China expects to build a comprehensive organ donation system by the end of 2011. As part of this plan, drivers in China will be given an option to register voluntarily as organ donors when they apply for the driver’s license, according to the Deputy Minister of Health, Mr. Huang Jiefu, in an interview on April 25. For two weeks, this proposed new registering practice has been bombarded by Chinese netizens, many scared, angry, or both. I was first puzzled but then deeply saddened as I followed people’s comments more closely.
Before I get into this issue, let me first give you some background. China has a severe shortage in organs for transplantation. It is reported that of the 1.5 million patients in China who need a transplant, only 10 thousand of them will receive one. Few organs used for transplantation are from voluntary donors upon death. Most of the transplants are from living donors, who are often related to the patients or recruited on the black market. Last year, throughout China, only 28 registered donors’ organs are harvested after their death. In 2009, the Red Cross launched a campaign for organ donation in ten provinces and cities across China, but the results were quite insignificant.
Registering organ donors with driver’s license application is part of the government’s effort to help solve the problem of organ shortage in China. However, the idea, which has worked well in countries such as the U.S., the U.K., and Australia, has faced with tremendous resistance from many Chinese. So what went wrong?
It certainly has to do with culture. Many Chinese believe that having to think about death when getting a driver’s license is inauspicious. In fact, emotionally, many Chinese can’t accept even the suggestion of the possibility of accident and death when they get their driver’s license.
A blogger wrote:
I am an “atheist,” but I believe this intent [to donate organs] can easily affect my mood, easily affect me so that when I drive later I won’t feel “sunny.” So, no matter how lightly the Health Ministry said [the intent] is “completely voluntary,” reasonably, I won’t sign up for this intent.
Another wrote:
Getting a driver’s license is also like starting a new chapter in life, especially for young people, another coming of age ceremony. At this ceremony, everybody is giving good wishes. If at this moment, the driver is asked to fill out an intent form for organ donation in case of an accident, it will make people uncomfortable, and even fearful.
To some people, asking about organ donation when getting a driver’s license equals to suggesting, as a blogger put it, “driving to death!”
This view is so pervasive in China that even a self-claimed physician wrote in his blog that asking drivers to sign the donor agreement “will depress people immediately, and leave scars in their hearts.” Then he continues to go down a slippery-slope road:
When they drive in the future, they will always think about one day their organs are going to be taken out. The thought of it makes me anxious. Once you sign the agreement, you’ll have to carry the burden for your life. How can someone live like this!! Very inauspicious.
This sort of panicky responses to the donor registration, although border on absurdity, are not rare online.
On a deeper level, organ donation is stigmatized in Chinese culture because it poses as a threat or contempt to the tradition of ancestor worship. In tradition Chinese culture, the body is a gift from the ancestors, and thus should be revered. Dismemberment is considered an insult to the ancestor and a very unfortunate thing that can happen to the deceased. There is a saying in Chinese, “siwuquanshi,” meaning “death without a whole body.” This is considered one of the most severe punishment and the most unfortunate fate for a person.
This notion of preserving body is one of the reasons why many Chinese oppose organ donation, like this blogger:
Personally I believe, organ transplantation should not exist. Our bodies and the skin are given by our parents. How can we give them away easily?
Another blogger, although agrees that organ donation is a “good thing,” admits that he won’t do it himself:
I am a conservative man from the countryside, even if I wanted to donate, I don’t think my parents would agree. Being filial should be put ahead of everything else, so I have to listen to my parents, our bodies, hair and skin are taken from our parents, we can’t decide on our own, had better think twice. So in the end, my opinion is that I won’t donate, but I don’t know if you will.
Although cultural traditions are a strong force in this debate, many observers believe that they can be overcome over time with education and as information about organ transplantation is more available for the public to access. However, this is only what it takes for Chinese public to accept the new policy. What’s more difficult to overcome are the public’s distrust in all levels government, public health and healthcare agencies, and the law enforcement and the fear that has grown out of this distrust. This distrust and fear are deeply rooted in China’s overall social and political climate as it charges forward with one of the most fast growing market economy in the world. The tension created in this climate has been an underlying cause of the growing anxiety in the Chinese public.
Some people criticized the organ donation system in China of being irresponsible and inefficient. They contribute the shortage to organs to the inefficient system rather than Chinese people’s unwillingness to donate. In fact, some people have lost faith in the entire organ donation system in China.
In response to this news one 163.com, a netizen wrote about her/his frustrating experience in the past when (s)he tried to register for donate marrow due to the inefficiency, poor management, and even indifference of the staff of China Marrow Donor Program. (S)he waited for a long time for the Red Cross to arrange the screening test, paid for it, which was very expensive, and donated some more money. Finally, (s)he’s registered. But after (s)he relocated to another city, she could not update her information and nobody with the Red Cross seemed to care to help her. She wrote:
[I] looked up their phone number online and called the Red Cross in Suzhou Province and the Red Cross in Jiangsu Province many times, requesting to update my contact information, but neither agency provided the service. They said they would contact me. They seemed to be very impatient with me, and hung up on me even before I finished talking. I don’t know how they could contact me without knowing my new contact information. Initially I thought donating stem cells could help saving lives and maybe a family, and thought it was worth it. But I was so naïve. In this system, it’s difficult! So, don’t just publicize the China Marrow Donor Program, or say that there’s a shortage of organs. We have to see what caused this, [what] caused us to lose the sense of security or compassion!
