A 2016 study done by Chinese surgeons was retracted from Liver International due to accusations that its data on the safety of liver transplantation involved livers that were extracted from executed prisoners of conscience.

The practice of harvesting organs from executed prisoners for transplants has been explicitly banned in January 2015 and a volunteer donation system has been put in place.

The study which was published last October, analysed 564 consecutive liver transplantations performed before the ban - from April 2010 to October 2014, at Zhejiang University's First Affliated hospital in China. The authors claim "all organs were procured from donors after cardiac death (DCD) and no allografts [organs and tissue] obtained from executed prisoners were used."

However clinical ethicist Wendy Rogers of Macquarie University in Sydney and her colleagues were suspicious and wrote to the editor of Liver International on 30 January, calling for the paper to be retracted in the "absence of credible evidence of ethical sourcing of organs."

They doubted that the Chinese researchers could have legally gotten over 500 livers based on their knowledge about the supply of livers in China and the proportion of livers that are typically viable for transplanting.

Voluntary liver donation numbers do not add up

Rogers stated that international programs report relatively low rates of procurement of livers from DCDs. Citing the US as an example, she stated that the rates of liver transplant from DCDs in the years 2012 to 2014 were 32%, 28% and 27% respectively.

"If retrieval rates are similar in China, this would require 1,880 DCD donors, assuming a retrieval rate of 30% to transplant the 564 livers reported in this paper," she argues.

However there were only 2,326 reported voluntary donations in China during 2011-2014, making it unlikely that the surgeons had exclusive access to at least 80% of all the voluntary liver donations during this period.

Rogers supported her argument stating that China also lacked a coordinated nationwide system of transporting organs within the time frame required for successful liver transplantations, therefore it seemed plausible that livers were harvested from executed prisoners.

Chinese authors did provide evidence to support their claim

"The authors' institution was given until 3 February to provide evidence against allegations supported by data that organ procurement for liver transplantation was not from executed prisoners. However, there was no answer," said professor Mario Mondelli, editor of Liver International. He promised a full retraction and accompanying explanation in the next edition of the journal.

This came a few days before a prestigious conference on combating international organ trafficking and transplant tourism was held in Vatican City last week. A storm of controversy erupted before and during the conference, over the participation of Dr Huang Jiefu and Dr Wang Haibo, controversial Chinese transplant surgeons as they provided an unconvincing defense of organ transplant reform in China.

Huang had only prepared two slides, one showing an increase in both living and cadaver donors in recent years, and another depicting efforts of clamping down on illegal transplantation activity. Afterwards, Wang argued that it was simply impossible for the regime to monitor all transplantation activity in the country as there are "one million medical centres and three million licensed doctors operating in the country."

Despite WHO support, critics remain unconvinced

The World Health Organisation (WHO) has announced that China has indeed taken steps to end its once-illegal-widespread practice of harvesting organs from executed prisoners, and echoed Wang, saying that it is impossible to know what is happening across the whole country.

But critics remain unconvinced.

"It sounds a little hard to believe that China could have so quickly made this change to its organ donation program," said Vivek Jha, executive director of the George Institute for Global Health in India.

He called for transparency, asking the Chinese government to provide evidence to the international transplant community, proving that its organs are no longer illegally procured.

"It could be the case that China has changed," he said, "The problem is we just have not seen the information to prove it." MIMS

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