As of yesterday, more than 8,000 people were on the waiting list for organ transplants run by the Taiwan Organ Registry and Sharing Center. The kidney list alone accounts for more than 6,000 people. The wait for an organ can take years, and for many on the list, it will prove too long.
Traditional mores account for the reluctance of many Taiwanese to consider donating their organs after death, but there has been an effort in the past two decades to encourage donations. However, a legal morass may be hindering the best intentions of would-be donors, while the growing demand is creating an ethical minefield for the National Health Insurance (NHI) system.
The first problem stems from a conflict between two laws. The second involves the use of organs taken from executed prisoners in Taiwan and the growing number of people who go to China — with its history of murky and unethical organ harvesting — for a transplant.
The Human Organ Transplantation Act (人體器官移植條例) was signed into law in 1987. The Department of Health (DOH) established an organ donation network on April 1, 2004, and an online system for donations, transplant registration and allotment was established a year later. However, demand has always outstripped supply. The center’s Web site states that on average, only 150 donors are found a year, accounting for a donation match rate of 0.00066 percent.
In 2011, the transplant act was amended to require that a potential donor’s consent be recorded on their NHI card and their consent form recorded into the system’s central database. The amendment was necessary, because under Article 6 of the act, doctors cannot remove organs from a donor’s body if the deceased has not left their documented consent or their immediate family members do not give their consent.
However, some, perhaps many, would-be donors’ wishes are not being carried out because their families do not agree to organ harvesting. The Medical Care Act (醫療法) states that hospitals must get the consent of a patient’s family before undertaking an operation and it appears that this act trumps the organ transplantation act.
To help reduce the waiting time for kidneys, which could be decades, the center and the DOH also encourage family members and relatives to act as living kidney donors.
However, people willing to donate organs after their death and those willing to donate a kidney to a relative barely make a dent in the waiting list. That is where the darker side of transplants comes in — the use of executed prisoners as donors and NHI coverage of post-transplant treatment and medication for people who have gone abroad to obtain an organ transplant. This situation was highlighted at a Feb. 27 meeting hosted by the Taiwan International Care Association for Organ Transplants and the DOH.
Democratic Progressive Party Legislator Tien Chiu-chin (田秋堇) told the meeting that a majority of organ recipients are going to China for transplants, raising the issue of the NHI and taxpayers becoming complicit in the “illegal and unethical organ-harvesting crimes perpetrated in China.”
An official from the DOH’s Bureau of Planning said that while the law does not ban the use of organs taken from executed prisoners, “the government does not encourage it and has stopped soliciting organ donations in prison.” If this is the case, then it should not, overtly or through omission, enable or encourage organ transplants using illicit or unknown organ sources, a situation that is rife in China.
Volunteering to be an organ donor benefits not only the recipients, but their families and society as a whole. It is an act that should be wholeheartedly encouraged and facilitated.
The government and the legislature need to act to clarify or amend the law to eliminate sources of confusion about organ harvesting and to ensure that transplants meet the highest medical and ethical standards. Lives depend on it.