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A fatal harvest

Evidence points to China forcing prisoners of conscience into organ donation, and some countries have banned medical tourism to China as a result. Will the United States do the same?

A fatal harvest

Medical staff carry donated organs at the hospital in Hefei, capital of east China’s Anhui province.

Dai Ying, a middle-aged Chinese woman, has fake front teeth. She says she lost her real ones when guards at a Chinese prison forced her to end a hunger strike by ramming a screwdriver between her clenched teeth. Her fingers are also deformed. She says that’s because the guards forced her and other prisoners to make leather shoes each day from 7:30 a.m. to midnight. She’s also blind in her left eye, a result of guards repeatedly shocking her with electric prods.

Her crime? Refusing to recant her belief in Falun Gong, a banned spiritual movement in China based on Buddhism and qigong exercises.

Dai calmly described these experiences from her stay in a Chinese prison from 2000 to 2005 as she sat in front of the China Tribunal in London last December. Headed by Sir Geoffrey Nice, a prosecutor at the UN criminal tribunal for the former Yugoslavia, the China Tribunal was initiated by the International Coalition to End Transplant Abuse in China.

One part of Dai’s testimony was of particular interest to the panel: Dai recalled that in April 2004 prison guards brought all the Falun Gong practitioners to the labor camp clinic where doctors drew large amounts of blood, performed X-rays and electrocardiograms, and pressed on their kidneys. None of the other prisoners at the camp received the tests. Afterward, Dai said, some of the Falun Gong members disappeared, perhaps transferred to other camps, and she never heard from them again.

Why give these tests when Dai’s torture clearly revealed that authorities did not care about her well-being? One chilling possibility: to create a giant organ bank where Falun Gong practitioners are killed to order for organ transplants.

At the same time that Chinese authorities were rounding up hundreds of thousands of Falun Gong practitioners like Dai, China’s organ transplant industry began to take off, as people around the world came to China for transplants due to the extremely short wait times. The Chinese government poured money into the building of large transplant hospitals and the training of doctors. Yet without a history of organ donation and an insufficient number of executed prisoners, the Chinese government had no plausible explanation for where the organs came from.

The seven-person panel of the China Tribunal listened to hours of testimony from Falun Gong practitioners, detained Uighurs, researchers, human rights activists, and doctors and read thousands of pages of reports.

It is impossible to speak with victims of organ harvesting, as the extraction process kills them. Other evidence is difficult to come by as victims’ bodies are cremated. Some Falun Gong activists are guilty of exaggeration, yet the combination of multiple witness testimonies, the short wait times for organs, and the data on the mismatch of transplant numbers and eligible voluntary donors led the panel members to say in an interim judgment in December 2018 that they “are certain—unanimously, and sure beyond reasonable doubt—that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims.”

This contradicts the government’s claim in 2015 that it no longer used the organs of executed prisoners for transplants, only voluntary donors. (The Chinese government has never admitted that it used the organs of prisoners of conscience.)

In its final report on June 17, the tribunal also stated that it feared Uighurs, an ethnic minority in China’s western Xinjiang region, were at high risk of organ harvesting as Chinese officials began blood and DNA testing the population in 2016 and placed more than 1 million in massive concentration camps. The tribunal determined that the Chinese government’s actions against Falun Gong adherents and Uighurs constituted crimes against humanity and asked other international groups to determine whether they also qualify as genocide.

Horacio Villalobos/Corbis via Getty Images

Falun Gong practitioners demonstrate against organ harvesting in Lisbon, Portugal. (Horacio Villalobos/Corbis via Getty Images)

SUSPICIONS ABOUT FORCED ORGAN HARVESTING in China have been around for years. In 2005 a patient with severe heart failure told Dr. Jacob Lavee of Tel Aviv that he was tired of waiting for a heart transplant in Israel and that his insurance company had helped him set up an appointment to have a heart transplant in two weeks’ time in China. Lavee was shocked: In order for a transplant to succeed, the donor has to die less than 24 hours beforehand, and at the time China had no voluntary donor system. How could they ensure the exact date of someone’s death?

