Doctor striving to change hearts and minds
Print Edition
WHEN Chen Xiaosong, an intensive care unit doctor, at Shanghai’s Renji Hospital, was asked several years ago to become the coordinator for an organ donation program, he turned down the offer.
“Who would want that job?” he said.
“It’s very hard to communicate with the families, and the success rate is extremely low.”
But in the summer of 2013, Chen relented. He scaled back his duties in the intensive care unit at Renji Hospital and moved into organ-donation work. At the time, he hadn’t a clue what was in store for him and his team.
Organ donation is a hard concept to sell in China because so many families cling to the traditional belief that a body should be buried whole.
The need for organs for transplants increased dramatically this year after the government banned the harvesting of organs from executed prisoners, which had accounted for about half of the supply.
Donor shortage is a global problem, but it’s especially critical in China, which has one of the lowest donor rates in the world.
According to former Health Minister Huang Jiefu, the nation has one donor for every 2 million citizens. By comparison, Spain, which has one of the best rates in the world, has 37 donors per million.
The shortfall means that many people who need organ transplants don’t get them. There are an estimated 300,000 people in the nation waiting for transplants every year, but only 10,000 get them.
Progress in changing public attitudes about organ donation is slow but steady. Last year the number of donors in Shanghai rose to 55 from five a year earlier. The figure is expected to reach 100 by the end of this year.
China has set up a national organ donation system run by the Red Cross Society of China. It started as a pilot project in March 2010 and was expanded to nationwide operation in February 2013.
Provincial Red Cross branches are in charge of the operation of the system in their regions.
The Shanghai program began in early 2013. To date, 11 local hospitals are licensed to do organ transplants and eight offices have been set up for organ procurement and for liaison with families of potential donors.
“Organ procurement in countries like the United States is handled by independent organizations, but our offices are affiliated with hospitals,” said Dr Huang Xiaowu, a surgeon at Shanghai’s Zhongshan Hospital who is involved with the organ procurement effort.
“The organ donation system is still young in China, so it helps to work inside big hospitals, where experienced professionals are at hand,” he said.
Coordination is important, he said. “If a patient donates two kidneys in one hospital in the district covered by our procurement office, Zhongshan can take one of the organs and the other can go to another hospital that might have a patient waiting for a transplant,” Huang said.
For Dr Chen, getting the public interested in organ donation is a job with a steep learning curve.
“Before this, I was always busy saving lives,” he said.
“If we couldn’t save someone’s life, we told the families, but now, if we can’t save a life, we ask the families to consider donating the patient’s organs to help someone else. For doctors, this change in thinking is huge.”
The pressure has been telling on Chen. In the first 15 cases he handled, he spent sleepless nights wondering about the morality of trying to secure permission for a patient’s organs even before a patient’s heart had stopped.
His team is often involved in cases with patients declared brain dead. Families often refuse to accept that diagnosis and are even less happy being asked about organ donation while the patient is still breathing though comatose.
According to Chen, only 20 to 30 percent of families are willing to meet with coordinators to discuss the possibility of organ donation. Sometimes staff don’t help the situation. Two-thirds of nurses polled at Renji Hospital said they object to organ donation.
Chen recalled the case of a child who was declared brain dead after three unsuccessful surgeries.
When the organ donation team arrived on the scene, the patient’s doctor was reluctant to introduce them to the family. When the team finally made contact, the family members were outraged and threatened to call the police.
For some families, social pressure overwhelms charitable feelings.
Chen cited the case of a man who was declared brain dead.
His son, a forensic pathologist, accepted the situation and, with his mother, agreed that the man’s organs could be donated. But extended family relatives who then arrived on the scene quickly quashed the idea.
In China, consent for organ donation can be registered by a healthy person in advance, or it can be given by the parents, adult children or spouse of a patient who is gravely ill or has just died.
“Many people don’t fully appreciate the life-giving aspects of organ donation. They don’t see it as a charitable act,” Chen said.
“They are suspicious that someone is trying to take advantage of them.”
Chen said he takes heart from the fact that the younger generation seems more open and understanding of the need for organ donations.
“We had only a 29 percent success rate with families we approached last year, but this year, it has been 50 percent,” said Dr Huang.
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