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Medical Debate Continues over Definition of Death
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The specific definition of death is at the center of a medico-legal debate in China with important implications for organ transplants, Vice Minister of Health Huang Jiefu told a press briefing yesterday.

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, Huang said, 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, also a liver transplant specialist, who completed his postdoctoral research at the University of Sydney in 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 consciousness.

Organs can be successfully harvested from a person who is brain dead but whose heart and lungs are kept functioning by machines.

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 1980s.

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 US, 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 at death by citizens who 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 said.

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.

However, it should be ensured that the doctors who pronounce "brain death" are not the ones responsible for organ transplants, Huang stressed at yesterday's press briefing.

(Xinhua News Agency April 29, 2007)

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