Canadian Transplant Ethics

(Remarks prepared for delivery at the Canadian Bioethics Society Conference, Banff Alberta, May 24, 2019)

By David Matas

The Canadian Society of Transplantation and Canadian Society of Nephrology in 2010 developed a policy statement on organ trafficking and transplant tourism. Its purpose was to establish a unified and consistent approach by Canadian health care providers in deterring transplant tourism.(1) The policy was intended to assist members of the two Canadian professional societies in their interactions with patients.

In 2006, the Government of China acknowledged that almost all organs for transplants were obtained from prisoners. The Transplantation Society (TTS) in November 2006 developed principles which “must be considered” before engaging with Chinese transplant professionals.(2)

The policy statement of the two Canadian professional societies in 2010 was prompted by a directive from the World Health Assembly in 2004 and The Declaration of Istanbul on Organ Trafficking and Transplant Tourism of 2008. The World Health Assembly directive urged member states to take measures to protect vulnerable groups from the sale of tissues and organs.

The policy statement of the two Canadian professional societies was limited to addressing the interaction between patients and health professionals. It did not address the interaction between Canadian health professionals and Chinese health professionals.

The situation in China has changed since 2006. The official position of the Government of China today is that no organs are being sourced from prisoners.

In Canada today, the issue of collaboration between Canadian and Chinese transplant professionals is addressed on an ad hoc basis. For example, the University of Alberta since 2016 has offered a Young Physician Training Program in partnership with the Chinese Zhejiang University School of Medicine Fourth Hospital. The University Clinical Islet Transplant Program, under the leadership of Dr. James Shapiro, refused to participate.

Dr. Shapiro familiarized himself with the human rights research into transplant abuse in China demonstrating that prisoners of conscience were being killed on a massive scale for their organ. He could not see his way through to a regulatory watertight oversight that would protect him and his Edmonton Protocol team from inadvertent unethical conduct. So, he rejected the collaboration with Zhejiang. The University now collaborates with other components of Zhejiang hospital, but not with islet transplantation.(3)

The ethics principles developed by the two Canadian professional societies to deter transplant tourism by Canadian patients through interaction between patients and Canadian health professionals is comprehensive and detailed. A specific Canadian ethics policy focused on protecting vulnerable groups in China from the sale of their tissues and organs through the interaction between Canadian and Chinese transplant professionals remains to be developed.

Measures necessary to protect vulnerable groups from the sale of tissues and organs can not be limited to deterring Canadian patients from transplant tourism. The purpose of this presentation is to suggest what a specific Canadian policy might be on the interaction between Canadian and Chinese transplant professionals.

Ostracism or engagement?

The first question which has to be addressed is whether there should be any interaction at all. Should there be ostracism or engagement?

Transplant health professionals today and mental health professionals yesterday faced similar dilemmas but have reacted quite differently. In the days of the Soviet Union, mental health professionals globally faced the abuse of psychiatry in the Soviet Union and acted strongly against it.(4)

Today, transplant professionals globally face the abuse of transplant surgery in the Communist China. However, the global professional response has been nowhere near as strong.

The global psychiatric profession, at the time of Soviet abuse of psychiatry, was part of the solution to that abuse. The global transplantation profession, with a few notable exceptions, when it comes to transplantation abuse in China, has, regrettably, become part of the problem.

The struggle against transplant abuse in China faces a paradox. Those outside of China who know most about the situation and are best equipped to do so something about it are the least likely to be effective in stopping the abuse. Those outside China who are the most likely to be effective in stopping the abuse know little or nothing about the situation and are among the least equipped to counter it.

Those outside of China who know most about the situation and are best able to do so something about it are the transplant abuse researchers, the China human rights experts, and foreign affairs China hands. Yet, the Party finds it as easy to ignore civil society abroad as it does at home. Foreign affairs China professionals operate behind closed doors and engage with thick skinned Party stalwarts who are indifferent to even the most blistering and well-founded criticism.

Those outside China who are the most likely to be effective are foreign transplant professionals, because they can exercise peer pressure. But, by and large, they know little or nothing about the situation and are among the least able to take meaningful action.

Human rights belong to all humanity. Their rights should be asserted by everyone. Nonetheless, there remains such a thing as human rights expertise – knowledge of the international human rights instruments, familiarity with discourse and patterns of behaviour of human rights violators, the lessons of history and so on. This is an expertise transplant professionals typically do not have.

