Pediatric Organ Transplantation in China

Key findings from this study

This research indicates that:

• Pediatric kidney, liver, and lung transplant volumes increased substantially between 2015 and 2024, with kidney transplants rising 4.9-fold.
• Priority allocation policies implemented in 2018 preferentially directed organs from pediatric donors to pediatric recipients.
• Reported 5-year survival rates reached 70.0% for heart and 95.5% for kidney transplants.
• Major transplant centers are geographically concentrated in four cities, creating regional access disparities.
• Data accessibility, donor shortages, and regional disparities remain substantial implementation challenges.

Overview

This review synthesizes national data on pediatric organ transplantation in China from 2015 to 2024, examining trends following the 2015 reforms that established voluntary citizen donation as the sole legitimate organ source. The analysis documents clinical outcomes, regulatory frameworks, and ongoing implementation challenges across a healthcare system serving over 1.4 billion people.

Methods and approach

Data were obtained from the Report on Organ Donation and Transplantation in China (RODTC) spanning 2015 to 2024. Pediatric patients were defined as those under 18 years of age. The review synthesizes information from national registries, regulatory documents, and transplant center reports to characterize trends and outcomes.

Results

Pediatric kidney, liver, and lung transplant volumes increased 4.9-fold, 2.1-fold, and 7.5-fold respectively from 2015 to 2024. Pediatric heart transplantation increased 2.5-fold between 2019 and 2024. In 2019, child donors represented 8.20% of the deceased donor population. The China Organ Transplant Response System (COTRS) implements transparent allocation protocols, with 2018 policy modifications granting priority to pediatric recipients and mandating preferential allocation of pediatric donor organs to pediatric patients.

Leading transplant indications varied by organ type: non-ischemic cardiomyopathy for heart transplantation, bronchiolitis obliterans for lung, biliary atresia and metabolic liver disease for liver, and glomerulonephritis for kidney. Reported 5-year survival rates were 70.0% for heart and 95.5% for kidney transplants. Major transplant centers concentrate in Shanghai, Guangzhou, Zhengzhou, and Beijing. Four national registries enable lifelong follow-up and quality monitoring across the system.

Implications

The 2015 regulatory reforms and subsequent allocation prioritization policies have created conditions supporting rapid growth in pediatric organ transplantation. Strengthened ethical oversight and transparent allocation mechanisms have enabled significant volume increases while maintaining favorable survival outcomes, suggesting that institutional frameworks substantially influence transplant access and equity.

Regional concentration of major transplant centers in four cities presents challenges to equitable access across China's diverse geography. Data accessibility limitations, regional disparities in infrastructure and expertise, and continuing donor shortages constrain further expansion. Regional collaboration strategies, particularly coordination with Hong Kong and Macao systems, represent potential mechanisms to address supply constraints and improve outcomes for underserved populations.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.