In the past month, PLOS ONE and Transplantation have retracted fifteen studies by authors in China because of suspicions that the authors may have used organs from executed prisoners.
All of the original studies — seven in Transplantation, and eight in PLOS ONE — were published between 2008 and 2014. Two involved kidney transplants, and the rest involved liver transplants. Two other journals, the Clinical Journal of the American Society of Nephrology and Kidney International, have recently issued expressions of concern for the same reason.
In an editorial explaining the seven retractions from its journal, the editors of Transplantation write:
It is clear, with the benefit of hindsight, and through the Chinese Government’s subsequent clarifications of their practices, that most deceased donors were from executed people, before the Government implementation of Donation after Circulatory Death in 2010 in selected hospitals and widely from 2015. This was not transparent to reviewers and editors at the time of original acceptance for publication of these articles.
As the editors explain:
The source of organs in China has been through several phases over the past 20 years, with small numbers of living donors and deceased donors in the early years. A great expansion of donation then occurred through the turn of the century and in the first 5 years of the 21st century, largely if not exclusively, from the use of organs from executed people. In 2010, the first 11 Chinese transplant programs began a program of ICU donors using Donors after Circulatory Death,6 which was expanded substantially in 2014, becoming the exclusive source for deceased donor organs since then. In retrospect, it is clear that the large majority of organs transplanted in the period 2006–2010 were from executed people and that between 2010 and 2015 the organs from 11 known centers were largely from conventional donation by people dying in intensive care units.
In one typical retraction notice, the PLOS ONE editors write:
Details as to the donor sources and methods of obtaining informed consent from donors were not reported in this article [1], and when following up on these concerns the authors did not clarify these issues or the cause(s) of donor death in response to journal inquiries. International ethical standards call for transparency in organ donor and transplantation programs and clear informed consent procedures including considerations to ensure that donors are not subject to coercion [3,4,5].
For a complete list of retractions for this reason — including another from Liver Transplantation from 2017 — search our database for “+Informed/Patient Consent – None/Withdrawn” as “Reason(s) for Retraction” and “(HSC) Medicine – Transplantation” as “Subject(s).”
The start of a flood?
Both Transplantation and PLOS ONE cite a paper published in BMJ Open in February of this year by Wendy Rogers of Macquarie University in Sydney, Australia, and colleagues that found more than 400 articles that likely used organs from executed prisoners in China, and called for the
immediate retraction of all papers reporting research based on use of organs from executed prisoners, and an international summit to develop future policy for handling Chinese transplant research.
Rogers, who has been writing about this issue for several years, told Retraction Watch that she and her colleagues “have not followed up with any journals following publication of the call for retractions in February,” but pointed to a story in Nature by David Cyranoski in which Cyranoski “did contact some journals asking about their responses to our research.”
Rogers continued:
We are pleased to see that at least some editors of the journals that we identified as publishing unethical research have started the process of investigating and retracting papers. Only one editor or publisher has contacted us directly as a consequence of our call for retractions. No editor or publisher has challenged our methods or findings so far as we are aware.
We are very pleased that some of the editors of renal journals (eg Clinical Journal of the American Society of Nephrology) have realized the implications of our study and undertaken their own investigations of papers from the People’s Republic of China that report on renal transplants, in some cases leading to expressions of concern and/or retractions. (Our study did not examine renal transplant papers.)
We reiterate our call for a systemic response by the academic transplant community – to issue a moratorium on publication of all transplant research from the PRC until guidelines are developed and implemented regarding compliance with international ethical norms.
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Doesn’t it add insult to injury, not only to steal your organs but then to carelessly throw away the findings? Criminals should be named and punished, no doubt about that. But why punish everybody else instead? Retractions are for cleaning up the scientific record, to rid it of wrong, false and misleading results. Scientific publishing is abot the truth, not the moral high ground. Mixing rules from completely disparate areas is nonsensical and helps noone.
Scientific research focuses on repeatable phenomena. If something happens once, it can be documented as an anecdote and described, but is not a repeatable event whose mechanics can be probed and characterized so as to understand the repeating event.
Unless the rest of the world starts harvesting organs from executed prisoners, this will be a one-off event such as events unfolding in Germany 80 years ago. Whenever research is conducted on humans under dire circumstances such as prisons and camps, the reproducibility of the findings is also in question, and from a moral point of view should also not be replicated. Who knows what sorts of stressors the prisoners were experiencing, and what effects such stresses had on their organs. Such recorded findings are not reproduced elsewhere, so the generalizability of the findings is in question.
Retract these papers and banish their findings to the ash heap of really bad and irreproducible ideas some misguided people have devised.