Chinese Communist Party discourse about organ transplant abuse is similar to discourse about a long list of other well documented violations – Mao’s forced starvation, the cultural revolution, the Tiananmen square massacre, forced abortion and sterilization, torture, forced labour camps, sex trafficking, prison conditions and so on. Transplant professionals typically are not familiar with the history of Party human rights violations and the propagandistic discourse the Party has used to exonerate itself.

The global transplantation profession can be broken down into three groups – the aware, the naive and the foolish. The aware have bothered to take the trouble to read the research and realize that what is going on in China with transplantations is mass killing of innocents and cover up. They react accordingly, distancing themselves from the Chinese transplant profession and encouraging others to do likewise.

The naive do not consider the research and claim that doing so falls outside their area of responsibility. They hear the research conclusions on the one hand and Chinese Communist Party propaganda on the other and draw no conclusions one way or the other. They encourage change in China and welcome claims from China of change.

The foolish buy Chinese propaganda hook line and sinker. They parrot the Party line that the research demonstrating mass killing of innocents for transplantation is based on rumour, though it is not. They echo the Party line that the research is unverifiable, though it is both verifiable and verified. They repeat the Party claim that abuses are in the past, when they are not. They make the outlandish claim that disinterested researchers are political and that Chinese Communist Party officials are academics. They accept Theresienstadt/ Potemkin village facades as reality. They endorse what they are misled into thinking is happening in China wholeheartedly.

A specific cost to the Party of Chinese internationalism is global push back. The more Chinese who go abroad, the more Chinese engaged in human rights abuses there are who go abroad. Indeed, perpetrators are more likely to go abroad than victims, since many of the perpetrators are the Party’s own, and many of the victims are hostile to the Party.

All too many non-Chinese are prepared to turn a blind eye to Chinese human rights violations. But there are sufficient numbers of others who care and are prepared to act to cause the Party a problem. Perpetrators may be allowed exit from China, but denied entry to foreign countries. The Party may allow and even encourage those complicit in abuses to teach, study or go to conferences abroad, but foreigners will deny them the opportunities they seek.

The mass killing of prisoners of conscience for their organs is part of the new China. It developed through the introduction of modern technology and catered to an international transplant tourist market. But it had an unintended side effect, the global ostracism of the Chinese transplant profession.

In the old days, that sort of ostracism would not have mattered. But in the new, internationally focused China it does.

The Transplantation Society refused to allow 35 Chinese participants for ethical reasons to attend the World Transplant Congress in San Francisco in July 2014.(5) For the October 2014 Hangzhou, China transplant conference, many invited overseas transplant experts failed to attend. A year before, in October 2013, the China Transplant Congress, also held in Hangzhou, had a raft of foreign expert attendees.

Ostracized professionals do not have the deep Party connections that make it easy for them to shrug off this foreign behaviour. What matters to them more is their careers. So, the Party had to react.

The strategy of choice to counter the specific problem of global transplantation peer ostracism was to target the global transplantation profession. Bring them on board or, at least, hoodwink their own professionals into thinking that outside professionals are on board and the specific problem which was disgruntling their own transplantation profession would be solved.

In what follows, I give three specific examples of Chinese Communist attempts to overcome the ostracism their professionals suffered in San Francisco in July and in Hangzhou in October 2014. The examples are The Transplantation Society Congress in Hong Kong in August 2016, the Vatican Transplant Summit in February 2017, and the Chinese transplant conference Kunming, Yunnan, China August 2017.

One could add on more examples. The general point is the same. The Chinese Communist initiative was successful in hoodwinking the transplantation profession. The Communists told the transplant professionals what they wanted to hear, generated some show displays, fabricated some statistics, and the professionals, with a few notable exceptions, were beguiled.

