang Zemin has met Wu Mengchao, “the father of Chinese hepatobiliary surgery,” four times. ¹⁸³⁵ Wu is the president of the Eastern Hepatobiliary Hospital of the Second Military Medical University and the chief advisor of the PLA Organ Transplant Conference. At a special ceremony held by the Central Military Commission, Jiang personally conferred upon Wu the honor of “Leading Model Medical Expert” and awarded him a “First-Class Heroes Medal.”

In 2005, Wu Mengchao was given the 2005 Annual National Supreme Science and Technology Award for solving several key issues surrounding rejection of liver transplants.¹⁸³⁶ On January 17, 2006, Sun Dafa, political commissar of the People’s Liberation Army General Logistics Department, awarded Wu a prize of 1 million RMB.¹⁸³⁷

As of 2010, among his 14,000+ liver surgeries, Wu had performed at least 9,300 tumor removals,¹⁸³⁸ while the remaining 4,000+ were unaccounted for and likely to be transplant cases. As of April 2011, even at the age of 89, he continued to perform 200 surgeries per year. ¹⁸³⁹

On October 10, 2011, the Central Propaganda Ministry, the Ministry of Health, the General Political Department, the People’s Liberation Army General Logistics Department, and the Shanghai Municipal Committee jointly held a report session on “Wu Mengchao’s chronology of achievements” in the Great Hall of the People. Those in attendance included Xu Caihou (former Vice Chairman of CCP Central Military Commission), Li Jinai (then-director of the General Political Department), and Liao Xilong (director of People’s Liberation Army General Logistics Department).¹⁸⁴⁰

Case Study: Leading Research at PLA No. 309 Hospital

Shi Bingyi, from People’s Liberation Army No. 309 Hospital and director of its PLA Organ Transplantation Research Institute, also established an early warning system and a non-invasive diagnostic system for rejection responses. It has become an important method of diagnosing acute rejection responses and established a low-dosage immunosuppressive system and a method integrating Chinese medicine to prevent and treat rejection responses.¹⁸⁴¹

When interviewed by Xinhua in February 2012, Shi Bingyi said that the most important issue concerning transplants is preserving the organ’s function and long-term survival. He explained, “There are two ways: one is a stem cell transplant; another is to improve the regulation of the immune system, such as T cells. The latter has a good effect on the long-term survival of transplanted organs and immune tolerance. This is one of world’s leading technological research topics that we’re carrying on in our center.” ¹⁸⁴²

Many other transplant hospitals have also explored this field.

Beijing Anzhen Hospital performed the world’s first four combined heart, bone marrow, and stem cell transplants as an innovation in the knowledge and techniques of improving immune tolerance. Heart recipients experienced lower rejection rates while maintaining resistance against viruses and bacteria. Thus, lesser quantities of immunological drugs were needed. This result can potentially be extended to the fields of lung and other actual organ transplants.¹⁸⁴³

The kidney transplant department at the First Affiliated Hospital of Henan University of Traditional Chinese Medicine combines traditional Chinese and Western treatment methods to minimize the incidence of chronic allograft nephropathy to a large extent. Its advanced follow-up system improves long-term graft survival.¹⁸⁴⁴

Fujian Medical University Union Hospital has recently made breakthroughs in immunosuppressive treatments and post-operative management. Its heart transplant recipients are able to walk within one to two days after surgery, leave the isolation ward after two weeks, and be discharged within two to three weeks, fully recovered. ¹⁸⁴⁵

With the rapid development of organ transplantation, China’s market in immunosuppressants has seen unprecedented growth. Our investigation of the over 160 transplant hospitals showed that the Government has incorporated organ transplantation into its national strategy. Below are examples of national programs that fund key research and development projects in transplantation technology and immunosuppressants:

• National High-Tech R&D Program of China (863 Program)
• National Program on Key Basic Research Project of China (973 Program)
• National Key Technology Research and Development Program
• National Natural Science Foundation of China (NSFC)
• “985 Project” (aims to build world-class universities)
• “211 Project” (aims to raise the research standards of 100 high-level universities)

These programs and funded projects have achieved fruitful results. For example, Li Leishi, an academician at the Chinese Academy of Engineering and director of the Institute of Nephrology Research at Nanjing Military General Hospital, found that Triptolide (monomer), the herbal extract of Tripterygium, has a distinct immunosuppression effect. His discovery has achieved positive outcomes for the treatment of acute rejection responses following kidney transplants.¹⁸⁴⁶

