Forced Organ Harvesting in China - A Research Paper by Sylvia Wang

 

Introduction

Over the past two decades, the People’s Republic of China has built one of the largest organ transplantation systems in the world. China’s organ transplant industry emerged within a matter of years despite a paucity of donations, and concerns regarding the sources of the organs have existed since the industry’s inception. Chinese officials have provided shifting explanations for organ sources over the years as investigations revealed mounting evidence of abuses. 

In 2006, allegations first came forward that prisoners of conscience were being killed for their organs in China.(1)(2) This sparked investigations by researchers all around the world, including former Canadian Secretary of State for the Asia-Pacific, David Kilgour, Canadian human rights lawyer David Matas, and London-based investigative journalist Ethan Gutmann. Kilgour and Matas compiled their findings in the book Bloody Harvest where they came to “the regrettable conclusion that the allegations are true.”(3) Gutmann reached similar conclusions in his book The Slaughter.(4) In June 2016, Kilgour, Matas, and Gutmann published Bloody Harvest/The Slaughter: An Update where they state, “The ultimate conclusion is that the Chinese Communist Party has engaged the State in the mass killings of innocents, primarily practitioners of the spiritually-based set of exercises, Falun Gong, but also Uyghurs, Tibetans, and select House Christians, in order to obtain organs for transplants.”(5)
 

An examination of available evidence asserts a substantial discrepancy between the number of transplants and the number of organ sources identified by the Chinese government- death-row prisoners and voluntary donors. This discrepancy leads many investigators, including Kilgour, Matas, and Gutmann, to conclude the above groups to have been the source of many, if not most, organs for transplants in China.
 

Organ Transplantation in China pre-2000
 

China’s first reported organ transplantation took place in 1960.  It was performed by Wu Jieping, a Chinese Communist Party member who would later on become one of China’s most prominent doctors.(6) However, there is little information surrounding the transplant, suggesting the patient did not survive long after the surgery.
 

Political abuses have accompanied the organ transplantation industry in China since almost the beginning. In 1970, the live organ harvesting of 18-year old Li Lian was the first reported case of such. Li Lian was a former Red Guard commander who was sentenced to death for questioning the political theories of Lin Biao, Party leader Mao Zedong’s second-in-command at the time.(7) The most well-known early case is that of Zhong Haiyuan, a young woman who was a middle school teacher in Ganzhou, Jiangxi Province, China. One of Haiyuan’s colleagues, Zhu Yi, had written articles and posters critical of Mao Zedong’s successor, Hua Guofeng. Zhu Yi gave them to Haiyuan for safekeeping when he learned that police were searching for him, and when the articles were later found in Haiyuan’s possession, Haiyuan was sentenced to death for “counterrevolutionary” offenses. On April 30, 1978, Zhong Haiyuan was shot twice in the head but did not die. She was taken to an operating facility on the prison grounds where both of her kidneys were removed, one of which was transplanted to the son of a high-ranking military official.(8)
 

From 1983 until 2000, China’s organ transplant industry experienced steady growth as a result of medical advancements and the Anti-Crime Campaign. The introduction of immunosuppressant drugs, such as Cyclosporine A, greatly increased the success rate of organ transplants. A series of “strike hard” or “crackdown on crimes” (yan-da) campaigns increased the number of criminals sentenced to death and hence China’s sole available organ source.(8)
 

Organ Transplantation in China post-2000
 

Starting in the year 2000, the organ transplant industry in China began to experience tremendous growth. The number of transplant centers in mainland China grew from 150 in 1999 to 570 in 2004, including 56 for heart transplants, 166 for liver transplants, and 348 for kidney transplants.(9)(10) China’s military-medical complex became heavily invested in transplant activity and research as the state began subsidizing organ transplantation projects. This, however, coincided with a gradual, then sudden drop in executions of death row prisoners.(11)(12)(13) These two conflicting trends raise questions about the source of the organs.
 

    1. Growth trajectories of China’s transplant industry

The surge in organ transplants after 2000 is indicated by remarks from senior transplant surgeons themselves.
 

According to He Xiaoshun, a member of the Expert Committee of the Human Organ Donation Commission and vice president of the First Affiliated Hospital of Sun Yat-sen university, “the year 2000 was a watershed moment for the organ transplant industry in China; the number of liver transplants in 2000 reached 10 times that of 1999. By 2005, the number had tripled further [since 2000].”(14)
 

On May 11, 2011, Wu Mengchao, president of the Affiliated Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University and “father of hepatobiliary surgery in China,”(15) said in an interview with Sina that “in terms of liver transplants, our quantity has been the largest in the world. The quality and result are also good. We have caught up with international standards.”(16)
 

Since 2000, the United States has performed an average of 6,600 liver transplants a year with 130 million registered donors.(17)(18) Tianjin’s Oriental Organ Transplant Center’s annual transplant volume alone surpassed the annual liver transplant average in the U.S.(19)
 

On-demand Transplants

Around the world, organ transplants are conducted only as donors become available and it may take years for a matching organ to become available. In China, however, organ transplants are conducted on demand with short wait times and can be scheduled in advance. In addition, organs, including vital organs, are usually taken from living sources and the right match can be made available as needed.
 

