Medical journals slated for ethics failure on Chinese organ donor articles

Organisation: Position: Deadline Date: Location:

OrganA world-first study has called for the mass retraction of more than 400 scientific papers on organ transplantation, amid fears the organs were obtained unethically from Chinese prisoners. The Guardian reports the Australian-led study exposes a mass failure of English language medical journals to comply with international ethical standards in place to ensure organ donors provide consent for transplantation. The study’s author, the professor of clinical ethics Wendy Rogers, said journals, researchers and clinicians who used the research were complicit in “barbaric” methods of organ procurement.

“There’s no real pressure from research leaders on China to be more transparent,” Rogers, from Macquarie University in Sydney, said. “Everyone seems to say, ‘It’s not our job’. The world’s silence on this barbaric issue must stop.”

A report published in 2016 found a large discrepancy between official transplant figures from the Chinese government and the number of transplants reported by hospitals. While the government says 10,000 transplants occur each year, hospital data shows between 60,000 to 100,000 organs are transplanted each year. The report provides evidence that this gap is being made up by executed prisoners of conscience.

In 2017 the European parliament passed a declaration condemning organ harvesting from prisoners of conscience, and called on Chinese officials to end it.

The report says Rogers and her team obtained all research papers reporting on Chinese transplant recipients published in English-language medical journals between January 2000 and April 2017. The 445 studies they identified involved 85,477 transplants. But 99% of those studies failed to report whether organ donors had given consent for transplantation. The 19 studies which claimed no organs from executed prisoners were used took place prior to 2010, when there was no volunteer donor programme in China.

The report says it is the first time a study has tracked the progress of the transplant community in blocking unethical research.

In 2017 the prestigious medical journal Liver International was forced to retract a scientific paper by Chinese surgeons who examined the outcomes of 564 liver transplantations over four years. But experts pointed out that it was impossible for one hospital to have obtained so many useable livers given the small numbers of volunteer donors in China at the time, especially given most livers came from donors after cardiac death, or “donation after circulatory death (DCD) donors”.

The report says livers from these patients are only viable for transplantation in about one third of cases, meaning the numbers of livers obtained in the study did not stack up with the number of deceased patients in China.

Rogers’s research found even the Journal of American Transplantation and the official journal of The Transplantation Society (TTS), which have policies barring unethical research involving executed prisoners, had published questionable papers. This was despite the TTS in 2016 declaring it would not accept papers where organs had been sourced from prisoners.

The report says the paper concludes: “The transplant community has failed to implement ethical standards banning publication of research using material from executed prisoners. As a result, a large body of unethical published research now exists, raising questions of complicity to the extent that the transplant community uses and benefits from the results of this research. We call for 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.”

The report says the International Committee of Medical Journal Editors was approached for comment.

“It’s not good enough to just have ethical guidelines without implementing them,” Rogers said.

The report says while China vowed to stop using organs from executed prisoners in 2015, no new law or regulation has been passed banning the practice. Humanitarian groups including Amnesty International have voiced concerns that the practice is continuing.

In December, the Independent Tribunal into Forced Organ Harvesting from Prisoners of Conscience in China issued its interim report, finding: “The tribunal’s members are all certain – unanimously, and sure beyond reasonable doubt – that in China forced organ harvesting from prisoners of conscience has been practised for a substantial period of time involving a very substantial number of victims.”

The report says the tribunal’s full report is due in 2019.

Objectives: The objective of this study is to investigate whether papers reporting research on Chinese transplant recipients comply with international professional standards aimed at excluding publication of research that: (1) involves any biological material from executed prisoners; (2) lacks Institutional Review Board (IRB) approval and (3) lacks consent of donors.
Design: Scoping review based on Arksey and O’Mallee’s methodological framework.
Data sources: Medline, Scopus and Embase were searched from January 2000 to April 2017.
Eligibility criteria: We included research papers published in peer-reviewed English-language journals reporting on outcomes of research involving recipients of transplanted hearts, livers or lungs in mainland China.
Data extraction and synthesis: Data were extracted by individual authors working independently following training and benchmarking. Descriptive statistics were compiled using Excel.
Results: 445 included studies reported on outcomes of 85 477 transplants. 412 (92.5%) failed to report whether or not organs were sourced from executed prisoners; and 439 (99%) failed to report that organ sources gave consent for transplantation. In contrast, 324 (73%) reported approval from an IRB. Of the papers claiming that no prisoners’ organs were involved in the transplants, 19 of them involved 2688 transplants that took place prior to 2010, when there was no volunteer donor programme in China.
Discussion: The transplant research community has failed to implement ethical standards banning publication of research using material from executed prisoners. As a result, a large body of unethical research now exists, raising issues of complicity and moral hazard to the extent that the transplant community uses and benefits from the results of this research. We call for retraction of this literature pending investigation of individual papers.

Wendy Rogers, Matthew P Robertson, Angela Ballantyne, Brette Blakely, Ruby Catsanos, Robyn Clay-Williams, Maria Fiatarone Singh

The Guardian report
BMJ Open abstract
The Conversation report

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