Nothing Will Change Without Sanctions, Says Israeli Doctor Behind China Boycott

The academic boycott of Chinese doctors is a very significant pressure tactic,' says Israeli author of International Society for Heart & Lung Transplantation’s declaration of boycott against China.

Published in "Haaretz": https://www.haaretz.com/israel-news/2022-09-07/ty-article/.premium/nothing-will-change-without-diplomatic-sanctions-says-israeli-doc-behind-china-boycott/00000183-170a-de57-a7d3-ffbbee160000

After years of receiving reports about thousands of transplant operations being carried out in China contrary to the rules of medical ethics, this June the International Society for Heart & Lung Transplantation issued a declaration acknowledging that China executes prisoners in order to harvest their organs for transplantation.

As a result, doctors from China will no longer be able to publish their research in the society’s prestigious medical journal or to present the results of their work at its annual conference. Practically speaking, the decision amounts to the imposition of an academic boycott on Chinese researchers and surgeons who deal with heart and lung transplants, keeping them out of the international transplantation community.

The organization’s statement explains that there is an accepted ethical framework for organ transplantation, and in particular for heart and lung transplantation. This framework consists of several rules, including that the source of the organ can only be a donation – not through coercion, and not through buying and selling.

Medical ethics also require that the process be conducted transparently, under regulation and subject to national and international oversight. In light of all this, and based on the UN Declaration of Human Rights, the Declaration of Helsinki (regarding medical experiments on humans), the Declaration of Istanbul (regarding organ trafficking and “transplant tourism”) and the World Medical Association’s statement on the transplantation of organs and tissues, the international group is explicitly instructing its members not to cooperate with surgeons and researchers who took part or are liable to take part in “transplantation crimes” such as harvesting organs from condemned prisoners or organ trafficking.

The declaration was issued in wake of a study published in April of this year, which found proof that from 1980 to 2015, China made frequent use of vital organs that were harvested from people who were executed for this purpose. Thus the Chinese authorities and medical establishment violated the most important ethical rule regarding transplantation – the Dead Donor Rule, which forbids the donation of vital organs from living donors and causing a person’s death in order to harvest their organs.

The study also found that Chinese doctors essentially participated in executions. It proves the allegations that have been made against China for many years by human rights activists and investigative journalists, as well as an international tribunal headed by British jurist Sir Geoffrey Nice, which found that “the Chinese campaign of forcible organ harvesting from innocent victims is a crime against humanity and one of the gravest atrocities of the modern age.”

Among the main victims of this practice were members of the Falun Gong, a spiritual movement that was outlawed in China 20 years ago and which faces persecution from the authorities. In recent years, the list of victims has also included the ethnic minorities in Xinjiang Province in northwest China, particularly the Uyghur minority.

The organs harvested from executed victims are allegedly sold to wealthy Chinese in need of a transplant as well as to “transplant tourists” from other countries, who can find information about transplants in China in advertisements that appear in English, Russian and Arabic on the websites of Chinese hospitals.

A website for an agency from Tianjin that offers foreigners transplants in China.
A website for an agency from Tianjin that offers foreigners transplants in China.Credit: Screenshot

The authors of the April study were Matthew Robertson, a doctoral candidate at the School for Politics and International Relations at Australian National University in Canberra, and Prof. Jacob (Jay) Lavee, who is also the senior author of the ISHLT declaration on Chinese organ transplantation. Lavi is a medical consultant to the Sheba Medical Center administration and a member of the transplantation organization’s ethics committee. He established and formerly ran the heart transplant unit at Sheba and served as president of the Israel Transplantation Society.

“The academic boycott of Chinese doctors is a very significant pressure tactic that has previously shown that it can bring about change,” Lavee says, noting that a similar academic boycott of China by international transplantation societies was lifted in 2015 following China’s announcement of the reform of its transplantation system.

“We know that the Chinese did institute a reform, but they also still continue with the organ trafficking and the use of organs from executed prisoners,” Lavee says. He says he hopes that the new declaration will pave the way for other international societies to follow suit. “I’m not so naïve as to think that the desired change in China will come solely from the medical community. If diplomatic sanctions at the level of international relations are not added to the academic pressure, there won’t be any change.”

Prof. Jacob (Jay) Lavee, who is also the senior author of the ISHLT declaration on Chinese organ transplantation. Photo: Tomer Applebaum

The ISHLT is a professional and interdisciplinary international organization whose mission statement says it is “dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support and innovative therapies via research, education and advocacy.” It has approximately 3,000 members in 50 countries. For years Lavee has been involved in the subject of the medical ethics of transplantation in China and other countries. In 2008, he helped author the Israeli legislation preventing insurance companies and health maintenance organizations from funding transplants for Israelis in countries that engage in organ trafficking.

