A Last Hurrah: Reply to Sharif et al Regarding China

We have been “called to task” for supporting and lauding extensive changes within the Chinese transplant system by a group of well-meaning but out-of-date colleagues. Our brief response is the following: in political circles, “The Last Hurrah” is the well-known effort of an unsuccessful final campaign for elected office.1 The letter by Sharif et al, although principled in theory, becomes inconsequential in light of the current changes in China.2 The Chinese transplant community (and government) responded to pressure from the international transplant community to cease the unethical and heinous practice of using organs from executed prisoners finally and officially in 2015. The government of China set up a centralized oversight system whose administrative data allow for the tracking and distribution of every deceased donor organ. Further listing practices and transplant outcomes are reviewed regularly with centralized reporting should any transgressions occur. The State Council of China has issued a 2024 set of regulations that fulfill World Health Organization guidelines.3,4 These contemporary rules are summarized in a document due to be published soon by authorship that includes the president of the Chinese Transplant Society. The government of China has officially proclaimed its support for a Resolution to be presented at the 77th World Health Assembly in Geneva in May 2024 that calls for regulatory oversight of every organ transplant, reporting the identity of every deceased and living donor. These advances by China should be championed as positive steps toward transparency and ethical transplantation. Perhaps this group of Sharif et al should redirect their efforts to those parts of the world using vulnerable live donors to support a system of transplant tourism, which may provide a source of national pride, but does not concern itself with the short-term or long-term harmful effects on donors.5-7