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Previous publications have described unethical organ procurement procedures in the People's Republic of China. International awareness and condemnation contributed to the announcement abolishing the procurement of organs from executed prisoners starting from January 2015. Eighteen months after the announcement, and aligned with the upcoming International Congress of the Transplantation Society in Hong Kong, this paper revisits the topic and discusses whether the declared reform has indeed been implemented. China has neither addressed nor included in the reform a pledge to end the procurement of organs from prisoners of conscience, nor has the government initiated any legislative amendments. Recent reports have discussed an implausible discrepancy of officially reported steady annual transplant numbers and a steep expansion of the transplant infrastructure in China. This paper expresses the viewpoint that, in the current context, it is not possible to verify the veracity of the announced changes, and it thus remains premature to include China as an ethical partner in the international transplant community. Until we have independent and objective evidence of a complete cessation of unethical organ procurement from prisoners, the medical community has a professional responsibility to maintain the academic embargo on Chinese transplant professionals., (© 2016 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of American Society of Transplant Surgeons.)

This response refutes the claim made in a recent article that organs for transplantation in China will no longer be sourced from executed prisoners. We identify ongoing ethical problems due to the lack of transparent data on current numbers of transplants in China; implausible and conflicting claims about voluntary donations; and obfuscation about who counts as a voluntary donor. The big unanswered question in Chinese transplant ethics is the source of organs, and until there is an open and independently audited system in China, legitimate concerns remain about organ harvesting from prisoners of conscience., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

The use of organs obtained from executed prisoners in China has recently been condemned by every major transplant organization. The government of the People's Republic of China has also recently made it illegal to provide transplant organs from executed prisoners to foreigners transplant tourists. Nevertheless, the extreme shortage of transplant organs in the U.S. continues to make organ transplantation in China an appealing option for some patients with end-stage disease. Their choice of traveling to China for an organ leaves U.S. transplant programs with decisions about how to respond to the needs of patients who return after transplantation. By discussing two cases that raised this dilemma, we argue for upholding medicine's commitments to traditional principles of beneficence and nonjudgmental regard in sorting out the policies that a transplant program should adopt. We also explain how position statements that aim for the high ground of moral purity fail to give appropriate weight to the needs and suffering of present and future patients in the U.S. and in China.

Life law is a new conception brought by the development of modern life science and biotechnology. There are many different ideas on the conception of life law in academy. The definition of life law should be footed on the domain of bioethics. Based on bioethics, life law is a group of legislations which are enacted or acknowledged by the state and implemented by the state compulsively with the goal of regulating all types of relations revolving the survival as well as terminal of human beings and some other creatures which play important roles in the maintenance of human's life and health. There are many problems in China's study on science of life law, which need paying special attention to by China's scholars.

Now that partial face transplantation has been performed, attention is focused on likely functional, aesthetic and immunological outcomes, and full facial transplantation is the likely next step. Facial transplantation has been the source of ethical debate, a key part of which focuses on valid informed consent. We review the process of informed consent in health settings, assessing how applicable the current standards are for facial transplantation. The factors which need to be assessed during the screening programme are outlined. We conclude that both individual and process factors are important in obtaining consent for radical new procedures, and outline our own gold standard for ensuring informed consent in facial transplantation.

Living organ donation is a medically established and morally acceptable method of transplantation. According to German Transplantation Law, an expert review by a local "Commission on Living Donation" (Lebendspendekommission, LSK) is required before transplantation. The legal task of this review is to ensure a voluntary decision by the donor and to rule out illegal trading of organs. Results from a national survey among all LSKs show that the process of review and assessment varies considerably among German LSKs. Most of them carry out a compulsory hearing of every potential donor, but this is omitted by some LSKs in a number of cases. Only 60% of all LSKs feel confident to determine donors' free will and protect their self-determination. Only 33% claim to be able to recognise illegal trading of organs. The LSKs even disagree on the exact borderline between legal incentives and illegal commerce. An expansion of living donation by financial incentives, pool-donation or crossover donation is supported only by a minority of German LSKs. The article argues in favour of establishing national standards for the process of LSK-reviews in order to foster procedural ethics and trustworthiness in the field of living organ donation.

The paper provides a short overview of key problems of medical ethics in the Russian and Soviet contexts--confidentiality, informed consent, human experimentation, abortion, euthanasia, organ and tissue transplantation, abuse of psychiatry. In Soviet ideology common interests were declared superior to private ones. Hence, medical confidentiality was viewed as a bourgeois survival. On the other hand, diagnosis was normally not disclosed to a patient in the case of an incurable disease (especially cancer). Due to the strong paternalistic traditions of Russian medicine the idea of informed consent is still disputed by many physicians. Abortions were first legalized in Soviet Russia in 1920. A brief history of this landmark event is provided. However, abortions were forbidden in 1936 and legalized again only in 1955. Active euthanasia was legalized in Soviet Russia in 1922 but for a short period. Federal law regulating human transplantation was adopted only in 1992 and based on the presumed consent model. Until then forensic autopsy and procurement of cadaver organs were viewed as equal procedures. In 1960s-1980s there was a practice of declaring political dissidents insane in their involuntary treatment.

