Organ transplantation is regarded as the “top of medicine in the 21st century” and is the only effective means to save the lives of patients with end-stage organ failure. In recent years, China's organ transplantation industry has realized leapfrog development in policy guidance, technological innovation, system construction and international collaboration, and has become an important force in the field of global organ transplantation.
Treatment
China's organ transplantation has formed a treatment system with full organ coverage and multiple parallel types, mainly including the following categories:
1. By donor type
Citizen organ donation after death (DCD): currently the main source of organ transplants in China (accounting for over 90%). The fair distribution and efficient utilization of organs is achieved through strict criteria for determining brain death and a coordination mechanism for organ donation.
Living organ donation: mainly kidney transplants and liver transplants between relatives (e.g., parents donating their livers to their children, couples donating their kidneys). Living organ transplantation has the advantages of high donor-recipient matching, short ischemic time and quick recovery after surgery, and is especially suitable for pediatric patients (e.g. “split liver transplantation” can split an adult liver into two parts and transplant them to adults and children respectively).
2. By organ type
Kidney transplantation: the most mature technology and the most widely carried out type of transplantation, with an annual operation volume of more than 10,000 cases in China and a 5-year survival rate of more than 85% (more than 90% in some top centers).
Liver transplantation: covering various types of end-stage liver diseases such as cirrhosis, liver cancer (meeting Milan criteria), liver failure, etc., with an annual operation volume of about 6,000 cases, and the technology of pediatric liver transplantation (e.g., “parental liver transplantation”) is leading in the world.
Heart and lung transplantation: mainly used for end-stage heart disease (such as dilated cardiomyopathy) and end-stage lung disease (such as pulmonary fibrosis). In recent years, with the advancement of ECMO (Extracorporeal Membrane Lung Oxygenation) support technology and perioperative management, the success rate of surgery has increased significantly.
3. Special types of transplants
Multi-organ joint transplantation: such as liver-kidney joint transplantation (to treat hepatorenal syndrome), pancreas-kidney joint transplantation (to treat diabetes combined with renal failure), which is technically difficult but with accurate efficacy.
Marginal donor organ utilization: repairing damaged organs (e.g. fatty liver donor liver, elderly donor kidney) through extracorporeal organ preservation technology (e.g. machine perfusion), expanding the donor pool and saving more patients.
Recommended Hospitals
China's organ transplant hospitals implement a strict qualification approval system (published by the National Health Commission), and there are currently 173 organ transplant qualified hospitals nationwide (2023 data). The following are the benchmark institutions in each organ field:
1. General hospitals with top comprehensive strengths
The First Hospital Affiliated to Zhejiang University School of Medicine: ranked first in the global liver transplantation volume for many consecutive years (more than 1,200 liver transplants will be completed in 2022), and internationally leading in pediatric liver transplantation (especially “split liver transplantation” and “assisted liver transplantation”); also conducting kidney transplantation, pancreas transplantation, and pancreatic transplantation; and providing a total of 173 organ transplantation-qualified hospitals nationwide (2023 data). It also carries out kidney transplants and pancreas-kidney combined transplants, and has a mature multidisciplinary collaboration (MDT) model.
Tongji Hospital/Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST): organ transplant center in Central China, with an annual volume of over 500 liver transplants, and outstanding achievements in liver transplantation for hepatocellular carcinoma (expanding the application of Milan criteria) and liver-kidney combination transplantation; the kidney transplantation team is very experienced in the field of living kidney transplantation for relatives.
Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences (PUMC): The comprehensive medical strength of PUMC is top-notch, focusing on the development of heart transplantation, lung transplantation, and difficult and severe transplantation (such as end-stage patients with combined multi-system diseases), and relying on the strong support of internal medicine (e.g., rheumatology and immunology, respiratory) to enhance the success rate of surgery for complicated cases.
2. Specialized hospitals with outstanding regional characteristics
West China Hospital of Sichuan University (WCHSU): the organ transplantation center in Southwest China, with an annual volume of kidney transplants exceeding 400 cases and a high proportion of living kidney transplants from relatives (with high technical safety and low rejection reaction); it also carries out liver transplants and heart transplants, and has accumulated rich experience in the field of transplants for the elderly patients (>65 years old) in particular.
The First Affiliated Hospital of Sun Yat-sen University: the core of organ transplantation in South China, with balanced liver and kidney transplantation techniques, and specialties in long-term management after liver transplantation (e.g., hepatitis B recurrence prevention, metabolic syndrome intervention).
