China’s Ministry of Health recently drafted a new organ transplant directive called “Management for the Acquisition and Allocation of Organs.” The directive should be implemented soon in the hope of setting up a fairer and more transparent organ distribution system as well as a national database.
A national organ database is an institution specifically set up for the procurement of human organs. It is independent from hospital organ transplant services, and is responsible for medical evaluation, data collection, organ procurement, distribution, transport, and the handover to the hospital undertaking the transplant operation.
In other countries around the world, a national organ database makes up an integral part of the transplant system. Previously in China, the death determination, organ procurement and transplant operation were generally all carried out at the same hospital. It lacked transparency. This is not only about the rights and interests of the donors and the fairness of the organ distribution system, but also about the possible conflicts of interest at the hospitals involved.
Huang Jiefu, the Vice Minister for Health, told Caixin that the creation of a sustainable organ donation system that conforms with social ethics is imminent. He revealed that a national database to record and distribute human organ donations was being established so that “hospitals are completely prevented from interfering in the procurement and distribution” of organs.
A convict's *donation*
China is the only country that systematically uses organs procured from executed convicts. A statistic from the Ministry of Health shows that, up to the end of 2009, 65% of transplanted organs came from cadaver donors (dead people). Among which, 90% were from executed prisoners. 35% of transplanted organs come from live donors.
In order to change this, in 2010, the Ministry of Health commissioned the Red Cross Society of China to launch a pilot trial of the organ donation program to raise awareness for voluntary organ donation. In 2011, the Ministry of Health carried out a one-year trial with voluntary donors who had been victims of cardiac arrests. It encouraged qualified hospitals to be incorporated into the operation so as to experience independent procurement and distribution of donated organs and offered the organs to the pilot hospitals.
As a new concept, the national organ donation system is gradually finding its place in China. Among its various functions, the public is most concerned about whether the donor’s rights, interests and dignity have been vigorously protected, and whether the donated organs have been distributed in a fair and transparent manner.
According to China’s policy provisions, there are currently 164 qualified hospitals accredited by China’s Ministry of Health as organ transplant hospitals. They are part of a network supporting the creation of the national organ database. This will maintain the transparency of organ procurement and cut off any direct link between procurement and allocation.
Even though under the current regulation China’s national organ database is not independent from the network of qualified transplant hospitals, the procurement and distribution of organs will be supervised by a committee headed by the Red Cross Society of China.
“This line of thought comes from the Spanish model,” Wang Haibo, who oversees the national organ donation allocation system, told Caixin.
Indeed, two models prevail internationally. One of them is represented by the American system, where the organization is set up independently from medical institutions. The other is the Spanish system, where a donating coordination team is established within the transplant hospitals, and remains independent from the hospital’s transplant team.
The American model involves a more complex system, has a higher operational cost, and higher requirements of professional qualification for staff and equipment. For China, which is still at the initial stage of creating a new system, the Spanish model is clearly more suitable.
Therefore, the hospital simply has to set up an independent procurement team funded by the hospital. Wang Haibo stressed that with the relative independence of the procurement team and the transplant team, even if they are composed of the same people, it won’t affect the fairness of the operation.
“The procurement team is also the most ideal transplant team, because the doctors can better determine which blood vessels need to be kept longer, or if other components are needed,” Wang said.
As for distribution, the new regulation requires that they should be allocated and shared under a unified system. The study and set-up of the system was commissioned in 2009 to Hong Kong University and was launched in April last year. The allocation system is based on the principles of medical ethics and scientific reason in line with international practice. It takes into comprehensive account the patient data from the entire database so as to assign the organs to the patients who most need them, as well as to those who best meet the conditions.
As a result, the procurement organization can in no way intervene directly in the allocation. Neither the procuring doctor nor the transplant doctor can decide the order of distribution. Neither can the hospital have direct access to organs of unknown origin and distribute them privately.
However, according to expert opinion, it’s still a long road before Chinese transplant hospitals can develop into mature organ procurement organizations. A proper procurement organization is very complex and requires integrated cutting-edge technology and advanced management.
For the moment, China still does not have a comprehensive network for donation and transplants. There are over 20,000 hospitals nationwide, whereas only 164 hospitals are accredited for organ procurement and transplants. They remain subject to geographical distance limits in their day-to-day operations. From the sudden death of a donor to his family’s agreement, the completion of relevant procedures often exceeds the acceptable organ warm ischemic time and affects the use of the organs. As Wang Haibo pointed out, such an organ procurement network is obviously needed to improve efficiency.