Lavee says that pressure was exerted on the ISHLT leadership to get it to back off of the boycott. But despite the pressure, the society issued its declaration and became the first international medical society to impose a new boycott on the Chinese medical establishment.

“Practically speaking, doctors’ academic advancement is dependent upon their ability to publish in scientific journals and present at conferences. Now those possibilities are blocked to the Chinese and I hope that this pressure will bring about an end to the criminal use of the organs of condemned prisoners,” Lavee says.

China Harvested Organs From Living People, Doctors Helped With Executions, Israeli Researcher Claims

Between 1980 and at least until 2015 China has violated two core values of medical ethics regarding organ transplants, according to a new research by Matthew P. Robertson and Israeli Prof. Jacob Lavee ■ The Chinese embassy in Israel: 'Some countries and anti-China forces have been hyping up lies and distorting facts on organ transplantation in order to smear China.'

Published in Haaretz: https://www.haaretz.com/israel-news/MAGAZINE-research-china-harvested-organs-from-living-people-doctors-helped-with-executions-1.10726687

The organ transplant industry in China has a dark, hidden and often illegal side, some foreign experts have claimed in recent years. According to these experts, Chinese authorities murder prisoners in “reeducation camps” to harvest their organs and sell them for transplant for high prices to local and foreign customers.

In 2019, an international tribunal headed by the British barrister Geoffrey Nice published a report on organ transplants in China. It was based on months of discussions, presentation of evidence and analysis of findings, calling these acts crimes against humanity and “one of the worst atrocities committed” in modern times.

Ethan Gutmann, a researcher and human rights activist, told Haaretz in late 2020 that some 15 million members of minorities in the Xinjiang province, including Uighur Muslims, underwent medical examinations essential to check matches of organs for transplant. He said over a million of those tested were in prison camps. “This is not sporadic,” he said, adding that China has “created a policy of ethnic cleansing – a potentially very profitable one.”

Gutmann estimated that China murders at least 25,000 people each year in Xinjiang for their organs. He described fast tracks to move the organs in local airports, and crematoria built to dispose of the bodies. Customers for organs these days, he said, are mainly wealthy Chinese. However, he noted, there are also “organ tourists.” They included Japanese, South Koreans and Muslims from the Gulf States who prefer “halal organs” taken from Muslims like the Uighurs, he said.

But despite the extensive evidence on organ trafficking in China, no “smoking gun” has been found yet in the form of official documents that could prove the state is behind the illegal, immoral and profitable industry. Until now, apparently.

‘The smoking gun’

China has violated two core values of medical ethics regarding organ transplants, according to an article published on Monday in the American Journal of Transplantation – the leading scientific journal in the world on transplants. Analyzing data between 1980 and 2015, the researchers concluded that the Chinese have routinely violated the Dead Donor Rule, which prohibits harvesting an essential organ from a living person and prohibits causing the death of donors to harvest their organ.

The 71 papers proving that organs were harvested before the subject’s death were spread out over a period of 35 years and came from 56 different hospitals in 33 cities and 15 provinces

The authors, Mathew Robertson, a doctoral student in politics and international relations at the Australian National University in Canberra, and Prof. Jacob (Jay) Lavee, also claim that the Chinese have violated the prohibition on the participation of physicians in the executions of prisoners. 

Professor Lavee is a medical advisor on risk management for Sheba Medical Center and a member of the board of ethics of the International Society for Heart and Lung Transplantation. He set up and managed Sheba’s heart transplantation unit and served as the president of the Israeli Transplantation Society. He told Haaretz that the research he conducted with his Australian colleague found the previously missing “smoking gun” on illegal transplants in China. “Until now, there was a lot of circumstantial evidence,” Lavee said. “However, our research provides for the first time testimonies by people involved in their own language.”

According to the dead donor rule, it is prohibited to cause death by procuring organs. Lavee and Robertson’s research checked whether Chinese doctors determined brain death as required before conducting operations to procure organs. “In order to determine that a subject is brain dead, the subject must unequivocally have no independent breathing capabilities,” Lavee said. “The test is done by cutting the subject off from artificial ventilation provided via intubation through the trachea. After cutting off ventilation, the doctors wait to see whether the patient is breathing independently. They also check CO2 levels in the subject’s blood.”

If the doctors have not observed spontaneous breathing, Lavee explained, they can determine that the subject has no breathing reflex and rule that the subject is brain dead and therefore proclaim the person dead. “The medical establishment accepts this standard worldwide,” he says. “Chinese medical literature also accepts this procedure for determining brain death, even though China lacks an explicit law governing brain death.” 

