HE idea of donating one kidney to my daughter had been lingering with me for some time," said Tan Shiping from Wuhan, capital city of Central China's Hubei Province, whose daughter was diagnosed as suffering from uraemia several years ago.

In September 2002, the 43-year-old mother donated her right kidney to her 16-year-old daughter, Wang Yaxin. Following the successful surgery, Wang now leads a normal life and has an excellent performance in school, which she believes is the best way to repay her mother who gave her a second life.

The development of anti-resistance drugs and advanced surgeries could save people's lives, but over two thirds of patients still die of organ failure due to the shortage of donated organs worldwide.

Take kidney failure, the most widespread type of organ failure, as an example. Among the over 1 million Chinese patients suffering from this ailment, half could be saved by a kidney transplanted. But each year only about 5,000 kidney transplants are performed in China and many patients die waiting for a matching organ.

Organ shortage

The experience of Western countries has shown that donated organs from dead bodies are far from sufficient to meet the demands of patients with organ failure.

"Close relative organ donation is the most effective method for solving the organ shortage problem, but this advanced concept has not yet been well accepted by Chinese," said Professor Chen Zhonghua of the Tongji Organ Transplant Institute of Tongji Medical School at Central China's Science and Technology University.

In addition, organ donations among those with blood ties or couples living together for over 20 years are more advantageous than other kinds of donation. In these cases, the recipients 15-year-survival rate (the most significant figure for successful transplants) is far higher and recipients are less likely to reject the transplanted organs.

In the US, among organ donation cases in 2001, over 52 per cent were donated by recipients' close relatives. However, 2002 only witnessed 76 cases of close relative live donations on the Chinese mainland, accounting for less than 2 per cent of the total donation cases.

Chen's institute is the largest organ transplant institute in China. "We have overseen a total of 70 such cases up till now, but the concept will still take time to be thoroughly accepted among Chinese. Effective public education will be necessary," said Chen.

Experts contribute the relative rarity of close relative organ donation in China to people's lack of awareness and to traditional concepts.

"Since 1963, I have been conducting surveys to investigate people's natural fears about donating an organ. A strong human reason is required to overcome these natural feeling," said Maurice Slapak, president of the World Transplant Games Federation. The international federation has organized regular sports events for organ recipients to advocate organ donation and transplant worldwide.

"In China as well as other Asian countries influenced by the religion of Buddhism, people regard organ donation as an imperfection of the body, so they are less willing to donate, even for family members," Slapak explained.

But the use of media to disseminate positive images of organ donation has produced good results. Statistics show that closely relative living donation accounts for about 19.1 per cent of all organ donation cases in Taiwan, while in Hong Kong, the figure has reached 22.6 per cent.

Tan said she never worried about possible bad results from donating a kidney, saying: "Nothing is more terrible than seeing your beloved one tortured and threatened by a deadly disease".

However, family member donors still face a financial problem because the cost of the donation operation itself - from 20,000 to 40,000 yuan (US$2,400-4,800) - is not covered by the medical insurance.

Illegal trading

As medical experts make great efforts to encourage organ donation, they are troubled by another type of organ donation.

As a search on the Internet quickly reveals, kidney selling advertisements or kidney donation notices in BBS are very popular.

In large local hospitals such as Huashan and the People's No. 1 Hospital, it is quite common to find notices such as "Donating a healthy kidney" along with contact details on walls or toilets.

"We have to wipe off the notices again and again. They even visit doctors, make numerous calls or write letters again and again," complained professor Ding Qiang, vice-president and chief of the Division of Urology at Huashan Hospital of Fudan University.

"Such donations are surely organ trading, but 'organ donation' for money is strictly banned in China," said Ding.

Generally, a kidney transplant in a hospital cost about 50,000 yuan (US$6,038) but one kidney is traded for 120,000 yuan to 150,000 yuan (US$14,500-18,115) in a black market. And the middle-persons between the donor and recipient usually takes the most profit.

To prevent organ trading occurring in the case of close living relative organ donation, patients and donors must provide legal certificates to prove their blood or marital relationship. In some cases, they are required to provide a DNA test report. Last year, the Ministry of Health issued a document requiring hospitals to apply even stricter processes when dealing with living organ donation in China after some organ trading cases were discovered.

Illegal organ trading seems impossible in big public hospitals. However, medical experts are worried that it is harder to regulate organ transplants in private clinics or small hospitals, which may leave space for illegal profitable organ trading.

Actually, another major obstacle for organ transplant in China is the lack of laws and regulations. Up till now, only one regional regulation has been put into effect when, last August, Shenzhen of South China's Guangdong Province set up a legal framework for organ donation.

Legislative support

Some Chinese medical experts such as Chen have been actively exploring and pushing forward the legislative process in the field of organ transplantation, organ donation and brain death. But the legislative progress has been quite slow due to various technical and ethical difficulties.

Chen's institute has pioneered two brain death transplantations since last year. In one case, the two kidneys of a brain dead boy were transplanted to two kidney patients. But Chen said he was quite careful in this area because without legal support, the doctors and hospitals could find themselves in a very difficult situation if the patients' family members took them to court.

The Ministry of Health recently denied a report that it had received and reviewed the "Brain Death Criteria" mapped out by the Tongji Organ Transplant Institute.

"Personally, I strongly advocate the legislation on brain death which would not only release important medical resources but also provide additional organs to save other patients," said Professor Gao Chenxin, a lung transplant expert at the Shanghai Chest Hospital who witnessed four patients die while on a waiting list for matched lungs since 2002.

"The legislation on organ donation not only accelerates medical development, it also reflects social progress and the advance of civilization," Chen said.