Hong Kong August 2016

The Transplantation Society had planned its 2016 conference for Bangkok, but decided to relocate to Hong Kong because of the Thai coup. Dr. Jay Lavee, president of the Israel Transplantation Society, a heart transplant surgeon, and a former member of Ethics Committee boycotted the conference. He wrote that to providing China a global platform, while ignoring reports of organ harvesting from prisoners of conscience, “is a moral stain on TTS ethical code”.(6)

This relocation became an opportunity for the Chinese Communist Party. The Party/state newspaper Global Times reported:

“Scholars say this special Chinese organ transplant meeting shows that the Chinese organ transplant world has been truly accepted by the Transplantation Society”.(7)

Philip O’Connell, the then President of the Transplantation Society rejected this boast, but in a peculiar way. He said

“It is important that you understand that the global community is appalled by the practices that the Chinese have adhered to in the past … As a result of these practices, the Chinese transplant centers have allowed a trenchant political opposition to their government to prosper …”

What is this political opposition to which he is referring? The New York Times wrote that

“he may have been referring to Falun Gong, a spiritual movement that is outlawed in China and that accuses the Chinese authorities of extracting organs from its members.”

What O’Connell is saying, as interpreted by the New York Times, takes a bit of unpacking. He endorsed, albeit elliptically, four elements of Chinese Communist Party propaganda.

One is that Falun Gong is a political movement opposed to the Chinese Communist Party. The second is that conclusion of the killing of prisoners of conscience for their organs comes from this political movement. The third is that sourcing of organs for transplant in the past have virtually all come from prisoners sentenced to death and then executed. The fourth is that those abuses are all past history.

O’Connell, after having entered into this imaginary framework, then proceeded to give the Chinese Communist Party political advice. He suggested that China should not have been sourcing organs from prisoners sentenced to death and then executed because this sourcing has provided an opportunity for his fantasized Falun Gong political opposition to fabricate charges of political prisoner transplant abuse victims.

Prisoners sentenced to death and then executed should not, of course, be organ harvested. However, even if one puts aside the sequence of factually incorrect assumptions on which O’Connell’s suggestion is based, for O’Connell to suggest that sourcing organs from prisoners sentenced to death has weakened the hold of the Chinese Communist Party over China is foolish.

Suppose that Falun Gong actually were a political movement. Why should O’Connell be giving the Chinese Communist Party advice about how to prevent a political opposition to prosper? It is unlikely he would be giving that advice to the governing party in his own country. Why should he give such advice to a ruling party in another country, and a repressive one, no less?

The implication of the advice he gives is chilling. His line of reasoning leads to the conclusion that those who want to oppose the Chinese Communist Party, who want the political opposition to prosper, should welcome the sourcing of organs from prisoners sentenced to death. That sort of conclusion makes no sense and was unlikely what he intended.

I do not pretend to know anything much about transplantation technology. I would not dream of walking into an operating room and attempting a transplant, even if I were allowed to do so. I am confident that, if I tried, I would make a total mess of the operation and put the life of the patient at risk. O’Connell makes a similar mess when talking about human rights violations in China, as much of a mess as I would in a transplant operating room.

The ultimate conclusion of O’Connell about the Party, that the global community was appalled by past Chinese practices, was. Unfriendly to the Party. Yet, in arriving at that conclusion, he swallowed and regurgitated Party propaganda.

O’Connell approached the issue of organ transplant abuse in the way the Party would expect any good apparatchik to do, from a base of Party propaganda and the perspective of what is good for the Party. The scolding O’Connell gave the Party must have led Party officials to rub their hands with glee.

The Vatican February 2017

The Vatican hosted a Summit on Organ Trafficking and Transplant Tourism in February 2017. The invitation to the summit of Chinese Communist Party/ state health officials became a flash point of controversy.

The Party newspaper Global Times reported

“Senior Chinese health officials are preparing to attend a high level summit at the Vatican on organ trafficking Tuesday, an invitation which recognizes China’s recent achievements in the field.”

Israeli transplant surgeon Dr. Jay Lavee opposed the invitation. About Huang Jiefu, the chief Party/state health official invited, Lavee said:

“Given his personal record and the fact that he still does not admit the use of organs of prisoners of conscience, he should not have been invited,”

Dr. Francis Delmonico, a former head of The Transplantation Society, who planned the summit, defended the invitation to Chinese officials. He said it that the summit was “an opportunity for them to proclaim a new day and be accountable” that the practice has stopped.

Chinese Party officials are quite happy to proclaim a new day, every day. As for being accountable, there is nothing in place. There are no accountability mechanisms. Nor did Delmonico propose any. As for accountability done through independent investigation, Delmonico just is not interested.

At a Congressional hearing on Chinese organ transplant abuse held in Washington DC in June 2016, Delmonico was asked:

“How do you independently verify that even though he [Huang Jiefu] may be very sincere that anything he says, zero foreign customers for organ trafficking in 2016, how do you independently verify that when there has been such a backdrop of terrible duplicity, lies, and deception on the part of the government?”

