法轮功器官来源大量证据及相关道德责任

【新生8月9日讯】中共政府自1999年7月起对非暴力法轮功学员进行的系统性迫害，已成为中国自文化大革命后，对单一修炼团体施加的最大人权迫害事件。这是独立于常规司法和上述程序以外的镇压计划。这样的迫害必须立刻停止。

此外，目前已有越来越多令人信服的证据，证实法轮功学员被迫成为中国境内器官移植的来源。这意味着人权迫害的范围扩及医学界，这是自1940年代迄今尚未记录在册的事件。许多接受这种器官的人是来自马来西亚、日本、欧洲及美国的患者。

2006年7月6日，加拿大律师大卫。麦塔斯（David Matas）及前亚太司司长大卫。乔高（David Kilgour）公布的“中国活体摘除法轮功学员器官指控的调查报告”，确认法轮功学员极有可能是器官移植的来源。所引用的证据包括访谈及电话查询在中国的特定医疗院所及医生。这些访谈内容?证法轮功学员的器官被认为是高质量、供应稳定、以及可在短时间内取得。这令人更加关注已经存在的从死刑犯身上摘取器官的器官移植系统。

2000年到2005年间，约有41,500个器官的来源仍然含糊不清。在中国，器官来自家人捐赠或脑死亡者捐赠的比例不到1％，而中国自愿性捐赠计划也尚未成形。而在这个期间，肾脏移植的数量却成长近三倍。全国的肝脏移植由1998年的135例，成长到2005年的4000例。各类广告宣传器官移植的价格从中国人的24,000美元（二十万元人民币）到外国人的98,000美元以上不等，差别很大。

各类器官移植网站许诺平均可在一周、一个月或最长二个月内获得一枚肝脏，肾脏则保证在二周内可以获得，而且如果第一枚肾脏不适合，可在一周内立即得到第二枚肾脏。这样的移植等待时间，必须有一个巨大的捐赠群体作后盾，而且事先已完成血型以及人类白血球抗原配对。遭到逮捕的法轮功学员已知被进行系统性的验血检查。鉴于肾脏在离体后必须在12到24小时内移植完毕，而肝脏的时间则是12小时，因此预定的配对无法在随机死亡的基础上得以保证（除非有计划的处死才能做到）。心脏或全肝移植则都要求捐赠者一经死亡就进行移植，或直接活体摘取器官。

打到器官移植处所甚至是拘留中心的电话记录一再显示，受访者确认法轮功学员是“活的”、“健康的”，而且是稳定的器官来源。受访的医生表示必须选择活的犯人，才能确保器官相容性。

虽然中共承诺在2006年7月1日实施一项新的“暂时性”规定以进行器官移植系统的改革，但该规定全文尚未公布供人们查阅。据报导，该规定要求器官移植应取得地方医院道德委员会的许可，并确认合法来源。然而，规定中没有表明是否减少中国器官移植系统对死刑犯器官的依赖程度，当然更不用说减少对法轮功的迫害了。

鉴于调查内容所反映出的器官移植院所之行为的严重性，此等人权迫害不能被说成是不法分子的个别事件，也不能说它是中国“独特”器官供应系统的偶发事件或鲜为人知的事件。最终由卫生部负责的平民医院和不属卫生部管辖的军事医院，这两者都是令人关注的对象。

鉴于这个器官移植系统总体是依赖死刑犯作为器官来源，以及有强烈证据显示器官来源尤其是法轮功学员，下列伦理准则和规范可以适用：

中共承认的基于死刑的器官移植体制，不能体现器官捐赠者是在非强制和知情的情况下作出承诺的。如果可以选择立刻执行死刑或在未来当血型及抗原配对适合预定受赠者时执行死刑，这就会使得捐赠者不能在自由、非强迫、知情的情况下作出决定，即使想要这样做也很难达到。

通过“器官移植观光”来作为从国外获取医疗创收的来源，加上让死刑犯成为器官来源和居高不下的器官需求两者的结合，使得处死较轻犯人的机会增加。在中国死刑罪包括谋杀，经济腐败，到模糊不清的反国家活动 – 就像针对法轮功学员那样。

