"They just reclassified prisoners as citizens," said Huige Li, a Chinese-born doctor at the University of Mainz in Germany. Transplant surgery in China is likely to entail organs harvested from prisoners. Credit:AP The announcement in December by Huang Jiefu, a former deputy health minister and chairman of the National Health and Family Planning Commission's Human Organ and Transplant Committee, was "an administrative trick", said Dr Otmar Kloiber, the secretary-general of the World Medical Association. The association opposes the use of organs from prisoners in any country that has the death penalty, saying there is no way of knowing if such donations are truly voluntary. The relabelling of prisoners has enabled Chinese officials to include them in a new, nationwide "citizen donation" system that China is building to reduce its long-standing reliance on organs from prisoners. The move has been described in multiple state reports quoting Mr Huang and other officials.

In January, the ruling Communist Party's publication People's Daily reported that voluntary donations from citizens had become the sole source of organs for transplant. It then quoted Mr Huang as explaining: "Death-row prisoners are also citizens, and the law does not deprive them of their right to donate their organs. If death-row prisoners are willing to donate their organs to atone for their crimes, then they should be encouraged." China has been accused of using an 'administrative trick' to continue using prisoners' organs in transplant operations. Credit:Peter Braig In March, Mr Huang told The Beijing Times, "Once the organs from death-row prisoners who have voluntarily donated are included in our national distribution system, they are counted as voluntary citizen donations." Dr Kloiber said the World Medical Association was aware of reports that China was continuing to use prisoners' organs, in contravention of the association's ethical standards. The China Medical Association is a member of the world body. The only exception under the association guidelines, Dr Kloiber said, was donations for immediate family members.

"The practice there is unethical and should be changed to an ethical practice," he said of China. "Administrative tricks don't make it ethical." The December announcement came at a meeting of the newly established China Organ Procurement Organisation Alliance. It is one of several organisations set up in recent years to help transform China's system from one depending heavily on organs from executed prisoners to one of voluntary donation, as in many developed nations. At the meeting, Mr Huang announced: "From January 1, 2015, we will completely stop using death-row prisoners' organs as a transplant source. The only source will be organs from dead citizens who have voluntarily donated." The discrepancy between that public statement and current practice is coming to light as doctors begin to speak publicly about what they call major changes in their country's troubled organ donation system. Broadly, China is trying to construct a more transparent system with a central organ pool for all, amid public anger at corruption and lack of equal access.

Previously, multiple medical centres operated, often secretly, to procure organs from prisoners or poor migrant workers and supply them to politically well-connected or wealthy patients, according to officials and researchers. Now, the government says it is working to create a single pool that will be fairly managed with organs distributed according to medical need. China began to solicit organs from the public in 2010. In a 2011 article in the medical journal Lancet, Mr Huang said about 65 per cent of transplants in China had been done with organs from dead donors, of which more than 90 percent were executed prisoners. The rest had been provided by living donors. When Chinese officials said last year that they would no longer use prisoners' organs, that meant they would no longer systematically harvest organs from death-row inmates, Dr Li said. Mr Huang "is separating dead prisoners' organs into two groups," Dr Li added. "One is the traditional style, 'I don't care if prisoners agree or not, we'll use them,'" which has been illegal since 2007, he said. That year, a new law on organ transplants banned trafficking in organs and removing them without written consent, although it did not mention prisoners. "When he said, 'We will completely stop using prisoners' organs,' he meant stop using that illegal component," Dr Li said.

New York Times