Core Treatment Methods
China's organ transplantation has shifted from “purely pursuing the success rate of surgery” to “whole life cycle management”, with the core technology covering three major aspects:
1. Precise preoperative evaluation
Donor assessment: Through imaging (CT/MRI), laboratory tests (e.g., organ function indexes, viral screening) and pathological biopsy, the quality of the organ (e.g., degree of hepatic steatosis, renal interstitial fibrosis) is comprehensively assessed to ensure that “the best organ is given to the most suitable patient”.
Recipient evaluation: taking into account the primary disease (e.g. stage of liver cancer, degree of cirrhosis), systemic status (cardiopulmonary function, nutritional status) and immune status (HLA matching, PRA antibody level), we will formulate a personalized transplantation plan (e.g., whether to reduce antibody with blood purification in advance).
2.Minimally invasive and precise surgery
Application of minimally invasive technology: Laparoscopic living donor nephrectomy (less trauma, faster recovery), da Vinci robot-assisted liver transplantation (precise anastomosis of blood vessels and bile ducts) and other technologies have been gradually popularized.
Key technological innovations: such as “ischemia-free liver transplantation” (maintaining organ activity through machine perfusion and reducing ischemia-reperfusion injury), “split liver transplantation” (maximizing the use of the donor liver), "micro-anastomosis technology for liver transplantation in children (maximizing the use of donor liver), “micro-anastomosis technology for pediatric liver transplantation” (reducing postoperative biliary complications), etc., all of which have reached the international advanced level.
3.Postoperative management
Immunosuppressive therapy: new drugs (such as new calcineurin phosphatase inhibitors, mTOR inhibitors) are used to realize individualized medication, balancing anti-rejection and drug toxicity (such as renal injury and infection risk).
Complication prevention and treatment: Early detection of rejection, infection, tumor recurrence through regular monitoring (e.g., blood concentration, viral load, imaging) and timely adjustment of the treatment plan.
Patient education and follow-up: Establishing a three-tier follow-up system of “hospital-community-family” to guide patients in diet, medication, exercise and psychological adjustment to improve their quality of life (e.g., the survival rate of renal transplant patients is over 60% in 10 years after the operation).
Advantages of Treatment
The rapid development of organ transplantation in China has benefited from the triple driving force of technological innovation, system improvement and social support, forming a unique competitive advantage:
1. Technological autonomy
Independently developed immunosuppressants (e.g., tacrolimus, mertiomacrophenol) have been localized, lowering the cost of medication for patients;
Key technological breakthroughs in organ preservation technology (e.g., localization of “UW fluid” and “HTK fluid”) and machine perfusion equipment (e.g., liver perfusion system) have improved the utilization rate of marginal donors;
In the fields of liver transplantation for liver cancer (“Hangzhou Standard”) and liver transplantation for children, the diagnosis and treatment standards proposed by Chinese scholars have been cited in international guidelines.
2. Efficient and fair donor system
Since 2015, China has set up the China Computerized Organ Transplantation and Sharing System (COTRS), realizing “open, fair and transparent” organ distribution;
By 2022, the number of organ donations nationwide will exceed 60,000, and the waiting time for organ transplantation will be reduced by 50% compared with that of 10 years ago (e.g., the average waiting time for kidney transplantation will be reduced from 5 years to 2-3 years).
3. Multidisciplinary collaboration (MDT) model
The transplant team integrates multidisciplinary resources from surgery, anesthesiology, intensive care medicine (ICU), infectious diseases, pharmacy, etc., and develops personalized plans for patients with underlying diseases such as combined diabetes, coronary heart disease, infection, etc. The transplant team has also been working on the development and implementation of the MDT model;
The success rate of difficult cases such as pediatric transplantation, geriatric transplantation, emergency rescue transplantation (e.g., fulminant liver failure) has been significantly improved.
4.Social support and humanistic care
The government reduces the burden of patients through medical insurance coverage (some regions have included transplantation surgery and postoperative immunosuppressants in medical insurance) and charitable funds (such as the “New Liver Baby” children's liver transplantation assistance program);
Transplant patient communities and public welfare organizations (e.g. China Organ Transplant Development Foundation) provide psychological support and rehabilitation guidance to help patients return to society.
Conclusion
China's organ transplantation therapy has moved from the stage of “technical exploration” to “high-quality development”, and has not only saved hundreds of thousands of patients' lives, but has also become an important player in the global organ donation and transplantation system. In the future, with the breakthroughs in cutting-edge technologies such as gene editing (e.g. pig organ xenotransplantation) and 3D bioprinting, China's organ transplantation will further promote the in-depth fusion of “precision medicine” and “life and health”, and will light up the hope of life for more patients with terminal illnesses. The Chinese organ transplant will further promote the deep integration of “precision medicine” and “life and health”, igniting the hope of life for more terminal patients.