China: A Case Study regarding Transplant Publishing Issues

IntroductionOrgan transplantation is somewhat of a stealth activity in China. There are no public databases that disclose China's transplant statistics such as number of transplants performed, source of organ (living versus deceased donor), donor and recipient demographics, or survival statistics. Unlike the US Freedom of Information Act, there is no Chinese equivalent that would require the Chinese government to disclose information about the transplants occurring in its country. Noteworthy, however, is the fact that the websites of Chinese transplant centers frequently boast of their transplant volumes and short waiting times for recipients, as well as even solicit foreigners to come to China to undergo solid organ transplantation. Although organs are in short supply in the US and elsewhere, in China, a steady supply seems to create a foreign demand. This raises the question, who are the donors?Outlawed in China in 1999, Falun Gong refers to five sets of meditation exercises (four standing and one sitting) and spiritual teachings related to Buddhism and Taoism.1 It is believed that up to 70 million people currently practice Falun Gong world-wide, including several thousand practitioners in the United States.2 China has labeled Falun Gong an "evil cult" and views it as a threat to its communist philosophy and government social control.3 There have been numerous allegations that the Chinese government has imprisoned, tortured, and killed known and suspected Falun Gong practitioners.4 These allegations also include live organ retrieval prior to death.5 Human rights organizations such as Amnesty International have published reports denouncing these practices6; yet, to date, the Chinese Government denies such live organ removal occurs.7 It does, however, admit to allowing organ removal after prisoners have been executed.8 Also, Chinese-American patients have admitted to obtaining organs from executed prisoners in China.9In July 2006, two Canadian human rights attorneys prepared a report of their research into the allegations of live organ retrieval from Falun Gong practitioners in China.10 Specifically, their investigation involved taping and transcribing telephone conversations with personnel at eight transplant hospitals in China. All hospitals admitted to either current or past use of organs from Falun Gong practitioners. In the wake of the Matas-Kilgour Report, we further investigated organ transplantation in China by exploring physician publishing practices. Journal articles are a tool by which transplant centers promote their programs; thus, publication of clinical or research data obtained via unethical practices propels the work of these programs. We sought to answer the following questions: Are journals publishing the work of hospitals with ethically problematic transplant practices? What are the characteristics of these journals? What ethics criteria do these journals employ?MethodsFigure 1 presents a research methods pictorial. Specifically, PubMed (1966-August 2006) was searched for all articles reporting cases of solid organ transplantation that were authored by physicians affiliated with the eight hospitals in the Matas-Kilgour telephonic investigation. China was the country of focus in this study as, to the best of our knowledge, it is the only country in which multiple hospitals have admitted to participating in transplant atrocities (refer to Matas-Kilgour report). Articles were excluded if they were topical review articles that did not report transplants performed at their facility. The articles obtained were reviewed for content pertaining to the donor organ source and donor/family consent. Also, the characteristics (location, language, impact factor) of the journals that published these articles were reviewed as well as the ethics components (authorship, informed consent, research board approval, conflict of interest, data integrity) of their publication policies ("Instructions for Authors"). …