Transplantation medicine, like no other medical specialty, is connected with a wide range of very difficult ethical issues. Among those are: availability of the treatment, consent for cadaveric donation, allocation of available organs, new categories of living unrelated donors and economic aspects of this method of treatment. Authors discuss sensitive aspects in societal perception of the Polish Transplantation Act, ethical issues of living donor kidney transplantation, the role of mass media and economic aspects of transplantation.

The first heart transplantation in Japan was performed in 1968. However, the surgeon was prosecuted, and transplantations from cadaveric donors came to an end. A new law in 1997 offered the possibility to choose how one would be pronounced dead, and if one chose to be declared dead according to brain related criteria, then one could become a cadaveric donor, if certain conditions were fulfilled. The first donations and transplantations took place in 1999. The Japanese public has been reluctant to accept the concept of brain death. The integrity of the dead body seems to command greater respect in Japan than in Sweden, and there is a reluctance to treat body parts as exchangeable. At the same time many Japanese travel abroad to obtain organs. The act of 1997 is a very interesting way of trying to integrate a new technology in Japanese culture, and the process of obtaining informed consent from relatives relies on traditional cultural roles.

Twenty-eight randomly chosen citizens originating from the three linguistic areas of Switzerland discussed transplantation medicine in November 2000. This PubliForum was organised by the Swiss Federal Office of Public Health, the Swiss National Science Foundation and the Swiss Centre for Technology Assessment. The aim was to explore the hopes, fears and emotions raised in the population by this highly sophisticated therapy. After a 2-day hearing of specialists and concerned persons, the citizens wrote a report dealing with the definition of death, the consent for organ harvesting, the criteria for the allocation of donated organs and xenotransplantation research. The panel made a plea for a thorough public debate on these topics. They also stressed that information and transparency are key issues to guarantee that the social and individual needs of the donors, the recipients and their involved relatives will be met.

Comparison of transplantation medicine in Sweden, Denmark, Germany, Spain and Portugal reveals many and important differences with respect to frequency of transplantations, frequency of life donations, legal regulations and influence of the family on organ donation. The differences observed are at least partly related to cultural and value differences between the various countries, but many questions need to be studied systematically and in more detail before useful conclusions can be drawn. One study would have to address the problem of how differences in the family influence on organ donation can be explained. Another question needing further clarification concerns the exact meaning of "medical decision" and "medical criteria" because these terms, on which access to- and selection from the waiting list largely depends, are equivocally defined and seem to differ according to different traditions. Open questions also arise with respect to the influence of "closeness or distance" on medical decision making. The findings indicate that it would be premature to propose common guidelines to be observed within Europe as long as the above mentioned and some further questions have not been systematically studied and thoroughly analyzed.

Living related donors are an increasing source of organs for transplantation. Although the use of this type of donation is widespread in the United States, the practice of placing donors at risk for injury or illness without physical benefit can create ethical dilemmas for health professionals dedicated to healing and avoiding harm. It is important for transplantation professionals to be familiar with the risks and benefits associated with living donation within their own specialty area. Placing living donation within an ethical framework can allow for careful consideration and guide decision making in each individual case. Drawing upon the literature for examples from several of the transplantation specialty areas, this article reviews some of the risks and benefits associated with living donation and identifies the limits of the utilitarian and casuistic ethical framework in guiding decision making in living donation. An ethical framework of virtue-principlism is offered as one which is grounded in an understanding of what it is to be human and in the nature of the health professional-patient relationship.

Thorough examinations and discussions made clear: brain-death must be identical with the total death of the individual person. This must be the basis for legal organ transplantation. However--as men always tend to make bad things out of good--there exists criminal organ trade, including murder on order. Serious medicine as well as the serious patient must keep complete distance to these malpractices, even regarding that there are scarcity of organs for transplantation and long waiting lists. Different countries have different legistic regulations. Austria is envied by many others for its legal regulations.