[S]he recounted another story she read, in which a corneal donor’s family tried to contact a hospital to harvest the organ, but because the doctors were not on duty, the donor’s family could only watch the corneal expire. After that, the family cancelled all of their organ donation registrations. mly412 wrote, “No matter what, now when they want me to register, I won’t. I’m afraid that my kindness gets trampled. Even after death one would be trampled by these lame people and this lame system.”
Organ transplantation costs 150,000 to 200,000 yuan ($21,500-$28,600) in China, and the whole process lacks transparency. Many Chinese worry that the hospitals will take this opportunity to make a profit on the donors. Many even think that it’s likely that the hospitals will put profit before people’s lives. A netizen wrote:
From now on, drivers must be careful! If you get into a serious accident and are sent to a hospital. The hospital checks online that you’re a donor, then they’ll stop saving you and announce that you’re dead. Then they will have organs for sale! The hospital can make a fortune!
Unfortunately, paranoid as it sounds, this is not an opinion of the minority. A netizen commented on 163.com:
Who can ensure that those in need can receive these organs for free, and ensure that these organs are not sold[?]
Another netizen wrote:
Even the dying are not spared. Whom did they donate their organs to? Who got the money?
And another wrote:
If there are cases where people are murdered for their organs, I won’t be surprised.
Some blame it to the declining moral principles in China as everybody is rushing to get rich. A blogger wrote:
In today’s China, there are beastie deeds happening every day, the milk powder scandal, the swage oil scandal, violent demolishing of residence, government corruption, and lastly the beef scandal and so on, countless facts all prove how low humanity has fallen in China today, far below the moral bottom line.
Behind all the fears is common people’s feeling of social injustice and a sense of powerlessness in a social system that is largely submitted to individuals’ power.
A netizen wrote:
I don’t want this to happen: when our car collides with that of a lingdao (government official), when we are sent to the hospital at the same time at the same time, the lingdao is more seriously injured, but I’m the one who dies and he lives. My families come, and they produce the agreement, I’m “beiziyuan” (“voluntaried” or forced to become voluntary).
In Chinese, bei denotes the passive voice. Like in the post above, I often see people use something like beisiwang (made dead), or beiziyuan. Chinese netizens’ coinage of these phrases in the passive voice shows how powerless they feel.
This feeling of powerlessness is expressed by another netizen:
This is horrifying, please don’t play us. I can’t be in charge of my organs. […] Surely this production line can create infinite profit. Your life is no longer controlled by you.
I have to note that this feeling of powerlessness and paranoia in these posts are more than just reaction to this single policy but is a ramification of the loss of confidence and trust in government and any governmental or social institutions in the general public in China today. Many netizens directly criticized the government and other institutions for their lack of ethics and credibility. A netizen wrote:
First fix government officials’ hearts, doctors’ ethics, traffic police’s professionalism, 120’s (emergency number) ethics, and then put (the policy) in practice. First elevate government’s credibility, its trustworthiness, elevate government agencies’ authority, and then put [the policy] in practice.
In their comments on the news, two netizens wrote:
– Is it possible that somebody has an accident on a trip, and when the family get there the organs are already taken.”
– Right, right. Those who can still be saved won’t be saved but get donated, the credibility in China is so low, why do we have to meet the international standard, our lives haven’t met the international standard!”
The latter comment is directed to the Health Ministry’s citation of other countries’ similar practice.
Finally, a netizen called for the government officials to first set the examples themselves before they require others to donate organs:
All these years, how many public servants and party members voluntarily donated organs? Or, as the entity that proposed this policy, how many people in the Health Ministry set the first examples? […] This time, can the staff members in the Health Ministry and other government agencies set an example for the common people?
I won’t claim that these quotations represent the public opinion on this issue in China completely and accurately, but I believe that they do reveal some serious social tensions in China. Personally, I hope this policy will be carried out. (Here I need to clarify with additional caution that this is a voluntary measure, and it is the drivers’ decision to make if they are willing to be a donor.) However, according to Huang, at this point, the policy is only a “concept.” Because other links in the organ donation system such as the process of getting the family’s consent and notarization still need to be improved, registering for donation alone will not likely to solve the problem of organ shortage in China. Nevertheless, Chinese public’s resistance to the policy, although based partly on panicky speculations and fear, is understandable and needs to be taken seriously, for a nation living in such anxiety, fear, and feeling of disfranchisement and insecurity is not going to go very far.
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