Lavee’s patient was the first Israeli to undergo a heart transplant in China, fully reimbursed by his insurance company, and indeed had the surgery on the date promised. Nine more Israeli patients would go to China for transplants; four of them would die in China.

Lavee, who also testified at the China Tribunal, said he then began to research organ transplantation in China and discovered the Chinese government was harvesting the organs of executed prisoners as well as Falun Gong practitioners without their consent. Angered, he began campaigning for the Israeli government to ban its citizens from going to China for organ transplants. In 2008 Israel’s parliament passed the Organ Transplant Law that stopped Israelis from going to China for transplants and banned insurance companies from reimbursing the operations.

By this time China had become a popular destination for patients in need of an organ transplant due to its short wait times: In 2003 one transplant hospital in China advertised that it would take one week to one month to procure a kidney, and if the kidney turned out not to be a suitable match, the hospital could try a transplant with a different kidney one week later, according to a 2006 report by Canadian human rights lawyers David Matas and David Kilgour. In Canada the median waiting time for a kidney in 2003 was 32.5 months.

Chinese officials claim the country performs 10,000 transplants each year. But Matas, Kilgour, and U.S. journalist Ethan Gutmann examined the transplant programs of hundreds of hospitals in China—analyzing bed counts, hospital revenue, surgical personnel, and so forth—and found the number was actually between 60,000 and 100,000. That raises the question: Where do those organs come from?

After the publication of the 2006 report, Chinese officials claimed the organs came from executed prisoners. Then in 2013 it started a nationwide voluntary donor system and by 2015 claimed that it had completely stopped using the organs of executed prisoners.

Lavee said he felt he had scored a victory after Israel’s Organ Transplant Law passed in 2008. For a time, he was able to convince medical professionals to boycott academic events put on by Chinese transplant doctors. But when Huang Jiefu, head of the China National Organ Donation and Transplantation Committee, announced in late 2014 that China had reformed its system, everything changed. Even the Vatican welcomed China back with open arms. “That unfortunately has totally changed the attitude of the international transplant community because now … we see all the Chinese transplant surgeons and physicians coming to international meetings and their papers being published,” Lavee said at the tribunal.

Yet finding holes in the Chinese government’s claims is as simple as looking at the numbers from each possible organ source. First, executed prisoners. Although China’s execution rate is a state secret, the number of executions has decreased after the Chinese government allowed the Supreme People’s Court to review all death sentences in 2007. Dui Hua Foundation, an NGO focused on prisoners in China, estimated that China executed 6,500 people in 2007, versus 2,400 in 2013. If executed prisoners were the only source of organs, the number of transplants would have also gone down.

To imagine that China’s donor rate is 140 times greater than the rates of the United States and other countries that have mature voluntary donor programs is implausible. 

Furthermore, researcher Matthew Robertson pointed out some prisoners have hepatitis B or blood-borne illnesses that make their organs ineligible for transplantation. Prisoners sentenced to death are executed seven days later, so again there’s no way to have enough “on-demand” organs strictly from prisoners.

The other organ source beginning in 2013 is from voluntary donors. In 2010 China first started a pilot program in 19 provinces, but it only resulted in a total of 207 donations. But it claimed that when the system expanded nationwide in 2013, voluntary donations made up 23 percent of transplants. Just one year later that jumped to 80 percent, and by 2015 China claimed that all organ transplants are from donations.

Again the numbers don’t add up. While Americans had 140 million registered organ donors in 2017, only 10,284 were eligible—meaning they died and had usable organs—according to a report by Doctors Against Forced Organ Harvesting (DAFOH). That’s less than 0.008 percent of the total pool. In contrast, China claimed 375,000 registered donors that year, and from that 5,146 were eligible donors, a rate of 1.4 percent. To imagine that China’s donor rate is 140 times greater than the rates of the United States and other countries that have mature voluntary donor programs is implausible.