The shortage of organs, breakthroughs in research, involvement of biotechnology companies, absence of ethically more acceptable alternatives, and a vaguely perceived "time to put man on the moon" feeling have contributed to the current reawakening of interest in xenotransplantation. The focus of ethical attention has changed from the moral correctness of using animals for research/therapy to an increasingly appreciated danger of the establishment and spread of xenozoonoses in recipients, their contacts, and the general public. The United Kingdom has established an embargo on clinical trials and has set up a national regulatory authority to oversee and coordinate the development of research, establish guidelines, and decide on when trials can proceed. In the United States, on the other hand, the overall attitude is to "proceed with caution," and the Food and Drug Administration has approved a number of xenotransplant studies. The Public Health Service guidelines on reducing infection risk are still evolving and are likely to end up being more cautions than they are currently. There are a number of reasons for not using subhuman primates for xenotransplantation, including their closeness to humans, the likelihood of passing on infections, their depletability (gorillas, chimpanzees), their slow breeding, and the expense of breeding them under specified-pathogen free conditions. The pig, although domesticated and familiar, is too distant to evoke the same feelings we have for primates, has the correct-size organs, is probably less likely to pass on infections, breeds rapidly, and is not endangered; moreover, millions of them are eaten every year. Although drawing ethical conclusions is difficult, at this stage of knowledge and debate it seems acceptable to manipulate pigs genetically and to proceed to using their organs for xenotransplantation trials when infection control measures and the scientific base justify it. The question of informed consent is likely to be a vexing one. It might end up more of a binding legal contract than consent as we understand it now. Xenotransplantation is also unlikely to cost less than, or significantly alleviate the shortage of, cadaveric organs in the short term. The international dimension of the risk of infection is becoming obvious, but there has so far been no effort to convene an international forum to agree on universally acceptable guidelines.

Assessments of the acceptability of new transplantation practices require a pinpointing of not only the meaning of death, but also the timing of death. They typically perceive elective ventilation as occurring just prior to death and non-heart-beating donor protocols as operative just after death. However, such practices in fact highlight the general vagueness and ambiguity surrounding these issues in both law and ethics. Supply-side dilemmas in transplantation lend real urgency to this "life or death" debate.

The message of the resurrection from the dead is relevant to human beings living and dying in the unity of body and soul. The personality of man is inseparable connected with this unit--even beyond death. Brain death only marks a (decisive) point during the process of dying, and it cannot be defined as the death of a human being (in general). Theological ethics object to this definition and to a new dualism of brain and body as well as of body and personality (i.e. soul), because this dualism socialises the organs of individuals and denies the personal dignity of disappearing life. Therefore, the explantation of organs must depend on a personal declaration of consent given by the adult sponsor himself. Each information given on organ transplants must clarify that the explanation of organs means an interruption of dying.

The message of the resurrection from the dead is meant to human beings living and dying in the unity of body and soul. The personality of man is unseparably connected with this unity--even beyond the death. The brain death only marks a (decisive) point during the process of dying, but the brain death cannot be defined as the death of a human being (in general). Theological ethics object to this definition and to a new dualism of brain and body as well as of body and personality (resp. soul), because this dualism socializes the organs of individuals and denies the personal dignity of disappearing life. Therefore the explantation of organs must depend on a personal declaration of consent given by the adult sponsor himself. And each information given on organ transplants must clarify that the explantation of organs means an interruption of dying.

Advances in transplantation technology and greater numbers of transplants have created an increasing disparity between the supply and the demand for organs. The new required-request legislation is only the beginning of legislation in this area. New legislation needs to increase the opportunity for donations without harming the rights of the patient. This author who has participated in the Surgeon General's Workshop on Organ Donation describes the issues involved in possible future legislation on organ and tissue donation.

Organ transplantation more than a scientific fact is now a social fact. Since the first organ transplantations in France, forty years ago, medicine demonstrated its ability to perform the operation and to obtain (what was more difficult) the tolerance of the graft but medicine so far remains unable to give the material: organs. These organs are given by the donor's relatives when the kidney is concerned and when it is a donation from a living person. But such donation remain strictly limited in our country (less than 5 p. cent of the kidney transplantations) due to the risk of moral pressure and commercialization. More often and for the other organs (liver, heart, lung) the donation is obtained after death, a special and dramatic death: the brain death. The nowadays spectacular results of organ transplantation 70 to 80 p. cent survival rate at 10 years with a complete rehabilitation gave a considerable increase on the demand. Unfortunately organ transplantation is the victim of its success, the number of donor's organ being insufficient to satisfy the needs. So in December 1990, 6,055 patients were on the waiting list and only 3,772 (56 p. cent) were transplanted. In December 1991, 6,334 patients were on the waiting list and may be only 4,000 could be transplanted. So the difference between the needs and the possibilities is increasing each year with for consequences, the death of 10 p. cent of the waiting patients and, for those who could be transplanted, a considerable increase in the waiting period responsible for slow deterioration of their status and less chances of success.(ABSTRACT TRUNCATED AT 250 WORDS)

Benefiting from a widely recognised experience of the field of bioethics, the Council of Europe which represents all the democratic countries of Europe, has embarked on the ambitious task of drafting a European Convention on bioethics. The purpose of this text is to set out fundamental values, such as respect for human dignity, free informed consent and non-commercialisation of the human body. In addition to this task, protocols will provide specific standards for the different fields concerned with the application of biomedical sciences. The convention and the first two protocols (human experiments and organ transplants) are due to be ready for signature by mid 1994.