The question of what constitutes death is at the center of a
medico-legal debate in China with important implications for organ
transplants, a senior health official said on Saturday.
In April, China issued its first regulation on human organ
transplants, aimed at banning organ trade in any form and
regulating the country's huge organ transplant market. It will go
into effect on May 1.
The new organ transplant regulations are a milestone in China's
health sector, but the legal framework remains incomplete, vice
minister of health Huang Jiefu told a press briefing, pointing out
that new legislation on "brain death" is needed.
He said the development of human organ transplants requires a
wider medical definition of death besides the traditional notion of
cessation of heartbeat.
"Fifteen minutes at most after the cessation of heartbeat and
breathing, organs are irreparably damaged and can no longer be
harvested for transplants," said Huang, a liver transplant
specialist, who completed his postdoctoral research at the
University of Sydney, Australia.
Most western countries stopped using cessation of heartbeat as a
sign of death before organ removal in 1968. Instead they use the
concept of "brain death," the criteria for which include absence of
brain-stem reflexes, no evidence of breathing and total lack of
Organs can be successfully harvested from a person who is brain
dead but whose heart and lungs are kept functioning by
However, the traditional Chinese view that "life goes on until
the last breath and until the heart stops beating" has held back
the introduction of legislation on brain death even though
academics have been urging the promulgation of such a law since the
Chinese medical experts say that if the law was amended to allow
organs to be removed from people declared "brain-dead," organ
supply would increase significantly.
China has been carrying out organ transplants for more than 20
years and is the world's second largest performer of transplants
after the United States. But there is a terrible shortage of
organs. Official statistics show that while 1.5 million patients
need organ transplants each year, only 10,000 can find organs.
Most organs are donated by ordinary citizens at their death who
have voluntarily signed a donation agreement.
As China's human organ transplant regulations do not recognize
brain death, it is currently illegal to take organs from a
brain-dead patient for transplant purposes, Huang previously
Huang, who has long advocated the recognition of brain death,
said an academic seminar planned for the second half of the year
will examine the concept of brain death, which is widely
misunderstood by ordinary Chinese.
"China will seek to change people's traditional views and -- in
a context of worldwide shortage of organs -- encourage a
humanitarian spirit of helping each other," Huang said in an
earlier interview in March.
"The country will probably establish a range of death criteria
covering brain activity, breathing and cessation of heartbeat and
allow people to choose the criteria that seem most appropriate to
them," he said.
Huang gave no more details of the legislation but stressed that
the drafters will ensure the doctors who pronounce "brain death"
are not the ones responsible for organ transplants.
Recognition of brain death is part of a package of criterion the
ministry of health is drawing up to implement the human organ
transplant regulation, Huang said.
Most of the criterion will be completed in three to five years,
he said, adding that a manual on liver transplant, the first of its
kind, will be released in this August, followed by the manual on
On Saturday, the health ministry also announced that the first
batch of more than 160 medical institutes have been granted the
license to transplant human organs.
About 600 hospitals and clinics have applied, the ministry
(Xinhua News Agency April 29, 2007)