那么，什么是国际医学界和研究团体应当负起的人权责任呢？

a. 专业联合会，如器官移植学会（The Transplantation Society），应停止对中国器官移植研究的支持与合作，因为这种合作会无形中促使这种违反人权的恶劣行径得以继续。

b. 学术期刊以及教育场所，如世界器官移植大会（World Transplant Congress），应拒绝基于违反《赫尔辛基宣言》的作法所取得数据的论文及报告。

i. 《赫尔辛基宣言》中说到：“关心受体的利益永远高于科学与社会之利益。”

ii. 发表经由不道德的研究程序所获的研究数据是不道德的行为。如果违反捐赠者应知情地做出器官捐赠的准则，那末这样的器官移植系统所产生的数据清楚地属于这一类。这也适用于那些用非法方式得到器官移植数据的论文。对已发表的论文作出伦理评估是适当的。

iii. 如果终身教职（tenure）评审委员会考虑这些通过不道德数据产生的文章或报告来作为晋升的基础，也是不道德的行为，即使它们有任何的技术价值。

iv. 虽然不符合道德伦理准则会使科学、职业、甚且是个人付出代价，但制造及施行此等不道德行为，以及事后通过藉口或操控使此等资料合法化的倾向，所付出的人权代价更高。

v. 发表经不道德手段得到的数据或依此等数据得到的结果，也是不道德的行为，因为它违反了自愿同意的准则。这样做会造成更多的需求以及对此等数据的容忍，而无视非自愿捐赠者的死亡。

c.学术机构应审查及暂停任何涉及中华人民共和国的器官移植研究合作以及来自中国的器官移植资讯，包括实际合作或过程示范。

i. 在中国体制内，虽然并非所有器官移植医生都同意政府的作法，但在器官移植领域违反基本人权及医学伦理准则的情况十分普遍。

d. 研究资助机构或基金会有道德义务只将项目基金拨给通过合法途径获取数据的研究项目。

e. 已掌握的证据表明，目前国际间到中国进行器官移植的病患，其所获得的益处是以默许支持继续严重违反人类尊严和人权为代价的。有关器官移植病患应被告知这些事实，并主动劝阻他们不要追求（到中国）这个治疗途径。

2006年7月24日

（本文作者为明尼苏达大学人权与医学计划副主任，其连系电话：612-626-6559 电邮：alli0001@umn.edu）

[英文原文]

Mounting Evidence of Falun Gong Practitioners used as Organ Sources in China and Related Ethical Responsibilities

24 July 2006

Kirk C. Allison, PhD, MS
Associate Director
Program in Human Rights and Medicine
University of Minnesota

The systematic government persecution of nonviolent Falun Gong practitioners in China since July 1999 has constituted the greatest concentration of human rights violations against a single cultural group in China since the cultural revolution. It is a program of suppression separated from conventional judicial processes or appeals. Such persecution should cease immediately.

Additionally, there is accumulating convincing evidence of the use of Falun Gong practitioners as involuntary sources for organ transplantation in China. This implies a scope of human rights violations involving institutional medicine not documented since the 1940s. Many recipients of such organs are foreign patients from Malaysia, Japan, Europe and United States.

The July 6 2006 “Report into allegations of Organ Harvesting of Falun Gong Practitioners in China” by attorney David Matas and Canadian former Asia-Pacific Secretary of State David Kilgour confirms with high likelihood sourcing of Falun Gong organs. Evidence includes interviews and telephone inquiries to specifically identified medical institutions and doctors in China. These interviews identify organs from Falun Gong practitioners as being of high quality, in supply, and usually accessible in a short period of time. This extends concern regarding a system of transplantation already sourced from executed of prisoners.

Between 2000 and 2005 the source of some 41,500 organs remains ambiguous. Family donors or nonfamily brain-dead donors account for less than 1% of donation in China. A national voluntary donor program is undeveloped. Kidney transplants nearly tripled in the same period. Liver transplants increased nationwide from about 135 in 1998 to over 4000 in 2005. Various advertised ranged widely from about $24,000 (200,000 yuan) for Chinese to $98,000 or more U.S. dollars for foreigners.