The other possible source is prisoners of conscience, namely Falun Gong practitioners. In 1999, one year before China’s push toward organ transplantation, authorities cracked down on the spiritual group as they felt threatened by the group’s size and independence from the state. Authorities threw hundreds of thousands into extrajudicial detention where they faced torture, forced labor, and, for some, death.

Some family members of Falun Gong practitioners who died in detention say they found their loved ones’ bodies beaten and bruised, with rough stitching on the torsos. Authorities then cremated the bodies without consent.

Murad Sezer/Reuters/Newscom

Gulbahar Jelilova (Murad Sezer/Reuters/Newscom)

UIGHURS, A LARGELY MUSLIM ETHNIC MINORITY living in the oil-rich western region of Xinjiang, may become another victim of forced organ harvesting. A Uighur separatist movement launched scattered terrorist attacks in the past, and the Chinese government has used counterterrorism as an excuse to transform the region into a surveillance state, sending more than 1 million Uighurs into reeducation camps and tracking the movements of every citizen.

In 2017 Human Rights Watch reported that authorities have done blood and DNA testing on all Uighurs between the ages of 12 and 65 in Xinjiang, but none of the Han majority. Released Uighur detainees recalled that inside the camps they received similar medical tests as the Falun Gong practitioners.

Gulbahar Jelilova, a Uighur from Kazakhstan, told the panel that in May 2017 authorities arrested her on accusations that she transferred money to a Turkish organization, which she denies. She was held in three detention centers before being released in September 2018 due to pressure from the Kazakh government. On the night of her arrival, guards stripped her naked and took blood and urine samples. A week later, she said, the guards placed black hoods over the heads of her and other prisoners and again took blood samples and ultrasounds. These continued at the other prisons where she was held.

Radio Free Asia reported in 2018 that authorities in Xinjiang were rapidly constructing crematoriums in the area even though traditional Uighur customs require burials complete with a religious ceremony. The Uighur diaspora believes this is an effort to wipe out Uighur culture as well as destroy any evidence for mistreatment inside the camps—or possibly missing organs.

This may not be the first time Uighurs have been targeted for organ harvesting. Enver Tohti, a Uighur doctor, told the panel that while he was working as a surgeon at an Ürümqi hospital in 1995, his two chief surgeons told him to drive to an execution ground and extract the liver and two kidneys of a prisoner who had just been shot by a firing squad. Tohti says he was shocked to find when he cut him open with a scalpel that he was not yet dead, yet his superiors forced him to continue extracting his organs. He says the chief surgeon told him not to tell anyone what had happened.

The tribunal said in its report that it did not have enough evidence to conclude that the government was harvesting the organs of Uighurs, but “the vulnerability of the Uighurs to being used as a bank of organs is also obvious.” China declined to participate in the tribunal and claims that it follows international medical standards in transplantation. Ahead of the final judgment, the Chinese Embassy called organ harvesting a “rumor,” according to The Guardian.

After the tribunal released its findings, DAFOH called on Congress to launch a formal investigation into China’s practices and whether they constitute genocide. While countries such as Norway, Israel, and Spain have banned medical tourism to China, the United States and the United Kingdom have not. In 2016 the U.S. House of Representatives passed a resolution condemning organ harvesting in China and calling on the State Department to investigate further, yet State officials have not yet done so.

“It’s time for the U.S. government to not just pass a resolution, not just say ‘this is horrible,’ but to take action now,” said Ann Corson, spokeswoman at DAFOH. She would also like to see the international medical community disengage from the Chinese transplant community.

U.S. Rep. Chris Smith, R-N.J., also called on the State Department to conduct a more detailed analysis on forced organ harvesting in its human rights report and deny entry visas to doctors involved in organ harvesting.

“There is mounting and credible evidence that a corrupt organ transplant system has operated in China, targeting prisoners and detained Falun Gong,” Smith said in a statement. “We must find ways to stop the black market in organs globally, including by curtailing the practice of transplant tourism to China, as other countries have done.”

June Cheng

June Cheng

June is the East Asia correspondent for WORLD Magazine. Follow June on Twitter @JuneCheng_World.