For their research, Lavee and Robertson scoured a database of over 120,000 papers in Chinese that deal with organ transplants. They then filtered out 2,800 articles dealing with heart and lung transplants and searched in the text for sentences that describe intubation into the windpipe of the deceased that was conducted only after determination of brain death or after the beginning of an operation to procure organs.

“Finding such a description proves that a test to determine cessation of breathing was not conducted,” Lavee said. It indicates that “the patient was not ventilated until that moment and breathed independently until the beginning of the organ harvesting operation and thus was not brain dead,” Lavee noted. “In 310 papers we found sentences that describe problems in determining the death of the donor. There was no clear and unequivocal testimony that ventilation was commenced after the start of the operation. But in 71 other papers, we found clear and unequivocal proof that brain death was not determined before the organ harvesting operation commenced.” 

The 71 papers proving that organs were harvested before the subject’s death were spread out over a period of 35 years and came from 56 different hospitals in 33 cities and 15 provinces. “This spread,” explained Lavee, “proves that this is not an isolated or temporary problem. It must be a policy.” 

Organ donation is only possible in the event of brain death because this condition provides a limited window of opportunity to preserve organ function artificially. In this time window, organ procurement surgery is performed because the organs will stop functioning after that and body systems will collapse.

Inadvertent admission

A website for an agency from Tianjin that offers foreigners transplants in China.Credit: Screenshot

Lavee said the “incriminating sentences” found in 71 papers were no more than a line or two within papers dealing with methodology. “The sentences show time after time that the organ ‘donor’ was ventilated only after the surgical procedure commenced, or was ventilated only with a mask – proof that the ‘donor’ had been breathing independently, without ventilation, up until the operation,” he explained.  

Lavee and Robertson don’t know whether or not the dead donor rule was honored in procedures mentioned in papers in which they could not determine a definite problem. The reason, they said, is that the authors of those papers did not detail the organ procurement procedure or note at what stage the person undergoing surgery was ventilated. They insist there is no other possible explanation for the findings in the 71 papers. “Our article was checked with a fine-tooth comb by the American Journal of Transplantation’s editorial board,” Lavee said. “Four external reviewers and three editors went over our article very carefully and none of them held up its publication. There is no other way to explain our findings.”

The mountains of papers the two researchers scanned did not state the identity of the ‘organ donors’ or whether they were prisoners. Lavee and Robertson said however that the Chinese have provided that information in the past. “The Chinese themselves admitted in 2007 that 95 percent of the organs for transplantation came from prisoners,” Lavee said. “The person who admitted this, Dr. Huang Jiefu, is in charge of transplantations in China. He has served as deputy health minister. He currently serves as the deputy head of the transplantation committee at the World Health Organization, where China has great influence. We explain in the paper’s introduction why it is clear that all the subjects undergoing surgery described in the papers had to be prisoners. There was no alternative voluntary organ donor system during the time in question.”  

“The unique discovery of our research,” says Lavee, “is the fact that the authors of those 71 papers, admit, without having intended to, that the organ procurement procedure was in fact the cause of death of the subjects in surgery as it was conducted prior to brain death.”  According to Robertson an additional important finding of the study is the “exposure of the involvement of physicians in the medical execution of prisoners. The data proves that there has been a very close connection, over decades, between the security apparatuses and the medical establishment in China,” Robertson said.  

Matthew Robertson, Photo: ANU

Robertson and Lavee rejected in their paper the claim by Chinese transplantation authorities that physicians were not involved in executions. “Our data contradicts this claim through their own words, in officially published papers,” Robertson said. Besides their paper, there are reports of events in Xinjiang while the number of organ transplantation centers in China is growing. Researchers fear massive trade in human organs is going on in China, with prisoners executed to provide the organs.

תקווה מהבד :Jacob Lavee, Photo

‘Just a few weeks wait’  

Nobody knows for certain just how many organ transplants are conducted every year in China. “The figure that we note in our paper – that some 50,000 organ transplants will be conducted in China in 2023 – is quoted from public Chinese statements,” Lavee said.

“We write in the paper that Chinese hospitals advertise waiting times of just a few weeks for organ transplants – compared with months and years in the West. The Chinese continue to advertise the sale of organs to transplant tourists on the internet in English, Russian and Arabic.”  Lavee noted that these ads do not state the origin of the organs. Rather, they show that organ transplant tourism is ongoing, and that livers, hearts and lungs are offered to potential customers with a wait time of just two-to-three weeks. 

