Imagine that you’re a prisoner on death row in China; it’s the day before you’re being executed. A few prison officials bring you into a room and sit you down at a table, with a crying woman on the other side. This woman, they explain to you, is the mother of a child who needs a kidney transplant of he will die. They want to use your kidney after you are executed. Upon first hearing this proposal, you are nervous and uncomfortable – you never agreed to have your organs harvested. However, they put a piece of paper in front of your face with a pen and practically make you sign it. It’s a consent form. Threats of violence are thrown out at you, and you are intimidated to sign, while the crying mother is staring you in the face. On the way back to your cell, you think about what you’ve just done. On the one hand, you’ve just signed away your organs to do with as they will when you die. On the other hand, they might save people’s lives. Still, it never really felt like your decision to make.
This situation is essentially what is happening in China right now, and has been for the past few decades (Cameron & Hoffenberg, 1999). China is currently one of the largest organ transplantation markets in the world, and a great deal of those organs come from prisoners on death row pending execution (Cameron & Hoffenberg, 1999). The ethical debate, then, rests on whether or not it is ethical to get organs from executed prisoners, with the possible use of coerced consent in the acquisition of such issues. Provided China continues on its course of correcting the ethical questions related to coerced consent, for the time being it is clear that organ transplants from executed prisoners must continue.
First of all, it is necessary to determine whether or not the practice of carrying out the organ of executed prisoners to use it for organ transplantation is happening in China. However, it is clear from the evidence that this is so: According to research, nearly 5,000 organs are taken from executed prisoners every year, 90% of them being kidneys (Westall et al., 2008). A regulation created in 1984 permits the use of organs from executed criminals, provided they give their consent, or get it from their relatives post mortem (Hinkle, 2001). Other reports state that the vast majority of organs used in transplants come from executed prisoners; while the numbers may be exaggerated, and reports vary, the fact of the matter is that executed prisoners, to some extent at least, are being used for organ harvesting in China. The use of the organs of executed prisoners is real and continues to occur in China, and even has far reaching implications beyond China’s borders. Despite rules in 2006 from the Chinese Government to make sure organs banning is traded, the practice still occurs, with foreigners coming in to get cheap, affordable and expedient organ transplants (Westall et al., 2008).
Now that the reality of organ transplants from executed prisoners has been established, the ethical conflicts must then be discussed. The primary issue people have to this practice is that it violates human rights, and that prisoners are often being tortured or abused in order to coerce consent to harvest their organs. The giving of organs should not be a side effect of a prison sentence, and their consent should not be forced out of them . There are many reasons for opposing the practice of condemned prisoner organ transplantation, including changing the method of execution to make donation more expedient, forcing executions just to get people’s organs, and more (Westall et al., 2008). While we question the presence of ‘coerced’ consent, some argue that the coercion will always be there by nature of the prisoner/government relationship (Westall et al., 2008). The for-profit sale of prisoner organs is also a possibility and an ethically dubious one at that; finally, the utility of organ transplantation from condemned prisoners starts to justify the procedure of execution itself, which for some is still an unethical practice (Westall et al., 2008). Because of these reasons and more, there is plenty of reason for people to be cautious of using executed prisoners as organ farms.
On the other side of the coin, organ donation, regardless of where it comes from, helps to solve the substantial medical problems that occur in countries without substantial dialysis programs, and makes use of organs that could be used to save lives. In a perfect world, the practice of organ harvesting should continue; however, it should be done in the right way. Health ministries should be given control and oversight over the procedures themselves, and prisoners absolutely must be given a proper chance to consent; if they do not, their wishes must be upheld. Discussions with prisoners regarding organ donation must be done in a fair and impartial way, with no emotional or physical incentive for doing so that falls under torture or enhanced interrogation (Hinkle, 2001).
One of the biggest reasons why organ transplantation from prisoners should be allowed is that it allows for an adequate source of organs, which is vital to public health. From a utilitarian standpoint, it is clear that China’s large population needs these organs in order to deal with the many of the nation’s sick that suffer from failing kidneys, lungs and so on (Cameron & Hoffenberg, 1999). When weighing the pros and cons of finding out which action actually brings about the greater good, it is arguably better to use the organs of the dead to help the living survive than it is to honor a culturally relative concept of consent that might not even strictly apply to the Chinese as a culture (Cameron & Hoffenberg, 1999). Because of China’s large population, there is a constant need for organs, and this practice, however difficult to regulate or inherently impractical, helps to serve those needs.
China is making great strides in regulating these practices, limiting the amount of coerced consent that is being administered and ensuring that these cases are handled fairly. Already, there are plans to create organ donation systems that will make use of organizations such as the Red Cross to oversee these practices to ensure that they adhere to international law (Shi & Chen, 2011). In 2011, an organ sharing program was implemented that has already started to increase the credibility and ethics of institutional organ transplanting through increased oversight and judicious use of existing and non-prisoner organs (Shi & Chen, 2011). While these efforts are not strictly fully implemented yet, and their effects are immeasurable at this time, it is clear that some strides are being made.
One important thing to keep in mind is the concept of cultural pluralism – where each culture has their own rules and ethics, which we must respect. Much of the opposition to organ transplantation is based in Western ideas about the death penalty altogether, which makes it difficult to have a reasoned conversation about the values of a completely different nation (Hinkle, 2001). When talking about issues such as coercion of the prisoner, exploitation of the execution system, it is clear that Chinese systems are much less concerned with individual autonomy than others – in these situations, the families are consulted rather than the prisoner (Cameron & Hoffenberg, 1999). Other systems would not work in China due to the difference in traditions and cultural norms – a Chinese-specific system is needed for China, and so organ transplants from executed prisoners must continue.
In the end, the fact of the matter is that the child in the story of our aforementioned prisoner would live if given the kidney of this man who is facing execution. While he pays his debt to society, he can lessen that burden further by saving the life of someone else through his death. Though the practice opens up many unique ethical dilemmas, including the training of doctors overseas and Westerners coming to China for cheap transplants, as well as coerced consent, the fact of the matter is that the system needs to be reformed to stop abuses, not be scrapped altogether. While we may personally be taken aback by the practice of using executed prisoners to transplant organs, efforts are being made to ensure that consent is reached without major coercion, and the organs themselves are serving an underserved population that desperately needs it.
References
Cameron, J. S., & Hoffenberg, R. (1999). The ethics of organ transplantation reconsidered: Paid
organ donation and the use of executed prisoners as donors. Kidney International 55: 724-732.
Hinkle, W. (2001). Giving until it hurts: prisoners are not the answer to the national organ
shortage. Ind. L. Rev., 35, 593.
Shi, B.Y. & Chen, L.P. (2011). Regulation of organ transplantation in China: difficult
exploration and slow advance. JAMA 306(4).
Wang, H. (2012). New era for organ donation and transplant in China. Bull World Health Organ
90: 802-803.
Westall, G.P., Komesaroff, P., Gorton, M. W., & Snell, G.I. (2008). Ethics of organ donation and
transplantation involving prisoners: the debate extends beyond our borders. Internal Medicine Journal 38: 56-59.