    1. Short waiting times

In China, where organ donation is culturally taboo, there was no voluntary organ donation system until 2010. But even before 2010, hospitals in China were quoting weeks or even days for organ transplant wait times, including re-transplants in case of failure.
 

For example, in 2004, the First Affiliated Hospital of China Medical University, China International Transplantation Network Assistance Center (CITNAC) reported on its website “As for kidney transplantation, it may take one week to find an HLA-matched donor, the maximum time being one month … If an abnormal situation with the donor’s organ is discovered, the center will be responsible for choosing a donor for the patient and commence the operation again within one week.”(20) Shanghai Changzheng Hospital’s organ transplant department claimed on its application form for liver transplants that the shortest waiting time was 4 hours.(21) Many Chinese hospitals publicly advertised these short waiting times, sending the message that donors were available as needed. These advertisements were mostly purged after 2006 when allegations of forced organ harvesting of Falun Gong practitioners emerged.
 

The short wait times suggest that China has a large number of readily available sources of organs waiting to be matched with patients. In cases of vital organs, such as the liver, the transplant of such an organ from the donor must coincide with the donor’s death. These two facts lead to the conclusion that China has a large number of captive donors who, when matched with patients, are killed for their organs.


    2. Transplants scheduled in advance
 

Most transplant surgeries in China are scheduled ahead of time, as seen reflected by hospital profiles and individual accounts, including foreign patients.
 

In November 2016, Australian Senator Derryn Hinch told Parliament that he was encouraged to get an organ transplant in China after being informed he only had 12 months to live.(22) In 2005, an Israeli patient traveled to China to get a heart transplant that was scheduled two weeks in advance.(23) In August 2016, a Canadian patient was able to receive a kidney transplant after waiting only three days in China.(24) These cases suggest that the Chinese transplant system not only guarantees a donor’s death, but also the time of the donor’s death.
 

    3. Organs from living sources
 

A transplantation ethical norm known as the “dead donor rule” stipulates that organ donors must be dead prior to procurement of organs and that organ procurement itself must not cause the death of the donor. However, there is evidence to show that some organs procured in China were from living people who were killed in the process.
 

The CITNAC website stated between 2004 and 2007 that “In China, we carry out living donor kidney transplants. It is completely different from the cadaveric kidney transplants you hear about in Japanese hospitals and dialysis centers.”(25) (26)During this time, China still did not have an organ donation system.
 

Dr. Liao Jixiang, an organ transplant coordinator at People’s Liberation Army Hospital No. 303 in Nanning, Guangxi Province, said on May 30, 2017, “We often have a lot of [organ sources] here and use those people from their teens to twenty years old, those kids, that kind of quality is very good … and we can’t use them all … for example, after procuring 100 livers, maybe our own center only does 20 transplants, and the other 70 or 80 are reallocated [to other transplant centers]. So, we usually keep and use the good ones, that’s for sure.”(27)
 

Cover Up and Falsification of Official Data
 

The Chinese government has hidden data, retroactively manipulated data, and provided inconsistent explanations for organ sources, especially after allegations of forced organ harvesting of Falun Gong practitioners emerged in 2006. 

The Chinese Communist Party’s official explanation  as to the source of organs has changed three times. Prior to 2005, China’s official stance was that organs were primarily sourced from voluntary donors. In 2006, China acknowledged for the first time that the majority of transplant organs came from death-row prisoners.(28) After live organ harvesting was exposed in 2006, China returned to its initial denial.(29)(30) Between 2007 and 2015, China claimed that the source of organs had primarily been death-row prisoners all along.(31) From 2015 and onwards, China has claimed that organs are sourced solely from voluntary, non-prisoner deceased donors.(32)
 

Instead of increasing transparency over time, China has been increasing opacity. There has been increasing cover up with the deletion of cited sources as reports emerge on organ transplantation in China. While the deletion of these sources does not necessarily indicate that the deleted information is true, it does show that what was deleted does not correspond with the current political stance of the Party.
 

    1. Declining death-row executions since 2000
 

The Chinese Communist Party provides no reliable, official national statistics on death penalty numbers, just as with many other aspects of the Party’s judicial activities. However, death penalty numbers can be estimated and a general consensus is that the number of death-row executions in China has been steadily decreasing since 2000, at which it was around 10,000 per year.(33)
 

Dui Hua, a human rights NGO, compiled data which shows an annual decline in death-row executions in China since 2000.(34)

The annual decline in death-row executions is at variance with the increase in organ transplants in China since 2000. Thus, it is clear that death-row prisoners can only account for a small fraction of the total number of transplants performed in China. While this does not mean that death-row prisoners were not maximally exploited to provide organs on demand, this does suggest there are alternative populations, beyond death-row prisoners, which are being used to source organs in large numbers.
 