Various transplantation websites have promised a liver within an average of one week, a month, or guaranteed by two. A kidney is promised within two weeks, with a second in one week should the first prove “unsuitable.” This time frame requires a large pool of donors pretyped for blood group and HLA matching. Systematic blood-testing of arrested Falun Gong practitioners is known. Given a 12-24 hour window for kidney transplantation, and a 12 hour window for liver, scheduled matching cannot be assured on a random-death basis. Heart or whole liver transplantation requires donor death, either prior to or directly by taking the organs.

Recorded telephone inquiries to transplant cites and even detention centers repeatedly identify Falun Gong practitioners as “live”, “healthy” and consistently available as sources of organs. Physicians have indicated selecting live prisoners to ensure compatibility.

While reform of the transplantation system has been promised in a new “temporary” regulation taking effect on 1 July 2006, the regulation has not been published verbatim for scrutiny. It reportedly requires that a local hospital ethics committee approve transplants and confirm legal sources. However, there is no indication of less reliance on execution in the transplantation system of China, and certainly no less persecution of Falun Gong.

Given the prominence of the transplantation institutions reflected in the inquiries, it cannot be claimed that such human rights abuses are isolated rogue occasions, unknown or incidental to China’s “unique” system of organ procurement. Concern applies both to civilian hospitals ultimately accountable to the Ministry of Health and to military hospitals which are not.

Given a transplantation system relying on executed prisoners generally, and strong evidence of Falun Gong practitioners as sources in particular, the following ethical principles and policy implications apply:

An organ transplantation system relying on execution, to which China admits, cannot embody non-coercive informed consent. An option between immediate execution or execution at an arbitrary future time, when blood group type and HLA matches a prospective recipient, makes free, uncoerced, informed consent impossible – if sought at all.

The advent of ‘organ transplantation tourism’ as a source of foreign medical income, and the confluence executon-related organ sourcing and high organ demand increases the likelihood of execution for marginal offenses. Capital offenses in China range from murder, to economic corruption, to nebulous anti-state activity – as leveled against Falun Gong practitioners.

What, then, are the human rights responsibilities of the international medical and research community?

a. Professional associations, such as The Transplantation Society, should place a moratorium on research support and collaboration with transplantation in China given that such collaboration tacitly facilitates the continuance of a gross violation of human rights.

b. Academic journals and educational venues, such as the World Transplant Congress, must reject papers and presentations relying on data derived from practices violating standards described in Helsinki Declaration of the World Medical Association Ethical Prinicples Regarding Medical Research Involving Human Subjects and international instruments.

i. The Helsinki Declaration states: “Concern for the interests of the subject must always prevail over the interests of science and society.”

ii. It is unethical to publish research data generated by unethical research processes. Data derived from a transplantation system violating the canons of informed consent clearly falls within this category. This applies to papers based on transplantation data involving procedures where organs are obtained by illicit means. An ethical review of past publications is in order.

iii. It is unethical for tenure or review committees to consider publications or presentations derived from such data as a basis for advancement – despite any technical merit.

iv. While there is a scientific, professional, and even personal cost to ethical and moral consistency, the human rights cost of its generation and underlying practices, and the tendency of after-the-fact legitimation of such data by rationalization and use, is much higher.

v. The publication of unethically generated data, or results based on this data, is also unethical, as it violates the canons of consent. Doing so creates additional demand and allowances for such data, here irrespective of the deaths of nonvoluntary donors.

c. Academic institutions should review and suspend research collaborations involving transplantation, and transplantation data sourced from the Peoples Republic of China. This also applies to practice collaborations or demonstration procedures.

i. While not all transplant surgeons within the Chinese system approve of state practices, the practices in this area are pervasively in violation of fundamental human rights and canons of medical ethics.

d. There is an ethical obligation for funding agencies and foundations to direct or redirect funding to projects with licit sources of data.

e. Given the evidence at hand, international transplant patients who obtain organs in China do so at the cost of benefiting from, and tacitly supporting, the continuance of an ongoing lethal violation of human dignity and human rights. Prospective patients should be informed of this fact and actively discouraged from pursuing this avenue of treatment.

发稿：2006年8月9日    更新：2006年9月30日