KIDNEY FAILURE AND TRANSPLANTATION IN CHINA

The incidence of chronic renal failure in China is approximately 120,0 00 cases per year; the vast majority of these new cases will die withi n a very short lime because of the shortage of Funds, dialysis machine s, and organs for transplantation. This paper focuses on the reasons b ehind the organ shortage and the strategies proposed by the Chinese me dical profession to increase the supply of transplantable kidneys. The data were gathered on multiple trips to China, Hong Kong and Taiwan b etween August 1993 and January 1995. During these trips the author spo ke formally with nephrologists, urologists, dialysis and transplant nu rses, and other individuals active in the field of organ procurement, and informally with others familiar with general hospital practice. Th e author also draws heavily on articles published in leading Chinese j ournals. The kidney shortage in China is produced by the same sorts of problems as exist in other countries, but the shortage is aggravated by certain beliefs and practices specific to Chinese populations. Live donation is hampered by traditional beliefs about the function of the kidney, while cadaver donation is hampered by reluctance to cut a bod y and a host of beliefs about ghosts. labeled ''feudal superstitions'' by the authorities. Cadaver donation is further restrained by the lac k of legal recognition of ''brain death''. In response to the organ sh ortage, the Chinese medical community has expanded the range of eligib le sources to include those condemned to death as criminals, a practic e itself usually condemned by the wider international community. At th e same time it has advocated: (1) enhancing corpse donation through pr opaganda work, administrative work, legal work, and incentives: (2) en couraging live donation; (3) familiarizing the public with the benefit s of organ transplantation, and (4) pursuing the development of artifi cial organs. (C) 1997 Elsevier Science Ltd.