The Chinese claim that they ceased using organs from prisoners in 2015. Indeed, Lavee and Robertson found no evidence in the papers they scanned that organ harvesting prior to determination of brain death has taken place since then. The big question is whether the Chinese have conducted reforms and corrected the system or whether they are just covering their tracks better.

“We can’t say whether the reason is that the situation has indeed improved because of international pressure, or if is possible that there has been no real change, just a change in what is published,” said Lavee. “However, I would like to be fair to the Chinese. I have no doubt that in recent years there have been reforms and increased use of perfectly legitimate organs. We wrote this in our paper.  What we claim at the same time is that the previous criminal activities continue and we have no way of knowing their scope.” 

Lavee and Robertson said that China is the only country in the world that exploits organs from executed prisoners for transplants. Taiwan was the only other example, but it ceased doing so over a decade ago. In other countries, it is forbidden to even ask death row prisoners for their consent to donate organs. There was one exception in the United States, where a death row prisoner was allowed to donate a kidney to a first-degree relative,” explained Lavee. 

One wonders why the Chinese didn’t hide the practice if they knew it was prohibited in the rest of the world. Lavee noted that papers he and Robertson scanned in their research were written in Chinese. The doctors who wrote them probably never imagined that one day someone would go through them and search for incriminating phrases. “These sentences do not appear in papers from China published in English,” Lavee pointed out. “If they had appeared there, not one editor of a medical journal in the West would have approved them for publication.” 

Prof. Lavee became interested in the topic of organ transplants in China after being stunned when learning that one of his patients had undergone a heart transplant there. He heard the whole process took only two weeks. “There have been many such stories in the past. I was not the only one to expose them,” Lavee said. “There is no doubt the Chinese have become far more aware of the issue in recent years. They claim, at least outwardly, they have put a stop to transplants tourism. I know for certain that not one Israeli patient has traveled to China since 2008, and that is the situation in many other Western countries. But we do know from unofficial sources that there is transplant tourism to China from Persian Gulf countries, among them Saudi Arabia.” 

The Israeli researcher does not know why doctors in Saudi Arabia or other countries don’t report this immoral practice, but he has no doubt about what the right thing to do is. “As the son of a Holocaust survivor who was in a Nazi concentration camp, I can not stand aside and remain silent when my professional colleagues, Chinese transplant surgeons, have for years been partners to a crime against humanity by cooperating with the authorities and serving as the operational arm for mass executions,” he says. 

The Chinese embassy in Israel responded:

“Some countries and anti-China forces have been hyping up lies and distorting facts on organ transplantation in order to smear China. The Chinese side firmly opposes such acts. If the study you mentioned is based on anti-China rumors, we hope Haaretz, as an influential media outlet, could view the facts and truth objectively, avoid being misled by false arguments, and refrain from providing a platform for spreading lies and rumors about China. 

The Chinese government has always followed the guidelines of the World Health Organization (WHO) on human organ transplantation, and has further strengthened the administration of organ transplantation in recent years. On 21 March 2007, China’s State Council adopted and enacted the Regulation on Human Organ Transplantation, stipulating that the donation of human organ shall be voluntary and free of any monetary payment or other reward of monetary value, that human organ trafficking shall be prohibited, and that human organs used by medical institutions for transplantation shall be obtained with the written consent of the donors. The transplantation shall also be prohibited if the donors and their next to kin don’t give their consent, and if the donated organs fail to meet medical criteria. On 3 December 2014, the Chinese government declared that donations from citizens shall be the only legal source for organ transplantation. China banned transplants of organs donated from executed prisoners on 1 January 2015. In accordance with relevant laws, China launched an organ transplant donation system for citizens to meet medical treatment needs, which has been welcomed by the Chinese people. The progress China made in organ transplantation has also been recognized by the international community. While some anti-China forces fabricate and spread rumors on China’s organ transplantation, their true, malicious intentions are becoming increasingly clear to and rejected by the international community”.

‘People just disappear in the middle of the night and their organs are harvested ‘

China experts and activists claim that the repression of minorities in Xinjiang has escalated in recent years, with thousands of Uighur Muslims in ‘reeducation camps’ being murdered and their organs harvested for wealthy Chinese and foreign patients. The Chinese deny all such allegations.

David Stavrou

Published in "Haaretz": https://www.haaretz.com/israel-news/.premium.MAGAZINE-china-s-xxx-files-people-just-disappear-and-their-organs-are-harvested-1.9340106

“The interrogation started at 9 P.M. and ended around noon the next day. The five officers didn’t hit me, but there was a sixth man and he beat me and threatened me. ‘I’ll remove your organs,’ he said, ‘and burn what’s left of your body.’” 