The research was conducted by Li Yantang and his student Qian Yeyong, using Chinese medicine’s Tripterygium Glycosides as an anti-rejection drug for kidney transplants. Li is the director of the Division of Urology at the People’s Liberation Army General Hospital and has received support from the National Natural Science Foundation.¹⁸⁴⁷ Qian Yeyong was the first to succeed in using this drug as an immunosuppressant for clinical organ transplantation.¹⁸⁴⁸

More examples include:

• “A novel immunosuppressant Fingolimod: research advances” ¹⁸⁴⁹ and “Research advances in the application of immunosuppressant in organ transplantation” published by the Institute of Basic Medical Sciences, Academy of Military Medical Sciences¹⁸⁵⁰
• a project on research and development of organ transplant immunosuppressant series products undertaken by the Lunan Pharmaceutical Group
• research in immunosuppressant withdrawal after liver transplantation by the Guangdong Provincial Organ Transplant Center, Sun Yat-sen University Institute of Organ Transplantation¹⁸⁵¹
• studies in basic immunology for organ transplantation conducted by the Fudan University Organ Transplant Center¹⁸⁵²

Ample funding promoted the rapid development of domestic immunosuppressant drugs. By 2004, domestic drugs began to catch up and shared almost half of the market with imported and joint-stock drugs. This development greatly lowered the cost of immunosuppressants and lifted a barrier for many patients who otherwise could not afford to receive organ transplants. It thereby contributed to a rapid growth in transplant volume in China before 2004. ¹⁸⁵³

The first domestic immunosuppressant was Ciclosporin made by the North China Pharmaceutical Group. In 2004, Professor Zhang Yuhai, director of the Urology Department of the Beijing Friendship Hospital, said that over half of kidney transplant patients chose to use domestic immunosuppressants, including not only self-funded patients but also many with free medical service or insurance.¹⁸⁵⁴

The 2011 China Science and Technology Development Report published by the Ministry of Science and Technology claimed in its section on the prevention of major diseases and practical health technology that the completion of a pilot production demonstration base for a series of immunosuppressive drugs and active pharmaceutical ingredients and preparations. It said that this has improved China’s research, development, and production capacity for immunosuppressive drugs. Domestically produced immunosuppressants reduce medical costs for transplant recipients and are exported to bring profit and enhance international competitiveness for China’s transplant immunosuppressant industry.¹⁸⁵⁵

According to data from the Southern Medical Economic Institute, domestic immunosuppressants had grown into a $10 billion RMB market by 2006.¹⁸⁵⁶ The market grew by an average of 13% every year between 2008 and 2014.¹⁸⁵⁷

As the patents of several major imported drugs expired, China began to produce a large volume of imitation products in addition to domestically developed drugs. These producers have achieved the same efficacy as imported immunosuppressants but at much lower prices. This increased the market share of domestic drugs. Major producers include Huadong Medicine Co., Ltd, North China Pharmaceutical Group Corporation, and Zhejiang Hisun Pharmaceutical Co., Ltd.¹⁸⁵⁸

Professor Tan Jianmin at Fuzhou General Hospital of Nanjing Military Command pioneered HLA and amino acid residue matching technology in China, enabling donors and recipients to be genetically matched before transplantation and significantly improving transplant quality. He won second prize of the 2001 National Science and Technology Advancement Award.¹⁸⁵⁹

Tan also established an anti-HLA antibody screening method, significantly reducing acute rejection responses. This technique has since been applied all over the country; Fuzhou General Hospital has established collaborative relationships more than 100 hospitals in 19 provinces and cities and organ sharing relationships with 15 transplant centers.

The Second Hospital of Shandong University started researching DNA microarray tissue matching technology in 2003, achieving strict gene pairing between donor and recipient prior to transplantation. As a result, its transplant quality has increased substantially.

Among hundreds of transplant-related patents in China, about half are related to anti-rejection drugs and organ preservation solutions.