    2. Blockage and deletion of information

Following the release of the Kilgour/Matas report in 2006, many hospital and transplant organization webpages and even entire websites were deleted.
The Society of Transplantation website (http://www.cstx.org/) under the Chinese Medical Association (http://www.cma.org.cn/) became inaccessible shortly after the live organ harvesting from Falun Gong practitioners was publicized on March 9, 2006. Searching for the Society of Transplantation website on www.archive.org shows that the website was taken offline in April 2006.
 

A report published by Xiangya Hospital of Central South University on May 16, 2006 titled “Our Hospital Again Sets a New Record in Organ Transplant Surgeries” stated the hospital set a new record by performing 2 liver, 7 kidney, and 8 cornea transplants in one day.(35)
 

David Kilgour and David Matas were able to gather information about transplant volume from the China Liver Transplant Registry in Hong Kong for their book Bloody Harvest. After the book’s publication, public access to the China Liver Transplant Registry was shut down and access is only available to those with a Registry issued login name and password.(36)
 

    3. The pretense of donor transplants

Many Chinese hospitals list living-donor and donation after cardiac death (DCD) as their main organ sources. However, the actual number of donations from these groups are extremely low.
 

Chinese tradition requires that bodies remain intact after death, so China has no significant voluntary organ donation. Between 2003 and August 2009, only 130 citizens successfully donated their organs after death in mainland China.(37)
 

    4. Falsified voluntary donor registry data
 

China’s new voluntary organ donation system has a national computerized organ allocation and registration infrastructure, known as the China Organ Transplant Response System (COTRS). Chinese officials have reported extraordinary successes from the pilot program. According to COTRS data, annual voluntary deceased donors increased from 34 to 6,314 from 2010 to 2018. Kidneys and livers transplanted increased from 63 in 2010 to 10,481 in 2016 (the last year for which precise data is available). However, a paper published in the journal BMC Medical Ethics in November 2019 found that these numbers do not appear to represent genuine transplants but instead falsified data as a result of statistical manipulation.(38)
 

The BMC Medical Ethics paper found that the COTRS data(39) presented in 2017 for deceased donors, deceased kidney, and deceased liver transplants conforms almost perfectly to a quadratic equation, meaning the growth of the data is extremely smooth.(38) The R-squared statistic, a commonly used measure-of-fit, was used to measure how closely fitted COTRS data was to quadratic functions. 

An R-squared value of 1 means the data is a perfect fit, meaning there is no difference between the data and the line which the data is being fitted.

The R-squared values for these data are 0.9993, 0.9995 and 0.9989 for donors, kidneys and livers respectively. This means the data is extremely close to the fitted quadratic functions. When similar data provided by the Global Observatory on Donation and Transplantation (managed by the WHO) for 50 other countries were fitted, the country with the closest R-squared was 1.30% away from 1(38); China’s three R-squared values ranged between .112% to .0478% away from 1.
 

The finding that China’s data for voluntary deceased donors, deceased kidney, and deceased liver transplants almost perfectly conforming to three quadratic equations is extremely surprising. A complex, growing organ transplantation system is not expected to produce genuine data with such a smooth curve. The authors of the BMC Medical Ethics paper believe the most plausible explanation for this is that COTRS data “is manual and deliberate manipulation in order to fit a target donor rate, with a mathematical function selected as the most efficient way to both 1) reach this goal in an apparently natural manner, and 2) provide a common reference and guide for derivative data through the Chinese system. It is the exquisite precision of the fit of the data to the Procrustean Bed of a smooth mathematical formula that we believe rules out competing explanations.”(38)
 

Prisoners of Conscience as Organ Sources
 

Since the official explanation of death-row prisoners being the main source of organs is at odds with available evidence, there must be alternative populations as sources of organ procurement.
 

