Unethical Surgery
Robert T. Sataloff, MD, DMA, FACS First Published May 6, 2019 Editorial
https://doi.org/10.1177/0145561319843031
Article information
Free Access
On February 6, 2019, The Guardian newspaper (England) published a troubling account of unethical surgery.1 Although it highlighted the call for retraction of over 400 scientific papers that had been published based on unethical surgery, this issue strikes much deeper than journal publication ethics.
The unusual and insightful article that led to the Guardian coverage was written by Wendy Rogers, a professor of clinical ethics at Macquarie University in Sydney, Australia, and it was published in the well-respected British Medical Journal Open.2 Rogers reviewed statistics and literature that suggest strongly that a large volume of organ transplant surgery performed in China and reported in English utilized organs obtained unethically from Chinese prisoners. This problem has surfaced before. In 2017, Kilgar et al published a report documenting an extraordinary discrepancy between the official transplant figures from the Chinese government and the number of transplants that Chinese hospitals had reported.3 While the government admitted to 10 000 transplants each year, data from hospitals showed that between 60 000 and 100 000 organs had been transplanted annually. This exceeded by far the number of voluntary organs available, and the evidence suggested that the discrepancy had been filled by organs harvested from prisoners of conscience who had been executed. The European parliament passed a declaration in 2017 that condemned the harvesting of organs from prisoners of conscience, and the parliament had extended a call to the Chinese government to end the practice.
Rogers et al reviewed all papers published between January 2000 and April 2017 in medical journals published in English that reported on Chinese transplant recipients. Of the 445 studies involving 85 477 transplant patients that they reviewed, only 1% reported whether organ donors had consented to organ donation for transplantation. Disturbingly, the 19 studies that claimed that no organs from executed prisoners had been used occurred prior to 2010; at that time, there was no volunteer donor program in China. Rogers et al called for the retraction of more than 400 papers that they believed had utilized organs harvested unethically. The authors argued that journals that publish papers reporting research using organs from executed prisoners are complicit in the unethical conduct. They called not only for immediate retraction of all papers reporting research using organs obtained in this fashion but also for an international summit to establish policy for “handling Chinese transplant research.” They also stressed that having ethics guidelines is insufficient unless they are actually implemented.
In my opinion, the issue is not so much the more than 400 English-language papers that have reported this research (which may be scientifically valid, given the large numbers of transplant operations that have been performed because of the almost unlimited supply of viable organs). The bigger problem is the probability that people are being executed as “prisoners of conscience” so that their organs can be supplied to a willing surgical community and patient population. Western nations have relatively little political control over nations in the Far East, Middle East, and elsewhere. Moreover, it is reasonable to argue that we should be very cautious about imposing our values, ethics, and definitions of right and wrong on other nations and other cultures. Nevertheless, lines must be drawn somewhere; this seems to be a place worth considering, especially since Western science can be considered complicit in this ethical breech. It is no coincidence that those 445 studies were published in English-language journals. Those journals are regarded throughout the world as preeminent, and they establish credibility for the authors who are fortunate enough to have papers accepted in the world’s premier journals. If editors and editorial boards had been more vigilant and demanding, those papers would have been rejected, just as we reject out of hand papers reporting human research that do not have institutional review board approval. Rogers et al are quite right. This profound violation of ethics spreads guilt not only among the surgeons and government in China but also among the editors and publishers who enabled their continued unethical practice by dignifying and validating their activities through publication.
While this situation is extensive, extraordinary, and appalling, it also raises questions about what other ethical violations may be getting published “under the radar” and harming segments of the public. This stunning revelation should be a wakeup call for all physicians and especially medical journal editors to examine our specialties, our clinical activities, and the rigor of our journal screening processes in great detail and to avoid diligently any similar ethical violations in all fields of medicine. It also should alert the general population to read medical research critically, even when it is published in the most elite journals.
Author’s Note
Republished with permission from: Sataloff RT. Medical Musings, 2nd edition. London: Compton Publishing, 2019; in press.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
References
1. Davey, M. Call for retraction of 400 scientific papers amid fears organs came from Chinese prisoners. The Guardian. 2019. https://www.theguardian.com/science/2019/feb/06/call-for-retraction-of-400-scientific-papers-amid-fears-organs-came-from-chinese-prisoners. Accessed February 7, 2019.
Google Scholar
2. Rogers, W, Robertson, MP, Ballantyne, A. Compliance with ethical standards in the reporting of donor sources and ethics review in peer-reviewed publications involving organ transplantation in China: a scoping review. BMJ Open. 2019;9(2):e024473. doi:10.1136/bmjopen-2018-024473.
Google Scholar | Crossref | Medline
3. Kilgar, D, Gutmann, E, Matas, D. Bloody Harvest/The Slaughter: An Update. The International Coalition to End Transplant Abuse. 2017. https://endtransplantabuse.org/wp-content/uploads/2017/05/Bloody_Harvest-The_Slaughter-2016-Update-V3-and-Addendum-20170430.pdf. Accessed February 7, 2017.