Shanghai Changzheng Hospital of the Second Military Medical University was one of the first in China to perform kidney transplants. Zhu and his team completed research on kidney and multi-organ preservation solutions. After 20 years of clinical application, this product is propelling China to the forefront in the field internationally.¹⁸⁶⁰ An archived webpage of Changzheng Hospital stated, “98% of hospitals in China use the organ preservation solution we developed.” ¹⁸⁶¹

In addition to military institutions, civilian medical universities and hospitals are also involved in these areas. We give some examples:

The Organ Transplantation Institute of China Medical University has also taken part in the Research and Development of organ preservation solutions; a kidney preservation solution they developed leads in the domestic market.¹⁸⁶²

Zhongshan Hospital of Shanghai Fudan University’s heart surgery department, which claims to account for approximately half of all heart transplants in China, innovated in the field of heart preservation technology and set a record for safely preserving a heart for 10 hours. It has developed a complete set of standard procedures for heart transplantation. All of its heart transplant patients achieve ambulation within 3 days. It also presides over China’s heart transplantation access ordinance. ¹⁸⁶³

Chen Jingyu, the director of the lung transplant center at Wuxi People’s Hospital, developed pulmonary perfusion preservation solutions, which prolong lung retention time from four to six hours to nearly eight hours, reaching an internationally advanced level and taking the lead in China.¹⁸⁶⁴

Transplant centers have also developed alternative solutions for prolonging organ life.

For example, the No. 181 Hospital of Guangzhou Military Command, in collaboration with cardiothoracic experts from the People’s Hospital of Guangxi, conducted experiments and clinical research in heart transplantation using a partially continuous beating technique (extending the heartbeat while excising the heart from the donor, in order to keep the organ fresh for a longer period of time).¹⁸⁶⁵ This technique is advanced internationally and has been applied in other hospitals.¹⁸⁶⁶

At No. 107 Hospital of Jinan Military Command, deputy director Du Yingdong of the liver transplant center claimed, “Over 10 years ago, it took us over 10 hours to complete a liver transplant surgery. Now our technology has matured, and a liver transplant only takes 4 to 5 hours. Sometimes, 3 to 4 surgeries can be completed in one day. The speed of development has caught up to that of high-speed rail.”¹⁸⁶⁷ In April 2012, the hospital opened a new ward building, increasing its bed count from 600 to over 1,000.¹⁸⁶⁸

Shen Zhongyang, the director of Tianjin Oriental Organ Transplant Center, set a world record for the fastest liver transplant surgery in 2003, taking 2 hours and 4 minutes between making the incision and closing the abdomen. No blood transfusions were used during the operation. The previous record was 3 hours.¹⁸⁶⁹

Zhongshan Hospital of Shanghai Fudan University performed its first liver transplant in 1978. Since 2001, liver transplantation at this hospital has seen rapid development, with increased variety, more innovations, shorter operating times (4 to 6 hours on average), less bleeding, and fewer complications. Some patients are discharged 9 days after their operation. Transplant recipients extend from patients of liver cancer to other end-stage liver diseases. The hospital’s quantity and success rate of liver transplantation lead both the Shanghai region and the country.¹⁸⁷⁰ Its liver surgery department recently started immediate outpatient follow-up treatments with its liver transplant patients, such that a patient receives their operation immediately after an exam and hospital admission, accelerating the treatment cycle. It has attracted patients from more than 10 countries and regions, including the U.S., U.K., Japan, Canada, South Korea, Hong Kong, Macau, and Taiwan. Even with a conservative two-week hospitalization period, its annual surgery volume can reach 5,000.

At Beijing YouAn Hospital, patients who recover quickly from liver transplants can be discharged in two weeks.¹⁸⁷¹

Fuwai Cardiovascular Disease Hospital’s website states that it has refined a set of conventions for heart transplantation. Most patients successfully recover after surgery, can begin walking after 2~3 days, and can be discharged after 2~3 weeks.¹⁸⁷²

In 2002, Shanghai Zhongshan Hospital eliminated the need for blood transfusions in one-third of its liver transplant surgeries. The entire operation time has been reduced to four and a half hours, and the lowest cost was 142,000 RMB.¹⁸⁷³

Shanghai Changzheng Hospital’s liver surgery department adopted an inferior vena cava (IVC) graft procedure on the basis of its traditional and piggyback liver transplants, reducing its surgery duration from 9 hours to 5 hours.¹⁸⁷⁴

The Third Affiliated Hospital of Sun Yat-sen University established a procedure for in vitro blood bypass orthotopic liver transplants to overcome limitations in piggyback liver transplants. The simplified procedure reduced anhepatic time to 20-40 minutes, the shortest reported in China. The hospital received a second-prize national science and technology advancement award for this procedure.¹⁸⁷⁵