    1. Evidence of Falun Gong practitioners as an organ source
 

Falun Gong is a Chinese meditation practice and spiritual belief which, by the end of the 1990s, Chinese officials estimated had over 70 million people practicing in China.(40) Starting July 20, 1999, the Chinese Communist Party launched a violent, eliminationist, extralegal political campaign towards Falun Gong.(41) Investigators estimate that there may be as many as 1 million held in custody at any time given China’s vast network of labor camps.(42)
 

Falun Gong practitioners report being subject to blood tests and medical examinations which are not administered to the general prison population.(43)(44) They are told of their test results and in the months that followed, tested prisoners begin disappearing without explanation.(45) China’s transplant industry began its rapid expansion just six months after the launch of the crackdown on Falun Gong, which coincides with the decline in the death-row population. There are numerous cases of young, healthy detainees dying in custody who are simply cremated. Their families are provided no information, only receiving an urn of ashes.(46) There are also documented cases of families being able to see the dead body of the detainee, which has scars indicating the body was tampered with. These scars are consistent with organ removal.(47)
 

    2. Evidence of Uyghurs as an organ source

Beginning in summer 2017, China began mass incarcerating Uyghur (though also Kazakh and Kyrgyz) Muslims in the Xinjiang Uyghur Autonomous Region. Detainees are held in large re-education camps where in addition to political and religious “re-education”, they also receive “vocational training.”(48) While relatively few reports of deaths of Uyghurs in custody exist, Uyghurs are subject to coercive state power and there is evidence to suggest they are another group targeted for organ harvesting.
 

Extensive surveillance in Xinjiang is used alongside widespread, coercive DNA and blood type collection of all Xinjiang residents between 12 and 65 years of age.(49) Several Uyghur and Kazakh detainees have testified to the China Tribunal, a people’s tribunal investigating allegations of forced organ harvesting from prisoners of conscience in China, that they were administered blood tests, urine tests, and physical examinations consistent with those required for assessing organ health. Gulbahar Jalilova, a Kazakh businesswoman, stated in her testimony: “On the night of arrival at the No. 3 prison, I was stripped naked for a medical examination. They took [a] blood sample and urine sample before placing me in a cell. In less than one week, I along with other prisoners with black hoods over our heads were taken to an unknown place, there was medical equipment in the corridor, we were examined and blood samples were taken, and we also had ultrasound tests. We were examined once a week stripped naked. I fainted once when I was in theNo. 3 prison, I was taken to the prison hospital where I saw many other prisoners and we all had medical examinations almost daily. In the No. 2 prison, there is a big medical clinic, we were examined regularly [using] blood samples and ultrasound tests. We had injection once every 10 days. On the 27th of August 2018, before I was due to be released, I was taken to a big prison hospital for a check-up.”(50)
 

Conclusion
 

There is a substantial amount of evidence to believe that forced organ harvesting of prisoners of conscience in China is being used to source organs for China’s massive organ transplantation industry. This is an inferred conclusion as, with other coercive acts, forced organ harvesting takes place behind closed doors where it is unlikely for defectors with primary pieces of evidence to emerge. The evidence provided above may be indirect, but should not be easily dismissed. Only a few possible explanations are yielded by the evidence, and the forced organ harvesting of prisoners of conscience is the most plausible explanation.




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42. Gutmann, "The Slaughter: Mass Killings, Organ Harvesting, and China’s Secret Solution to Its Dissident Problem." Appendix: “How Many Harvested? A Survey-Based Estimate of Falun Gong Murdered from 2000 to 2008.”
43. Matas D, Kilgour D. Bloody Harvest - Revised Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China. 2007. http://organharvestinvestigation.net/report0701/report20070131.htm#_Toc160145147
44. Gutmann E. Congressional Testimony: Organ Harvesting of Religious and Political Dissidents by the Chinese Communist Party (Hearing before House Committee on Foreign Affairs). 2012. http://archives-republicans-foreignaffairs.house.gov/112/75859.pdf
45. Ethan Gutmann makes extensive documentation of such cases in Gutmann, The Slaughter: Mass Killings, Organ Harvesting, and China’s Secret Solution to Its Dissident Problem. See also interview of asylee Yu Xinhui: World Focus, “生死之间2013版 (4)：活摘器官真相迟早会在中国大陆大白于天下 [Between Life and Death. 2013 (4): The Truth of Organ Harvesting Will Be Revealed in China Eventually].” https://www.youtube.com/watch?v=jfkxshiw08I
46. “中共强行火化冤死者遗体的目的是什么？[What Is the Communist Party’s Goal in Cremating Those Who Have Died Unjustly?].” https://www.minghui.org/mh/articles/2016/11/25/338146.html
47. Larry Ong, “Seeking Justice in a Lawless China,” https://www.theepochtimes.com/seeking-justice-in-a-lawless-china_1891080.html
48. Gerry Shih, “China’s Mass Indoctrination Camps Evoke Cultural Revolution.” https://apnews.com/article/kazakhstan-ap-top-news-international-news-china-china-clamps-down-6e151296fb194f85ba69a8babd972e4b 
49. Human Rights Watch “China: Minority Region Collects DNA from Millions.” https://www.hrw.org/news/2017/12/13/china-minority-region-collects-dna-millions#
50. Jelilova, “Statement of Gulbahar Jelilova for the China Tribunal.” https://chinatribunal.com/wp-content/uploads/2019/11/Gulbahar-Jelilova.pdf

 

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