Google Scholar
Robert T. Sataloff, MD, DMA, FACS First Published May 6, 2019 Editorial
https://doi.org/10.1177/0145561319843031
Article information
Free Access
On February 6, 2019, The Guardian newspaper (England) published a troubling account of unethical surgery.1 Although it highlighted the call for retraction of over 400 scientific papers that had been published based on unethical surgery, this issue strikes much deeper than journal publication ethics.
The unusual and insightful article that led to the Guardian coverage was written by Wendy Rogers, a professor of clinical ethics at Macquarie University in Sydney, Australia, and it was published in the well-respected British Medical Journal Open.2 Rogers reviewed statistics and literature that suggest strongly that a large volume of organ transplant surgery performed in China and reported in English utilized organs obtained unethically from Chinese prisoners. This problem has surfaced before. In 2017, Kilgar et al published a report documenting an extraordinary discrepancy between the official transplant figures from the Chinese government and the number of transplants that Chinese hospitals had reported.3 While the government admitted to 10 000 transplants each year, data from hospitals showed that between 60 000 and 100 000 organs had been transplanted annually. This exceeded by far the number of voluntary organs available, and the evidence suggested that the discrepancy had been filled by organs harvested from prisoners of conscience who had been executed. The European parliament passed a declaration in 2017 that condemned the harvesting of organs from prisoners of conscience, and the parliament had extended a call to the Chinese government to end the practice.
Rogers et al reviewed all papers published between January 2000 and April 2017 in medical journals published in English that reported on Chinese transplant recipients. Of the 445 studies involving 85 477 transplant patients that they reviewed, only 1% reported whether organ donors had consented to organ donation for transplantation. Disturbingly, the 19 studies that claimed that no organs from executed prisoners had been used occurred prior to 2010; at that time, there was no volunteer donor program in China. Rogers et al called for the retraction of more than 400 papers that they believed had utilized organs harvested unethically. The authors argued that journals that publish papers reporting research using organs from executed prisoners are complicit in the unethical conduct. They called not only for immediate retraction of all papers reporting research using organs obtained in this fashion but also for an international summit to establish policy for “handling Chinese transplant research.” They also stressed that having ethics guidelines is insufficient unless they are actually implemented.
In my opinion, the issue is not so much the more than 400 English-language papers that have reported this research (which may be scientifically valid, given the large numbers of transplant operations that have been performed because of the almost unlimited supply of viable organs). The bigger problem is the probability that people are being executed as “prisoners of conscience” so that their organs can be supplied to a willing surgical community and patient population. Western nations have relatively little political control over nations in the Far East, Middle East, and elsewhere. Moreover, it is reasonable to argue that we should be very cautious about imposing our values, ethics, and definitions of right and wrong on other nations and other cultures. Nevertheless, lines must be drawn somewhere; this seems to be a place worth considering, especially since Western science can be considered complicit in this ethical breech. It is no coincidence that those 445 studies were published in English-language journals. Those journals are regarded throughout the world as preeminent, and they establish credibility for the authors who are fortunate enough to have papers accepted in the world’s premier journals. If editors and editorial boards had been more vigilant and demanding, those papers would have been rejected, just as we reject out of hand papers reporting human research that do not have institutional review board approval. Rogers et al are quite right. This profound violation of ethics spreads guilt not only among the surgeons and government in China but also among the editors and publishers who enabled their continued unethical practice by dignifying and validating their activities through publication.
While this situation is extensive, extraordinary, and appalling, it also raises questions about what other ethical violations may be getting published “under the radar” and harming segments of the public. This stunning revelation should be a wakeup call for all physicians and especially medical journal editors to examine our specialties, our clinical activities, and the rigor of our journal screening processes in great detail and to avoid diligently any similar ethical violations in all fields of medicine. It also should alert the general population to read medical research critically, even when it is published in the most elite journals.
Author’s Note
Republished with permission from: Sataloff RT. Medical Musings, 2nd edition. London: Compton Publishing, 2019; in press.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
References
1. Davey, M. Call for retraction of 400 scientific papers amid fears organs came from Chinese prisoners. The Guardian. 2019. https://www.theguardian.com/science/2019/feb/06/call-for-retraction-of-400-scientific-papers-amid-fears-organs-came-from-chinese-prisoners. Accessed February 7, 2019.
Google Scholar
2. Rogers, W, Robertson, MP, Ballantyne, A. Compliance with ethical standards in the reporting of donor sources and ethics review in peer-reviewed publications involving organ transplantation in China: a scoping review. BMJ Open. 2019;9(2):e024473. doi:10.1136/bmjopen-2018-024473.
Google Scholar | Crossref | Medline
3. Kilgar, D, Gutmann, E, Matas, D. Bloody Harvest/The Slaughter: An Update. The International Coalition to End Transplant Abuse. 2017. https://endtransplantabuse.org/wp-content/uploads/2017/05/Bloody_Harvest-The_Slaughter-2016-Update-V3-and-Addendum-20170430.pdf. Accessed February 7, 2017.
Google Scholar
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