The Hangzhou Resolution and Report of Meeting with Minister Bin Li of the National Health and Family Planning Commission of the People's Republic of China

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China transplant leaders with TTS President Francis L. Delmonico witnessing the signing of the Hangzhou Resolution by first 3 leaders of China

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From left to right: Xiaoshun He, Vice President, The First Affiliated Hospital of Sun Yat-sen University, Shusen Zheng, President, Chinese Society of Transplantation, and Yongfeng Liu President-elect Chinese Society of Transplantation committing their centers to fulfill the NHFPC program of Minister Bin Li

 

October 29, 2013
Beijing
Office of the Minister
National Health and Family Planning Commission (NHFPC)
 
Participants from left to right in the enclosed picture:           

Zhou Jun  Deputy Director-General, Department of Medical Administration, NHFPC
Wang Haibo  Director, China Organ Transplant Response System Research Center (COTRS)
Huang Jiefu    Head, National Organ Transplantation Committee of the NHFPC
Delmonico Francis   President, The Transplantation Society, Representative of the Declaration of Istanbul Custodian Group
Bin Li   Minister, NHFPC
Ren Minghui    Director-General, Department of International Cooperation, NHFPC
Liu Yong      Division Director, Department of Medical Administration, NHFPC

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This meeting at the Ministry was arranged by Jiefu Huang  ---with much appreciation.
 
Minister Bin Li initiated the discussion with a prepared statement of a five-point plan for organ donation and transplantation under the authority of the National Health and Family Planning Commission of the People’s Republic of China (NHFPC):

1.     Human Organ Donation System:

The organ donation system is led by NHFPC and involved by Red Cross of China, to promote the organ donation campaign throughout the nation.

2.     Human Organ Procurement and Allocation System:

The practice of human organ procurement and allocation will be “open and transparent” by an executive order (The Human Organ Procurement and Allocation Regulation) released from the NHFPC in August 2013 that requires:

·         Transparency in the allocation of organs to a national computerized waitlist (COTRS);

·         The development of the organ procurement organization structure in each province;

·         The training of organ donation coordinators.

This regulation of the NHFPC is aligned to the State Council directive that mandates transparency and fairness in the practice of organ transplantation in China.

Minister Bin Li further emphasized that the recent mandatory implementation of an information technology system (COTRS) accomplishes a transparent and fair practice of the distribution of deceased donor organs in China.

3.     Human Organ Transplant Clinical Service System:

The authorization of 169 transplant centers to provide transplant service in China;

4.     Scientific Registry System for Human Organ Transplantation:

The scientific registry systems for the transplantation of liver, kidney, heart, lung, intestine and pancreas will record each case of organ transplantation in China with appropriate follow-up of the recipients.

5.     Human Organ Transplant Regulatory System:

A regulatory authority of NHFPC that oversees the practice of organ donation and transplantation in China, referenced to more than 30 existing laws and regulations developed by PRC State Council and NHFPC since 2007.

At the time of the meeting with the Minister, there had been 1161 deceased organ donors (not involving the use of organs from executed prisoners) resulting in more than 3175 organ transplants ----and combined with the experience of living donor transplantation, these deceased and living donor transplants now constitute 49.4% of organ transplantation in China in 2013.

Minister Bin Li expressed the resolve of the PRC Government---- that the reliance of transplant centers upon organs from executed prisoners-- must cease. The government of China has affirmed its commitment to prohibit transplant tourism and shutdown organ trafficking and transplant commercialism.

The five-point plan as elaborated above was then promulgated at the 2013 Chinese Transplant Congress in Hangzhou (November 1-2) -- releasing the Hangzhou Resolution as a commitment of NHFPC to align practices of organ donation and transplantation in China with WHO Guiding Principles and the Declaration of Istanbul, ---and subsequently adopted by the World Health Assembly.

China needs the support of the international community to implement this new system and the international community needs the involvement of China in progress of organ transplantation as a field of medicine. The Minister was concerned to learn that the experience of Chinese transplant professionals had not been either sought or accepted because of the reliance upon the use of organs from executed prisoners. However, as of this seminal interaction, she pledged her commitment to resolve that exclusion and to promote an academic exchange with international community.  That academic interaction will now have the underpinning of the five-point NHFPC plan, to include cessation upon the reliance of the use of organs from executed prisoners and efforts to end the illegal practice of organ trafficking.

The support of the NHFPC for the Hangzhou Resolution was affirmed at the meeting with Minister Bin Li (and for the leadership of Dr. Jiefu Huang and for the transparent system for organ allocation --COTRS developed by Dr. Haibo Wang).

A proposal was made to the Minister that NHFPC convene a meeting of the international transplant community in China in June 2014 with the participation of the World Health Organization. The Minister accepted this proposal and plans are now underway to develop such a Congress. The agenda and involvement of the WHO and TTS and the request of TTS to major international organizations to participate in this proposed meeting will be dependent upon the fulfillment of the five-point NHFPC program and the cessation of organs being recovered from executed prisoners.
 