The answer Delmonico gave was this:

“I am not here to verify. That is not my job.”

So, Delmonico wants accountability, but will not himself verify. Delmonico sees verification or accountability as the job of someone else. But who would that someone else be?

The separation between hosting Chinese health officials, on the one hand, and verification/ accountability, on the other, means that there is no linkage between the two. Delmonico was prepared to host Chinese health officials no matter what they did or would do, as long as they said the right thing, proclaimed a new day. Determining whether that verbiage meant anything he left for someone else.

Verification, for Delmonico, would not be that hard. He would not have to do the research himself. All he would have to do is read it and assess it. But that, so he says, is not his job.

Lavee said that Delmonico “is simply willing right now to close one of his eyes and be blind to what continues to go on while celebrating the fact that there has been some reform in China.” For the Chinese Communist Party, that is all just fine.

Kunming, Yunnan, China August 2017

Chinese Communist Party/state health officials hosted a transplant conference at Kunming, Yunnan, China in August 2017 in which many international transplant figures issued supportive statements for the Chinese transplantation program. While the international media ignored the conference, other than for a passing reference in an Associated Press story, the Communist Party press gave it a great deal of attention.

The Global Times, in advance of the meeting, wrote:

“In an unprecedented move, four top international health organizations expressed their appreciation for China’s efforts in organ donation and transplantation reform, and also their expectations for more engagement from the country to global governance in the sector.

The acknowledgment was expressed in a letter sent to Huang Jiefu, a former Chinese vice minister of health and current head of the National Human Organ Donation and Transplant Committee, ahead of the upcoming national conference on organ transplantation next week.

The letter that was disclosed to media on Wednesday said that China’s reform of its organ donation and transplantation program is ‘ethically proper,’ which experts and officials hailed as a powerful response to the criticism and scepticism the country has faced for years. …

The letter also shows China’s model of building an open, transparent and fair organ donation and distribution system is acknowledged by international society, Huang added.

‘The acknowledgment from the four organizations is historic, as this is the first time they jointly expressed a crystal clear and positive appreciation of China’s progress on organ transplant reform,’ Wang Haibo, head of the China Organ Transplant Response System, told the Global Times.

The letter was signed by heads and senior officials from the World Health Organization (WHO), the Vatican’s Pontifical Academy of Sciences (PAS), The Transplantation Society (TTS) and the Declaration of Istanbul Custodian Group (DICG), four of the most influential societies in promoting global ethical practices in organ transplantation.”

The article adds:

“The acceptance from international organ transplant bodies is due to China’s efforts to introduce its progress and reform to the world, including to those who hold a sceptical or even hostile attitude toward China’s organ transplantation systems, Huang said. ‘We need to keep our friends close, and our enemies closer’ he said.”

Like most Communist Party propaganda, the story is inaccurate. Indeed, a reader can get a better picture of reality by assuming the exact opposite.

Despite the statement that the letter from the four organizations was released to the media, it is not publicly available and we do not know what it says. In light of the Party penchant for fabricating quotes, we do not know even if the claimed quotes from the letter are accurate.

As well, the statement of an effort to engage “those who hold a sceptical or even hostile attitude toward China’s organ transplantation systems” is a fabrication. None of the sceptics were invited to the Kunming meeting.

The reference to critics as “enemies” is a fair portrayal of the way the Party views them. Say that the Party has done something wrong, even if accurate, does not make you just an enemy of what was done wrong; it makes you an enemy of the Party.

China Central Television or CCTV showed a video of Jose R. Nunez, from the World Health Organization, who attended the Kunming meeting, saying:

“Well, I think that China, especially since January 2015 when they decided not to use organs from prisoners any more, that’s a great reform. It’s a hard reform to do. But they are doing and they’re moving in the proper direction right now, and what they are achieving now is just amazing!”

Nunez, as one can see, equates the Chinese Communist Party says with reality. The Party announces reform. Nunez asserts that the reform is happening.

CCTV also broadcast a video clip of Nancy Ascher, current president, Transplantation Society:

“We were at a recent meeting at the Vatican, where every single country talked about their people who went outside their own countries to get transplants at other places. And what was clear from that meeting was that people who are looking for illegal transplants are not coming to China.”

