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 , 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.”
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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