678 Higgins WC, et al. J Med Ethics 2020;46:678–684. doi:10.1136/medethics-2019-106044 Against the use and publication of contemporary unethical research: the case of Chinese transplant research Wendy C Higgins , 1 Wendy A Rogers , 1 Angela Ballantyne, 2 Wendy Lipworth 3 Feature article To cite: Higgins WC, Rogers WA, Ballantyne A, et al. J Med Ethics 2020;46:678–684. 1 Department of Philosophy, Macquarie University, North Ryde, New South Wales, Australia 2 Centre for Biomedical Ethics, National University of Singapore; and Department of Primary Health Care and General Practice [Wellington], and Bioethics Centre [Dunedin], University of Otago, Wellington, New Zealand 3 Sydney Health Ethics, The University of Sydney, Sydney, New South Wales, Australia Correspondence to Professor Wendy A Rogers, Department of Philosophy, Macquarie University, North Ryde, NSW 2109, Australia; wendy.rogers@mq.edu.au Received 19 December 2019 Revised 7 February 2020 Accepted 5 March 2020 Published Online First 1 July 2020 ► http://dx.doi.org/10.1136/ medethics-2020-106535 ► http://dx.doi.org/10.1136/ medethics-2020-106581 ► http://dx.doi.org/10.1136/ medethics-2020-106719 ► http://dx.doi.org/10.1136/ medethics-2020-106878 © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Recent calls for retraction of a large body of Chinese transplant research and of Dr Jiankui He’s gene editing research has led to renewed interest in the question of publication, retraction and use of unethical biomedical research. In Part 1 of this paper, we briefy review the now well-established consequentialist and deontological arguments for and against the use of unethical research. We argue that, while there are potentially compelling justifcations for use under some circumstances, these justifcations fail when unethical practices are ongoing— as in the case of research involving transplantations in which organs have been procured unethically from executed prisoners. Use of such research displays a lack of respect and concern for the victims and undermines efforts to deter unethical practices. Such use also creates moral taint and renders those who use the research complicit in continuing harm. In Part 2, we distinguish three dimensions of ’non-use’ of unethical research: non-use of published unethical research, non-publication, and retraction and argue that all three types of non- use should be upheld in the case of Chinese transplant research. Publishers have responsibilities to not publish contemporary unethical biomedical research, and where this has occurred, to retract publications. Failure to retract the papers implicitly condones the research, while uptake of the research through citations rewards researchers and ongoing circulation of the data in the literature facilitates subsequent use by researchers, policymakers and clinicians. INTRODUCTION AND BACKGROUND In February 2019, there was a call for the retrac- tion of 445 papers reporting on the outcomes of Chinese transplant research. 1 The authors of this call, published in February 2019 in BMJ Open, claimed that the papers should be retracted because the ‘trans- plant community has failed to implement ethical standards banning publication of research using material from executed prisoners’. 1 Taking organs from executed prisoners is in breach of internation- ally recognised ethical guidelines which require the autonomous and voluntary consent of donors and reject the possibility that consent can be obtained from individuals facing the death sentence. 2 3 Further, guidance from The Transplantation Society (the peak international body for transplantation research and practice) prohibits presentation or publication of any subsequent research based on transplantation of organs taken from prisoners. 4 Those authors calling for retractions noted that all of the papers included at least some data from transplants that occurred before the alleged move to a fully volunteer Chinese organ donor programme on 1 January 2015 and was thus prima facie in breach of international ethical guidance. Prior to 2010, the Chinese organ trans- plantation system had relied almost exclusively on organs procured from executed prisoners. 5 Between 2010 and 2015, a pilot volunteer donor scheme commenced. By 2015 the Chinese govern- ment claimed to have moved to a 100% volun- teer donor system. 6 There is, however, evidence of ongoing killing of prisoners of conscience for their organs; 7 and doubts remain regarding both numbers of voluntary donors in China and the voluntariness of in-hospital donations due to large payments to families of the deceased. 8 In calling for a mass retraction, the authors of the review claimed that retention of the research in the literature raises questions of complicity and hypocrisy on the part of researchers, peer reviewers and journal editors who simultane- ously publicly condemn and benefit from the use of executed prisoners’ organs in research. 1 The authors did not, however, engage in detailed arguments regarding use of unethical research or establish the different ways in which research may be ‘used’. Nor did they locate their claim in the wider literature about the permissibility of using unethical research, where debates are ongoing. This paper addresses these issues. In Part 1, we systematically evaluate arguments for and against the use of unethical research[ i ] as relevant to Chinese transplant research. We conclude that the research should not be used; largely because the alleged abuses are ongoing. In Part 2, we articulate three dimensions of ‘non- use’, including non-use of published results by researchers, non-publication, and retraction and argue that all three types of ‘non-use’ should be upheld in the case of Chinese transplant research. We encourage the research community to consider the relevance of our arguments to other instances of ongoing unethical research including gene editing and DNA surveillance. PART 1: AGAINST THE USE OF CHINESE TRANSPLANT RESEARCH There is a large literature on the morality of using unethical research, dating primarily from Nazi and i Here we intend the term ‘unethical research’ to include both to research that is itself unethical (eg, lying to participants) and research that derives data from unethical practices, such as taking organs from executed prisoners. on December 4, 2021 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2019-106044 on 1 July 2020. Downloaded from