It seemed not to occur to Ascher that people who are coming to China and the doctors in the countries from which they came might not want to talk about it openly. Yet, there is plenty of evidence to this effect, transplant tourism into China blanketed by a conspiracy of silence.

CGTN, the China Global Television Network, in a report of the Kunming meeting quoted Jose Nunez from the World Health Organization as saying:

“I think the reform in China is great, especially since January 2015 when they decided not to use organs from prisoners any more. They are moving towards a proper direction now,”

The gist is the same as that of the CCTV clip, that what the Chinese Communist Party says in its propaganda is reality.

CGTN quotes Nancy Ascher from The Transplantation Society as saying:

“What I’ve seen in this visit is the Chinese people are embracing the notion of organ transplantation and I have no doubt that you will be able to achieve a very large number of voluntary donors. I think as Chinese transplant professionals become involved, and they will also reach out and be able to teach the rest of the world because Chinese experiences will soon be greater than the rest of the world,”

The notion that Chinese within China are free to embrace or not to embrace Chinese Communist Party propaganda as they see fit is something only someone unfamiliar with China could say. Not only does Ascher give the Party the benefit of the doubt. Her faith in the Party is doubt free, a faith in which she has “no doubt”.

Delmonico, in his testimony to Congress in June 2016, noted the Haibo Wang, the deputy health official to Huang Jiefu, had been put under house arrest for his efforts at transplant reform. At the San Francisco World Transplant Congress in 2014, which I attended, I went to hear him speak, but he did not show up, because he had just been arrested at that time.

Even if the global transplant leadership does not have the time to read research into transplant abuse in China, or the grace to invite researchers to the events the leadership helps organize, they should at least listen to what they themselves are saying. People in China, especially state officials, who deviate from the Party line get arrested. That is pervasive across all areas of policy, and not just something which happens in the transplantation field. They get released only if, before release, they undertake after release to conform to the Party line. There is no other basis for release, except for extreme illness. For foreign transplant leaders to then take at face value what a released official says, without investigation or verification, means that they too are adopting the Party line.

Outside of China, organ sources are either dead, at least brain dead, both before and after the sourcing or alive both before and after. China is the only country where sources are killed by organ extraction, where sources are alive before and dead afterwards.

This practice, as well as being murderous, presents unusual transplantation problems, because the practice increases the amount and type of pharmaceuticals required to be injected into the source. That increase can potentially cause problems for the patient who receives the organ. Substantial Chinese transplant research has gone into addressing this problem, trying various combinations of drugs which can create the desired impact on the source without harming the organ being transplanted.

Chinese transplant professionals may well someday be teaching foreigners about the killing of political prisoners for their organs. But we outside China should do what we can to prevent that.

Just prior to the Kunming conference, the Xinhua news agency reported:

“Recent correspondence with the World Health Organization (WHO), the Pontifical Academy of Sciences, the Transplantation Society (TTS) and the Declaration of Istanbul Group both surprised Huang when his dedication to organ transplants was recognized by world professionals.

‘You are widely acknowledged as an academic leader who has revitalized liver transplantation in China and led the transplant reform by Chinese transplants professionals, with organ transplant regulations in China consistent with WHO (international) principles of practice and shared by the global community,’ said an email.”

There is an equation here of Chinese law and policy with practice, showing a lack of awareness that the law can in China can not be enforced against the Party, since the Party controls all aspects of the enforcement of the legal system. The four organizations are pleased that the Party said what they wanted to hear.

Generally, repressive regimes, when faced with criticism of their human rights records, produce one of two responses. Either they say “go away, this is our business, your own country has many human rights violations which should concern you”. Or, they say, “you are right, come help us, we need your expertise”, but nothing changes. In both cases, the result, in terms of respect for human rights is the same. The only difference is that in the second case the beguiled are disgraced. Lack of expertise in human rights includes ignorance of this pattern, an ignorance the four organizations manifest.

Governments often face the question whether to engage or boycott. Relations between governments cover a wide range of matters. Deciding whether to engage or boycott involves trade-off. Is it worth the cost of cutting off relations in areas where engagement is beneficial in order to express strongly enough the repugnance for the behaviour which prompted the call for a boycott?