In the United States, 58 independent organ procurement organizations (OPOs) coordinated the donation process. Each of these organizations is a member of the organ procurement and transplantation network (OPTN). Hospitals are also asked to cooperate with OPOs so that no matter whether patients are dying or have just died, they will notify the organizations in the most timely manner.
The Ministry of Health is encouraging more hospitals in China to apply as accredited organ procurement organizations. At the same time, a set of standards are to be established so as to assess the quantity as well as quality of operations of the accredited hospitals and avoid the waste of the very limited organ resources.
A neo-Nazi has been buried in the former grave of a Jewish musicologist Max Friedlaender – not an oversight, but a deliberate provocation. This is just one more example of antisemitism on the rise in Germany, and society's inability to respond.
BERLIN — If you want to check the state of your society, there's a simple test: as the U.S. High Commissioner for Germany, John Jay McCloy, said in 1949, the touchstone for a democracy is the well-being of Jews. This litmus test is still relevant today. And it seems Germany would not pass.
Incidents are piling up. Most recently, groups of neo-Nazis from across the country traveled to a church near Berlin for the funeral of a well-known far-right figure. He was buried in the former grave of Jewish musicologist Max Friedlaender, a gravesite chosen deliberately by the right-wing extremists.
The incident at the cemetery
They intentionally chose a Jewish grave as an act of provocation, trying to gain maximum publicity for this act of desecration. And the cemetery authorities at the graveyard in Stahnsdorf fell for it. The church issued an immediate apology, calling it a "terrible mistake" and saying they "must immediately see whether and what we can undo."
There are so many incidents that get little to no media attention.
It's unfathomable that this burial was allowed to take place at all, but now the cemetery authorities need to make a decision quickly about how to put things right. Otherwise, the grave may well become a pilgrimage site for Holocaust deniers and antisemites.
The incident has garnered attention in the international press and it will live long in the memory. Like the case of singer-songwriter Gil Ofarim, who recently claimed he was subjected to antisemitic abuse at a hotel in Leipzig. Details of the crime are still being investigated. But there are so many other incidents that get little to no media attention.
The grave of Jewish musicologist Max Friedlaender
Crimes against Jews are rising
Across all parts of society, antisemitism is on the rise. Until a few years ago, Jewish life was seen as an accepted part of German society. Since the attack on the synagogue in Halle in 2019, the picture has changed: it was a bitter reminder that right-wing terror against Jewish people has a long, unbroken history in Germany.
Stories have abounded about the coronavirus crisis being a Jewish conspiracy; meanwhile, Muslim antisemitism is becoming louder and more forceful. The anti-Israel boycott movement BDS rears its head in every debate on antisemitism, just as left-wing or post-colonial thinking are part of every discussion.
Jewish life needs to be allowed to step out of the shadows.
Since 2015, the number of antisemitic crimes recorded has risen by about a third, to 2,350. But victims only report around 20% of cases. Some choose not to because they've had bad experiences with the police, others because they're afraid of the perpetrators, and still others because they just want to put it behind them. Victims clearly hold out little hope of useful reaction from the state – so crimes go unreported.
And the reality of Jewish life in Germany is a dark one. Sociologists say that Jewish children are living out their "identity under siege." What impact does it have on them when they can only go to nursery under police protection? Or when they hear Holocaust jokes at school?
Germany needs to take its antisemitism seriously
This shows that the country of commemorative services and "stumbling blocks" placed in sidewalks as a memorial to victims of the Nazis has lost its moral compass. To make it point true north again, antisemitism needs to be documented from the perspective of those affected, making it visible to the non-Jewish population. And Jewish life needs to be allowed to step out of the shadows.
That is the first thing. The second is that we need to talk about specifically German forms of antisemitism. For example, the fact that in no other EU country are Jewish people so often confronted about the Israeli government's policies (according to a survey, 41% of German Jews have experienced this, while the EU average is 28%). Projecting the old antisemitism onto the state of Israel offers people a more comfortable target for their arguments.
Our society needs to have more conversations about antisemitism. The test of German democracy, as McCloy called it, starts with taking these concerns seriously and talking about them. We need to have these conversations because it affects all of us. It's about saving our democracy. Before it's too late.
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