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Moral hazard: papers on organs from prisoners raise ‘issues of complicity’

Numerous papers published on transplants involve organs unethically harvested from executed prisoners, a new review argues.

Australian and international researchers investigated whether papers reporting research on transplants in China from 2000 to April 2017 comply with such international professional standards as excluding research that involves biological material from executed prisoners and consent of donors.

Hundreds of papers failed against those metrics. Of the 445 included studies, 412 (92.5 per cent) failed to report whether or not organs were sourced from executed prisoners and 439 (99 per cent) failed to report that organ sources gave consent for transplantation.

When held against another standard looked at, Institutional Review Board (IRB) approval, the papers fared slightly better. Almost three quarters (324) reported approval from an IRB.

Curiously, the authors said that of the papers claiming that no prisoners’ organs were involved in the transplants, 19 of them involved “transplants that took place prior to 2010, when there was no volunteer donor programme in China”.

“A large body of unethical research now exists,” the study read, “raising issues of complicity and moral hazard to the extent that the transplant community uses and benefits from the results of this research”.

The practice has been deemed unethical by leading health and transplantation bodies, notably because the “coercive situation of being on death row undermines the possibility of ethically valid consent”. Other concerns include the potential for a complete lack of consent and reports of non-voluntary organ harvesting.

Unethical procurement of organs from China is not unique to fields of research. Recently, a controversial exhibition featuring plastinated human cadavers, organs, embryos and foetuses came under the scrutiny of a parliamentary inquiry. It held that the Real Bodies exhibition was “illustrative of an apparent gap in the current legislation” surrounding human organ trafficking and organ transplant tourism.

MP David Shoebridge told the sub-committee investigating human organ trafficking: “The proprietors… have been asked about the circumstances in which these bodies came into their possession, and they have been unable and unwilling to prove that any of the persons on display ever gave their consent.”

The authors of the scoping review into papers reporting on Chinese transplants said continued use of the research in question raises similar potential issues of complicity as data obtained from medical experiments in wartime.

They wrote: “There is broad consensus that it is unethical to make use of the data obtained from Nazi and Japanese medical experiments where the victims were killed or harmed in the course of the research. The use of research based on organs sourced from executed Chinese prisoners, many of whom are prisoners of conscience, falls at the severe end of this spectrum of moral wrongs in research.

“The continued presence of these papers in the literature creates moral hazard as it demonstrates that breaches of ethical standards in research will be ignored or tolerated, thereby removing incentives for future compliance with these standards.”

They called for immediate retraction of all papers reporting research based on use of organs from executed prisoners, pending investigation of individual papers.

Determining the likely veracity of claims about ethical organ procurement requires sustained investigation, the authors said.

“Such investigation is possible, and has formed the basis for a retraction of a paper that falsely claimed more organs were procured from volunteers than there were reported volunteers at the relevant hospital. This is to date the only retraction in the literature.”

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