The transplantation profession does not have to consider any such trade-offs. Relations between the foreign and Chinese transplantation professions concern transplantation only. The question whether the value of engaging in one area is worth the loss suffered by not boycotting for repugnant behaviour in another area does not arise. Transplant professionals who preach engagement rather than boycott as a way of effecting change in China are oblivious to this difference.

In the Xinhua quote, the four agencies refer to a Communist Party propagandist as an academic, giving him and the Party a false aura of expertise and authority. The problem here is not just a propagandist is recast as an academic. As noted earlier, The Transplantation Society recasts independent researchers as politically motivated. This is the sort of inversion of reality which would make the Chinese Communist Party proud.

The Transplantation Society immediate past president O’Connell said at the Kunming conference

“Now no one up here has any evidence that supports the Falun Gong claims. If we had, we wouldn’t be up here,”

The statement of O’Connell that “no one up here”, that is to say Kunming, had any evidence of the killing of prisoners of conscience for their organs is likely true, since anyone who had that evidence or even was aware of that evidence was not invited. He confirms the New York Times analysis of remarks he made at the time of the Hong Kong conference, first that he endorses the Chinese Communist Party propaganda about Falun Gong that a set of exercises is an organization. Second, he attributes research coming from disinterested researchers who do not practice the exercises to this imaginary organization.

Summation

The Chinese Communist Party has no credible factual answers to the work of independent researchers who have demonstrated the mass killings of innocents for transplantation. Indeed, given the massive scale of the transplantation business in China, it is impossible to deny this research in any credible manner. Party propaganda, denying official data, pretending what is there is not there, can persuade only the gullible or the willfully blind.

A main line of defence for the Party has become the statements of these gullible or willfully blind, what Communists refer to as useful idiots. The Party publicizes and exaggerates the endorsements of the naive and the foolish.

TTS 2006 China policy

The Transplantation Society, as an organization, has lost its way on this issue. It nonetheless in 2006 started off with a policy that at least made an attempt to address the problem.

The Society recommended seven principles. In what follows, I set out these principles and my reaction to them in light of subsequent experience.

The first principle The Transplantation Society recommended was this:

Only those doctors who sign the Statement of The Transplantation Society for Membership agreeing to conduct clinical practice according to The Transplantation Society policy about not sourcing organs from prisoners should be permitted to become members.

My reaction to this is that it needs some enforcement. There has to be a reality behind the signatures and a price for dishonesty, including willful blindness. There needs to be added to this statement the principle that anyone about whom there are reasonable grounds to believe has participated in sourcing organs from prisoners should, if not already a member, not be allowed to join, or, if already a member, have his or her membership revoked. That principle should also be true for national transplantation societies.

The second principle The Transplantation Society recommended was this:

Presentations of studies involving patient data or samples from recipients of organs or tissues from executed prisoners should not be accepted.

This principle needs a bit of tweaking. Chinese Communists, as noted, have admitted to sourcing organs from prisoners but deny sourcing organs from prisoners of conscience, prisoners who are not sentenced to death and are typically sentenced to nothing. The phrase “executed prisoners” buys into this Chinese Communist fantasy that the prisoners sourced for organs are or were common criminals sentenced to death and rejects only the narrative that these prisoners donated their organs to atone for their crimes. The phrase “executed prisoners” should be instead “executed prisoners or prisoners of conscience”.

Beyond that, the problem with the principle is its application. A study published in February 2019 canvassed 445 papers reporting research on Chinese transplant recipients. 412 (92.5%) failed to report whether or not organs were sourced from executed prisoners. 439 (99%) failed to report that organ sources gave consent for transplantation. Of the papers claiming that no prisoners’ organs were involved in the transplants, 19 of them involved transplants that took place prior to 2010, when there was no volunteer donor programme in China. The study called for retraction of all the papers published pending investigation of individual papers.(8)

If simple dishonesty is enough to circumvent the policy, then the policy is meaningless. The principle sets up a dichotomy between organs sourced from prisoners and organs not sourced from prisoners. While in theory the dichotomy is real, in practice it is not, because of Chinese Communist practices of denial, cover up, bamboozlement, bafflegab, propaganda, and dishonesty.

The onus should not fall on publishers or transplant professionals to show something is amiss in China. The onus is rather the reverse. The onus falls on the Chinese transplant profession to show beyond a reasonable doubt that there is no sourcing of organs from prisoners of conscience. Studies emanating from China which do not show that should be rejected for publication.

