Three years ago, in New York, one of Dr. Thomas Diflo's patients on a long waiting list for a kidney transplant showed up with a new problem: She no longer needed a kidney, but suddenly needed after-transplant care.
"She had just returned from a trip to China and, to my surprise, had undergone a transplant while she was there," said Diflo, of New York University Medical Center, where he is director of kidney transplants.
The woman, a Chinese-American, was vague about where the kidney had come from, but others who have come to Diflo for treatment have been more forthcoming, confiding that they got the organs from executed Chinese prisoners.
Kidneys, livers, corneas and other body parts from these prisoners are being transplanted into US citizens or permanent residents who otherwise would have to wait years for organs. Many of the patients come back to the US for follow-up care, which Medicaid or other government programs pay for.
The transplants in China, which doctors in both countries say are increasing, has presented the US medical establishment with an ethical quandary: Should US doctors treat patients who have received organs from executed prisoners and, if so, would they be tacitly condoning the practice and encouraging more such transplants.
Or should they rebuke patients who, in desperation, participate in a process that mainstream transplant advocates condemn as morally wrong?
"That's a decision that has to be made by each individual physician," said Dr. Thomas McCune, a transplant physician in Norfolk, Virginia, and chairman of the patient care and education committee of the American Society of Transplantation.
Executed prisoners are China's primary source of transplantable organs, though few of the condemned, if any, consent to having their organs removed, people involved with the process say. Some of the unwitting donors may even be innocent, having been executed as part of a surge of executions propelled by accelerated trials and confessions that sometimes were extracted through torture.
The American transplantation society says that decisions to donate organs must be made freely and without coercion or exploitation of any sort. It opposes any organ donations by prisoners, even to their relatives, because the circumstances of incarceration make it impossible to ensure that the decision is not colored by secondary benefits, like an improved diet, that a prisoner may stand to gain. Donations from death row inmates are even more suspect.
Various initiatives are under way to protest the harvesting of organs from China's prisoners. One bill would bar entry to the US of any doctors from China who want transplant training. Chinese transplant specialists now travel freely to the US to take part in seminars and other activities that help hone their skills.
But US doctors say there is little they can do to stop the flow of prisoner organs to the US because the Chinese supply is growing just like the American demand.
More transplantable organs are available in China because more people are being executed. This year, 5,000 prisoners or more are likely to be put to death during a nationwide anti-crime drive. Many of them will be stripped of their vital organs, though there is no available data to say how many. Government policy allows the harvesting if the prisoner or the prisoner's family has given written consent, or if the body is not claimed after execution. In practice, though, the rules are often ignored and illegal harvesting tolerated.
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