China lung transplantation developing: past, present and future

Abstract

Lung transplantation in China has been developing for almost 40 years (1979-2019). The pioneers of this procedure experienced struggles and obstacles upon accomplishment of the initial 20 cases of lung transplantation. Like the expanding process of transplant programs elsewhere in western countries and other regions in Asia, transplant teams in China have found their own way to step forward, with the establishment of the two largest centers in Beijing and Wuxi. Since 2015, which was a novel start and milestone for transplant affairs in China, the pace of transplant volume and comparable quality of care for lung transplant recipients have increased noticeably. We reviewed the advancement of lung transplantation programs and registry setup in China and indicated that more socioeconomic factors and human care aspects needed to be considered to benefit Chinese recipients, which may further inspire the modification of criteria of listing and organ utilization based on East Asian cultural and traditional origins.

Keywords: China; Lung transplantation; organ donation; registry.

Figure 1

Memory of China lung transplantation stepping forward in 40 years. (A) In 1979, Dr. Xin performed the first lung transplantation case (Courtesy of China-Japan Hospital); (B) in 2003, Dr. Yuping Chen, Dr. Fengrui Zhao, Dr. Jingyu Chen and Dr. Guoliang Zhang, the key pioneers in Chinese lung transplantation, gathering in a meeting; (C) in 2017, Dr. Chen took charge of the Lung Transplant Center at the Beijing-China Friendship Hospital; photo taken with the former chief of the hospital, Dr. Yuling Xin.

Figure 2

Attempts before fully established lung transplantation techniques. History of lung transplantation with those pioneers who began their work before the 1990s.

Figure 3

Representative chart of indication distribution in registries in Greater China region. (Data representation as, case number, %) (A) Data collected from established registry since 2015 in China; (B) data subtracted from (26); (C) data subtracted from (27).

Figure 4

Expanding volume of lung transplantation centers in China. (A) Yearly lung transplantation volume in Wuxi center (blue bar) and Beijing center (orange bar), with the figure trend showing a sharp increase in the Beijing center in 2 years compared to 15 years at the Wuxi center; (B) with increment of lung transplantation nationwide since 2015, more cases have been performed in emerging centers.

Figure 5

Distribution model of qualified lung transplantation centers registered in China (red) and the emerging teams trained by the Wuxi or Beijing teams (blue). [Map cited from http://bzdt.ch.mnr.gov.cn/ and approved number GS (2019) 1671].

Figure 6

China organ donation and transplantation system structure, supervised by the National Health and Family Planning Commission (now nominated as the National Health Commission) with the steering committee board, composing of five systems (Reorganized from NHC official files).

Figure 7

China lung transplantation registration. (A) Statistic data of yearly organ donation quantity and donors, presented by PMP (Data from National Health Commission). Registration system (B), quality management and control workflow (C) of lung transplantation data in China.

Figure 8

Organ donation, allocation and transplantation across China. (A) Official approval file for construction of the “Green channel” organ transplantation; (B) confirmation file for receiving the allocated organs; (C) before the donation procedure, surgeons stood in silent tribute for the donor.

Figure 9

Patient Groups established for assisting better treatment for pneumoconiosis (A), to find suitable oxygen machine for patients (from “Love save pneumoconiosis” foundation and by courtesy of Dr. Jingyu Chen). (B) Patients education activities and research attendance of LAM patients (from “LAM CHINA” foundation, courtesy of Dr. Ji Zhang). (C) Commemoration of PAH day in 2012 by PAH patients and doctors, which was reported and promoted by PAH UK (from “iseek” foundation and by courtesy of Dr. Jingyu Chen).

Figure 10

China Lung Transplantation Alliance (CLTA) and its operation illustration. (A) Establishing memorial ceremony of the China Lung Transplantation Alliance (CLTA), on Sep 21st, 2018 (courtesy of Dr. Jingyu Chen). (B) Representative model for alliance member operation. When receiving notification of simultaneously donation of two lungs, a “third” center of organ procurement team in the nearest location to both donors and recipients responds. A day of “to-and-fro” trip help three centers for donation and transplantation. [Map cited from http://bzdt.ch.mnr.gov.cn/ and approved number GS (2016) 1596].