The Hangzhou Resolution:
 
On October 31, 2013, the National Organ Transplant Committee of the NHFPC held the 12th OTC meeting in Hangzhou, Zhejiang, China to promulgate the Hangzhou Resolution before the 2013 China National Transplantation Congress, which was organized by the Chinese Organ Transplant Association. The meeting in Hangzhou featured a keynote address by OTC Head Jiefu Huang who proclaimed a "New Era for Organ Transplantation in China”.
 
The Hangzhou Resolution was adopted by the OTC for all transplant professionals to comply with the five-point plan of the NHFPC as elaborated by Minister Bin Li and in accordance with China State Council law. The Hangzhou Resolution aligns the practice of transplantation with China culture and traditions and to WHO Guiding Principles (and those of the Declaration of Istanbul).
 
Henceforth organs must be recovered from deceased donors following the national protocol for the three China categories of deceased organ donation:
China category I: organ donation at the brain death
China category II: organ donation after circulatory death
China category III: organ donation after brain death followed by the determination of death by circulatory criteria.
 
The Hangzhou Resolution concludes the reliance of transplant centers on the use organs from executed prisoners. It calls for a commitment of transplants centers to ensure that the source of organs is in compliance with international ethical standards. Immediately after the presentation of the Hangzhou Resolution on Nov 2nd, 2013, the leaders of 36 transplant centers made a written commitment to the cessation of organs from executed prisoners.  More hospitals are anticipated in the days ahead. The names of these centers and these transplant leaders will be presented to the international community to enable the publication of data from their centers in the medical literature and their presentations at international scientific congresses.

This picture was taken at the ceremony presenting the Hangzhou Resolution by the leadership of China Transplant Association ---Yongfeng Liu, President-elect Chinese Society of Transplantation and Shusen Zheng, President, Chinese Society of Transplantation to sign the Resolution.  Seated along side: Drs. F. Delmonico, P. O’Connell, Haibo Wang, John Fung and Michael Millis.

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This picture is of China transplant leaders with TTS President Delmonico witnessing the signing of the Hangzhou Resolution by first 3 leaders of China to sign (symbolically of their leadership) --left to right: Xiaoshun He, Vice President, The First Affiliated Hospital of Sun Yat-sen University, Shusen Zheng, President, Chinese Society of Transplantation, and Yongfeng Liu President-elect Chinese Society of Transplantationcommitting their centers to fulfill the NHFPC program of Minister Bin Li ----and to no longer use organs from executed prisoners.

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What is Achieved:

·        A commitment by a list of transplant professionals and centers (now numbering 40) that they will no longer use organs from executed prisoners.
However, the candid awareness of government and all international stakeholders that the use of organs from executed prisoners still constitutes 50% of the transplantation experience of China.
·        The awareness of all transplant professionals of China that authorization for the practice of organ donation and transplantation will not be provided unless the center complies with the five-point NHFPC program and that the use of organs from executed prisoners must cease.
·        The support and commitment of the Chinese government to implement these initiatives throughout China.
 
What is Missing:

The resolve of all China transplant professionals not to use organs from executed prisoners.
 
Next Steps:

With the release of the Hangzhou Resolution and the engagement of those centers committed to no longer use organs from executed prisoners, TTS and the Declaration of Istanbul Custodian Group will work withthe support of the China Organ Transplant Development Foundation to accomplish the widespread implementation of the NHFPC five-point plan throughout all the provinces of China involved with organ transplantation.

A meeting is planned for Beijing in June 2014 under the chairmanship of Jiefu Huang, that would invite the leadership of the major international societies (such as ISHLT, ILTS, IPTA and ISN) and major regional societies such as AST, ESOT, STALYC and MESOT -----and the World Health Organization, to endorse the changing practice of organ donation and transplantation in China. The agenda of that meeting would be to establish China as a model for the international standards now set forth by WHO Guiding Principles and the Declaration of Istanbul.  Data from the China transplant registries will be presented and compared with those of major international organizations in their review of worldwide data. The experience of those Chinese transplant professionals that have committed themselves to the program of the NHFPC espoused by the Hangzhou Resolution will be presented.  
 
The strategic planning group for the June Beijing meeting with representatives from TTS--- John Fung, Frank Delmonico and Phil O'Connell (but not shown in this picture ad hoc at the Dragon until) and leadership of China (left to right) Huang Jiefu, Head of Organ Transplant Committee of NHFPC,  Yongfeng Liu, President-elect Chinese Society of Transplantation  Shusen Zheng, President, Chinese Society of Transplantation (and Haibo Wang but not in this picture).
 

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Picture of Haibo, Jiefu, Frank, Zheng with Rotary Club of Hong Kong Leaders Kenneth Wong and Hing Wang Fung celebrating the Hangzhou Resolution
placing forward only their right hands – in a tribute to TTS logo
 

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On behalf of Philip O'Connell, John J. Fung, Wang Haibo and J. Michael Millis
thank you for your attention,
Francis L. Delmonico

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