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Journals retract 15 Chinese transplantation studies over executed prisoner concerns

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5220 (Published 20 August 2019) Cite this as: BMJ 2019;366:l5220
  1. Owen Dyer
  1. Montreal

The journals Transplantation1 and PLOS One2 have retracted 15 articles reporting studies from China in the past month after the study authors failed to fulfil requests to provide evidence on the source of transplanted kidneys and livers.

Kidney International3 and the Clinical Journal of the American Society of Nephrology4 have also both published recent expressions of concern about three kidney transplant studies from China.

In explaining their decisions all four journals referred to an article published in BMJ Open this February, in which a team led by Wendy Rogers of Macquarie University in Sydney, Australia, reviewed 445 transplantation articles from China published from 2000 to 2017.5

They found that 92% of the studies did not report whether organs had been sourced from executed prisoners, and 99% did not report that organ sources had given consent for transplantation.

“The transplant research community has failed to implement ethical standards banning publication of research using material from executed prisoners,” wrote Rogers and her colleagues. “As a result, a large body of unethical research now exists, raising issues of complicity and moral hazard.”

They called for “retraction of this literature pending investigation of individual papers” and for “an interim moratorium on publication of all relevant papers, pending an international summit to develop policy.”

Great expansion in donation

Transplantation, in an editorial explaining the reasons for seven recent retractions, suggested that China’s use of executed prisoners’ organs ceased after 2014 and was replaced by a programme based on deaths in intensive care units (ICUs).1

The article said, “The source of organs in China has been through several phases over the past 20 years, with small numbers of living donors and deceased donors in the early years. A great expansion of donation then occurred through the turn of the century and in the first five years of the 21st century, largely if not exclusively, from the use of organs from executed people.

“In 2010, the first 11 Chinese transplant programs began a program of ICU donors using Donors after Circulatory Death, which was expanded substantially in 2014, becoming the exclusive source for deceased donor organs since then.”

The editorial was co-written by Mehmet Haberal, president of the Transplantation Society. It continued, “It is clear, with the benefit of hindsight . . . that most deceased donors were from executed people, before the [Chinese] government implementation of Donation after Circulatory Death in 2010 in selected hospitals and widely from 2015. This was not transparent to reviewers and editors at the time of original acceptance for publication of these articles.”

Rogers queried this last claim, pointing out to The BMJ that Huang Jiefu, the Chinese official who oversaw the ICU based programme, had acknowledged in 2006 that organs came from executed prisoners.

That same year the Transplantation Society sent a letter of guidance to all members, warning that in China “almost all organs are likely to have been obtained from executed prisoners.”6

Rogers also took issue with the editorial’s assertion that Chinese transplant organs today come from volunteers. “There is no evidence that forced organ harvesting from prisoners of conscience has stopped,” she said. Instead there were “repeated assertions from Chinese spokespersons” that “have not been independently verified. Prisoner organs are counted as volunteer organs if prisoners have given consent, which of course is an oxymoron in international transplant ethics.”

She added, “I put significant weight on the findings of the China Tribunal,7 that forced organ harvesting from prisoners of conscience is continuing.”

The BMJ is investigating three articles in its journals that Rogers and colleagues identified as potentially documenting research involving unethically sourced organs in China: one in BMJ Open8 and two in the Postgraduate Medical Journal.910

References

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