Qian Gongtao: 'We present it to families as a chance to do a good thing' © Tom Hancock

When someone in the eastern Chinese city of Wuxi suffers brain death after an accident or illness, Qian Gongtao is among the first to know. Tipped off by doctors, he rushes to bereaved relatives at the deceased’s bedside. 

But the white-coated Mr Qian is no physician. His government-issued card reads “organ donation facilitator”, a thousands-strong new profession created to address the country’s chronic shortage of organs for donation. 

Just over 4,000 Chinese people donated organs in China last year, while 300,000 waited for transplants.

Donation rates — 2.98 per million people compared with double-digit rates in the EU — are “small and pathetic”, according to Liu Xiuqin, head of a Chinese organ charity. The shortage has been deepened by a 2015 ban on the use of executed prisoner's organs, long the main source for transplants. 

“We present it to families as a chance to do a good thing,” said Mr Qian of his main persuasion method. The softly spoken 35-year-old deals with about four cases per month but the vast majority of his efforts are fruitless because of a lack of tradition of organ donation.

Regulations stipulate that all direct family members including parents and spouses must sign off on any donation. “One successful case in 10 is a good ratio,” he said. 

China has hired about 2,000 donation facilitators in recent years, a quarter of whom were trained in 2016, with salaries of up to Rmb10,000 ($1,450) a month.

“We are developing from a very low base,” said Hou Fengzong, who runs a state-funded training facility in Beijing. “We use indirect methods to explain to relatives that they can still give life to others. It requires a great deal of skill.”

Mr Qian insists that donations “must be voluntary” but he is able to marshal a range of incentives. “If you donate, then if you have any requests from the government, such as with schooling, of if you have any problems, then we can help,” he said.

Households designated as poor can receive Rmb10,000 each for signing off on a donation. Those who donate can have their names inscribed on a plaque in an exclusive graveyard, where their ashes can be stored and are honoured in an annual ceremony.

China’s organ donation system is now “fully in line with World Health Organisation guiding principles,” the organisation’s China representative Bernhard Schwartländer told reporters this month.

He added that violations of the prohibition on the use of prisoner organs could not be ruled out, but he “had no evidence that the law is being breached”. 

Chinese tech group Alibaba has added a feature to its Alipay service allowing users to sign up as donors, with more than 100,000 people currently registered. But because of regulations requiring relatives’ consent, it is mainly a symbolic effort.

Chen Jingyu, one of China’s leading lung transplant surgeons, said agreements with families had a tendency to fall apart at the last minute. The number of facilitators is “far too low”, he said, estimating that the country would need 10,000 in years to come. 

In an office at the hospital where he also works part-time as a manager, Mr Qian said volunteer rates had improved since the use of prisoner organs was abolished. “There has been a change in attitudes, from flat rejection to greater acceptance,” he said. “There are few cases when my words alone can move someone".

Additional reporting by Emily Feng

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