A couple registers to become organ donors in an activity themed “Gifts of love,” co-sponsored by the Red Cross Society of Tianjin and the Tianjin Municipal Health Bureau, on Feb. 28, 2014.

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For Li Dan, a white-collar worker from Shenzhen, her 25th birthday on Dec. 25, 2016, was particularly special. After logging on to the “love·hope” website under the National Health and Family Planning Commission of China, she officially became a voluntary organ donor.

To date, the number of Chinese volunteers registered on the website has reached 110,000.
“Organ donation makes it possible for patients with severely dysfunctional organs to have their lives renewed and prolonged,” said Huang Jiefu, director-general of China Organ Transplantation Development Foundation (COTDF).

 

Donation: procedure simplifying
A survey conducted by COTDF showed that 56 percent of the Chinese are unwilling to register for donation because they do not know where to register or there are too many details involved in the procedures and formalities of donation registration.

But now the registration process has been simplified, and the Internet has played no small part. The whole process—inputting personal information, choosing the organ to be donated and confirmation—took only two minutes to finish online, Li said.

On Dec. 22, 2016, COTDF began cooperation with the mobile application program of Alipay, China’s leading third-party online payment platform, which has 450 million real-name registered users enrolled. The cooperation further shortened the time required for organ donation registration, which can be finished in 10 seconds.

 

Transplantation: system building
Since the mid-20th century, organ transplantation has grown into a mature clinical technology in China. In addition to the shortage of donors, many other factors still restrict the clinical treatment of organ transplantation. It is estimated that there are about 300,000 patients afflicted with organ failure anxiously awaiting organ transplants in China each year, but the actual number of transplants is only about 10,000.

“Though the organ is provided free of charge, the cost of procuring, preserving, transporting and transplanting it is high, and the expense of the transplant operation itself is enough to make many patients hesitant,” Huang said. He said much remains to be done to lower the cost, such as further reforming medical insurance.

Another obstacle is the gap between supply and demand. “We need more doctors, hospitals and coordinators who specialize in the surgical process of organ donation. The country now has only several hundred doctors in this sector, and only 169 hospitals are licensed to conduct organ transplantation operations,” Huang said, calling for a larger number of hospitals to be made eligible—roughly an increase to 300 to 500.

Many of the coordinators are volunteers. They contact the relatives of the donors, publicize the donation policy and assist with the donation process—on one end of their job, is passing away; on the other, is rebirth.

“Their task is to race with time in the relay of extending life,” Huang said. “By the end of 2014, the registered and certified coordinators of human bodily organ donation in China had reached 1,151, but we need more people to join this group to better adapt to the expanding sector of organ donation and transplantation.”

 

Going global: Chinese solution
On Oct. 31, 2016, American scholar Robert Kuhn published an article on the subject of China’s human right progress in People’s Daily. He argued that China has made two historic achievements in the field of human rights in recent years. The first is the deepening of judicial system reform. The second is that since January 2015, China has ended the use of organs from executed prisoners, and voluntary donations are now the only source of organ transplantation.

To minimize human intervention, China assigns the job of organ allocation to the human organ allocation and sharing network designed by relevant scientific research departments. Wang Haibo, head of the network, said this computer system uses the patient’s need for medical treatment and degree of organ congruity as the two criteria of organ allocation. It then automatically generates donor-specific match lists for suitable recipients and provides the medical monitoring to the national and local regulatory agencies.

The network is just one example of China’s recent progress in promoting the organ donation and transplantation sector. “Our legal system related to the sector is substantially improving and the proportion of citizens’ voluntary donations is growing, displaying China’s image as a responsible power that reveres human rights and the rule of law,” Huang said.

Huang recently received a special invitation letter from the Pontifical Academy of Sciences at the Vatican. The academy will host an international conference against organ trading in February 2017. The attendees also include the World Health Organization and Global Organization for Organ Donation. At that time, the Chinese delegation led by Huang will share the country’s solution and path of organ donation and transplantation with the world.

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Spain: government coordination
Currently, Spain has the highest rate of organ donation in the world. As early as in 1965, Spain had already had organ donation cases. In 1979, Spain passed “presumed consent” laws under which individuals are automatically considered organ donors unless they opt out and refuse consent to donate.

In 1989, Spain established the National Transplant Organization (NTO), an institution belonging to the Spanish Ministry of Health, Social Services and Equality. The NTO is a nationwide transplant coordination network in charge of procurement, distribution and transplantation of organs as well as patient waiting-list management and information updates.

Moreover, the government has implemented a nationwide donation mechanism and standard while setting up donation coordination teams on a hospital basis that can get consistent professional training. For patients who cannot afford transplant operations, the government will offer financial aid.

 

US: complete system
In 1984, the US Congress passed the National Organ Transplant Act, prohibiting the selling of human organs and establishing the Organ Procurement and Transplantation Network (OPTN) to ensure fair and equitable allocation of donated organs, and the Scientific Registry of Transplant Recipients to conduct an ongoing evaluation of the scientific and clinical status of organ transplantation. The OPTN is in charge of the allocation of donated organs and the collection of transplant data nationwide.

In 1986, the United Network for Organ Sharing (UNOS) and the US Department of Health and Human Services signed the first contract for the operation of the OPTN under the direction of UNOS. The OPTN provides services for equitable access and allocation of organs and sets the membership criteria and standards for transplant centers in the United States.

Under the UNOS organizational system, the US is divided into 62 local areas, grouped into 11 regions. A local organ procurement organization operates within each of the 62 areas.

 

Australia:  standard procedure
The Australian Organ and Tissue Donation and Transplantation Authority was established on Jan. 1, 2009, to create a nationally consistent and coordinated approach to organ and tissue donation and transplantation.

In recent years, Australia has been committed to establishing a secure, fair and transparent national transplantation procedure, including a unified national transplant recipient selection criteria and a waiting list as well as a unified national organ distribution network.

Organ allocation is required to follow and respect the ethical principles established by the National Health and Medical Research Council, while reducing the side-factors affecting organ allocation to conduct scientific and systematic organ transplants.

Australia has a specialized forum and transplantation society for advocating, promoting and supporting organ donation and transplantation, laying the public foundation for Australia to become the world’s leading organ and tissues donation and transplantation nation. Forum members include patients awaiting transplants, donor families, living donors and transplant recipients, as well as organ donation and transplant doctors, nurses and other staff. Members of the transplantation society include transplant clinicians and other health professionals as well as multidisciplinary teams, such as patient representatives.