Your objection would be valid, if that were the only way to get organs. I have donated my body (minus the medically usable organs) to science.
My objections are only valid within a community of conscientious actors with a sense of human rights in line with rights now codified in various United Nations declarations and related global treaties forged from the ashes of events such as World War II, slavery trade and the like.
You have, I presume, voluntarily and without coercion declared your desire to have medically usable organs harvested should you unfortunately become brain dead, or otherwise donated to science if your death involves your heart stopping.
No prisoner is in a state to voluntarily, without coercion, make such a free choice. Very few prisoners live in comfortable conditions free of threatening circumstances.
I have never condoned that in the slightest. We are talking after the fact here. What I object to is treating the perpertator and the knowledge gained as one and the same, worse, punishing the article while letting the crimainal go scot free.
And once you’ve executed someone, isn’t it just adding insult to injury when you just throw away their organs when you could be selling them to the highest bidder?
We should skip the injury to which you suggest adding the insult.
In the USA:
https://optn.transplant.hrsa.gov/resources/ethics/the-ethics-of-organ-donation-from-condemned-prisoners/
The US Department of Health and Human Services (HHS) Organ Procurement and Transplantation Network (OPTN) works with the United Network for Organ Sharing (UNOS), a non-profit 501(c)(3) organization. The HHS webpage shown above cites the UNOS Ethics Committee which states:
“The UNOS Ethics Committee has raised a small number of the many issues regarding organ donation from condemned prisoners. The Committee opposes any strategy or proposed statute regarding organ donation from condemned prisoners until all of the potential ethical concerns have been satisfactorily addressed.”
The UNOS website also states:
https://unos.org/transplant/facts/
“Fact: If you are sick or injured and admitted to the hospital, the number one priority is to save your life. Organ donation can only be considered after brain death has been declared by a physician.”
Organs can not be reliably harvested from, say, traffic fatalities or heart attack deaths and so on, as the organs will have suffered irreparable damage from loss of oxygen. In the case of hospital patients suffering brain death, the heart is still supplying oxygen to organs and they can be harvested.
In the case of prisoners, the cause of death will be the removal of the organs as the inmate is not brain dead. This puts the medical doctor in the position of being the executioner, which is, thankfully, still frowned upon by the physicians practicing in the USA.
The HHS OPTN website above reports “Many physician groups, including the American Medical Association, have prohibited physician participation in state executions on ethical grounds.”
The journal Nature just published this piece:
https://www.nature.com/articles/d41586-019-01890-4
which links to
https://chinatribunal.com/
providing much information on this topic.
We should be very careful about advocating for such gruesome organ harvesting schemes.
I have never advocted this atrocious practice. My sole criticism is about destroying the knowledge gained after the fact, when it’s already too late to save anyone. Punish the perpetrators, not the general public.
For the various reasons I have outlined in my other posts here, the knowledge from such misguided deeds is of most dubious value. Using information acquired from such heinous acts is advocating for such acts, as it is then suggested that the information gleaned under such horrible circumstances has some value.
The general public is precisely who was punished in this sad affair. Members of the general public (in Germany 80 years ago, and now in current day China) who express ideas unpopular with despotic leaders find themselves imprisoned, tortured, experimented upon, and murdered in horrendous fashion. The evidence of these crimes lives on inside of patients who received organs. DNA analysis will no doubt eventually reveal the people murdered for their organs, and journalists will continue to document the family stories of those victims.
If you read associated news stories and reports you will see that harvesting organs is done upon live prisoners and is their cause of death. Using any data from such practices will only serve to perpetuate them.
The general public has already been punished. Using data acquired is hardly punishing the perpetrators, rather it suggests that there is some value to the acts carried out by the perpetrators. As a part of punishing the perpetrators, this “knowledge” must be shunned and shamed.
Might want to reconsider. How about the atrocities committed by the Natzies?
I fully agree with what Steven MC Kinney already said. Before execution the prisoners will surely have suffered a lot of stress.
Furthermore, you say scientific publications have to be true while the moral behind a publication is not so important. However, we do talk about medical, scientific publications and that to me means that the Hippocratic Oath also is important here, not merely regarding treatment. If the way one got the organs is unethical, how could publishing about it not be?
I never said or hinted in the slightest that it was less important. Quite the contrary. Putting the focus on the article takes it off the deed and the perpetrator. Pythagoras murdered a student for contradicting him. Should we no longer use the law of right-angled triangles?
good. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61536-5/fulltext
Thank you to Retraction Watch for posting this story. And thanks to Dr. Caplan for linking to his important article in the Lancet.