The third principle The Transplantation Society recommended was this:

Doctors and health care personnel from transplant programs in China or other countries that utilize organs or tissues from executed prisoners should be accepted as registrants in meetings of The Transplantation Society.

The Transplantation Society justified that principle by reasoning that acceptance would allow for promotion of dialogue and education of doctors engaged in abusive practices. My reaction to this principle is that it has been contradicted by history.

The notion that Chinese Communists are killing prisoners of conscience for their organs out of ignorance and that if only they were properly educated they would stop is itself ignorant. It is the transplantation professions who need education – on human rights, the dynamics of persecution and Chinese communism.

China Communists have propagandized any form of contact as endorsement and acceptance of current practices. Ostracism works. It should not be abandoned in favour of naive hopes of education.

The fourth principle The Transplantation Society recommended was this:

Collaboration within clinical studies should not be considered if the study involves recipients of organs or tissues from executed prisoners. Collaboration with experimental studies should also not be considered if the material derived from executed prisoners or recipients of organs or tissues from executed prisoners is used in the studies.

That principle is fine, with the caveat expressed earlier that the to the phrase executed prisoners should be added the phrase “prisoners of conscience”. The problem here is application, the same problem identified earlier when I was addressing the second principle about presentation of studies.

The fifth principle The Transplantation Society recommended was this:

Members of The Transplantation Society should accept invitations to give scientific or educational lectures or to provide their expertise to support various transplant program activities in China with the proviso that care is given to ensuring that the participation facilitates development of Chinese transplantation programs and does not promote the practice of transplantation of organs from executed prisoners.

This principle is a half-way house, assuming that proper transplant practices can live side by side with improper practices and encouraging foreigners to promote the proper component. This half way house is a form of self-delusion. In reality it amounts to foreign contribution in building a Communist facade, making it an international effort.

The notion that the Chinese transplant system can be part good and part bad and that foreigners can participate in the part that is good is mistaken. One rotten apple spoils a whole barrel. When the Chinese Communists tolerate transplant abuse anywhere the whole system is wrong.

The basic question we need to address is “How do we impact on transplant abuse in China?” The answer is to exact as high a price as possible for that abuse. Funneling those Chinese transplant professionals who want international endorsement into a component of the system that the internationals are prepared to accept relieves pressure on the transplant profession in China generally by removing the incentive from those who want contact with foreign professionals to be agents of change.

The sixth principle The Transplantation Society recommended was this:

Members of The Transplantation Society should accept clinical or pre-clinical trainees from transplant programs that use organs or tissues from executed prisoners, provided care is taken that it is their intention that their clinical career will not involve sourcing organs from prisoners.

This is a most strange principle. Those who use organs or tissues from prisoners of conscience are accessories after the fact to murder. It is not ok to train murderers in enhanced killing techniques as long as they say they do not intend to kill again. This principle, suggesting the contrary, goes in exactly the wrong direction.

Not every ethical breach justifies professional disqualification. But surely, for transplant professionals, being complicit in sourcing organs from prisoners of conscience, even if the complicity amounts only to willful blindness, should justify disqualification.

Future intentions in this context are hard to enforce or even credit. But even if they could be credited, even if they could be enforced, the past history of such candidates should put them out of contention for any training.

The seventh principle The Transplantation Society recommended was this:

International registries should accept data from patients transplanted with organs or tissues from executed prisoners, provided the source of the organ or tissue is clearly identified and recorded as procured from an executed prisoner and provided also that the data is not incorporated in the total analysis of outcomes of transplantation or other scientific registry studies.

Here the notions of clear identification and executed prisoners clash. China sources organs from prisoners in secrecy. It does not identify even one prisoner of conscience as a source of organs. The proviso of clear identification is fine. The trouble is that it sets a standard that can not be met in any case. The Transplantation Society can not be clear unless the Chinese Communists are clear. Yet, they are anything but.

That does not mean that we should ignore data from patients who come from China. What it does mean is that we should be classifying that data as all entirely problematic until it is established beyond a reasonable doubt that it is not.

Conclusion

Obviously I do not agree with all principles that The Transplantation Society has proposed. The Transplantation Society has not given the right answers. But they have asked the right questions. The questions they have asked are questions Canadian transplant professionals must ask if they want to develop a comprehensive set of transplant ethics.

David Matas is an international human rights lawyer based in Winnipeg, Manitoba, Canada