This is what Huiqiong Liu told Haaretz recently in a video call from her home in Europe. Liu was arrested at her Beijing home in 2001 when she was 29 years old, and taken for “reeducation through labor” as part of the Chinese government’s battle with Falun Gong – the spiritual movement that has been persecuted by the authorities since the late 1990s. 

Liu was in the camp for about 18 months, and was imprisoned again between 2005 and 2007. She says that during her first imprisonment, she was taken to a hospital for tests. “I told [a doctor] I have a heart problem, but she said my heart is fine. I asked if they’re planning to take it away from me, and the doctor said: ‘That will be decided by someone at a higher level.’” Liu decided to go on hunger strike. Eight days later, she weighed just 88 pounds (40 kilograms) and the doctors decided that her organs were no longer viable.

Liu says she also underwent blood tests, blood pressure tests, X-rays and ECGs during her incarceration. “Sometimes they would take us to a hospital; other times, a large vehicle full of medical equipment would come to the camp and the checkups would be done in it,” Liu recalls. “They gave us all numbers and the doctors would follow-up on our situation. The doctors only knew the numbers, not our names. Sometimes they would ask for a specific number to be taken to the hospital. Those people never came back.”

Liu says she has another vital piece of evidence: “Before I was taken to the hospital during my first arrest, they gave me a form to sign with my fingerprints,” she recounts. “The form was already filled out but the name and address on it wasn’t mine, it was a name I didn’t recognize. I didn’t want to sign, but they made me do so anyway. They didn’t let me see what it was I was signing, but when I asked other women who were arrested with me, one of them – a woman who was sentenced to death – told me it was a consent form, saying I’m willing to donate my organs after I die.”

‘Harvesting never left’

In recent decades, alongside China’s rising political and economic power, reports have also surfaced of human rights violations and methodical oppression of minorities and opponents of the regime. 

During this time, the Chinese authorities have been accused of torture, executions and organ harvesting from tens of thousands of Falun Gong practitioners and selling the organs to patients in need of transplants. Repression, ethnic cleansing and even genocide of minorities living in the Xinjiang province, northwestern China, has also been alleged. 

According to numerous testimonies, minority groups – the largest of whom are the Uighur (aka Uyghur) Muslims, who number some 12 million – are suffering restrictions on their rights and liberties, surveillance and privacy invasions, separation of children from parents and forced abortions. It is believed that more than 1 million members of minority groups in Xinjiang are now in “reeducation camps,” which combine violent indoctrination with forced labor, rape and torture.

A number of international researchers and human rights activists say the oppression of minorities in Xinjiang has only grown worse, and that some prisoners are being murdered and their organs harvested. 

Ethan Gutmann, an independent researcher who’s considered a world expert on this issue, unequivocally believes the practice is occurring. “Harvesting never left Xinjiang, it just took a vacation,” he tells Haaretz. “The Chinese Communist Party [CCP] first experimented with the live organ harvesting of death row criminals on the execution grounds of Xinjiang as early as 1994. By 1997, surgeons were extracting livers and kidneys from Uighur political and religious prisoners for high-ranking CCP cadres – small-scale, but it set a precedent. 

“The explosion in transplant activity that followed and the use of surgeons as executioners?” he asks rhetorically. “This was fueled by Falun Gong organs. Now China appears to be running out of young and healthy Falun Gong, and, like ‘a dog returning to its vomit,’ the party’s killing machine has returned to Xinjiang.”

Gutmann, 62, authored the 2014 book “The Slaughter: Mass Killings, Organ Harvesting, and China’s Secret Solution to Its Dissident Problem,” is co-founder of the International Coalition to End Transplant Abuse in China (ETAC), a China Studies research fellow at the Victims of Communism Memorial Foundation (VOC) and was nominated for the Nobel Peace Prize in 2017.

Ethan Gutmann Photo: Simon Gross

The executions and organ harvesting are not sporadic or local, he says. “China’s transplant volume is 60,000 to 100,000 transplants per year. Beijing has no intention of dismantling its vast transplant infrastructure. Over 15 million Uighurs, Kazakhs, Kyrgyz and Hui have been blood tested, compatible with tissue matching. Over 1 million are in camps. So yes, the CCP has created a policy of ethnic cleansing – a potentially very profitable one,” the American scholar asserts.

Matthew Robertson is anothe research fellow at the VOC and a doctoral student at Australian National University, Canberra. He told Haaretz that while China claims to be performing over 20,000 transplants annually, sourced exclusively from voluntary donors, the figures appear to have been falsified, since they conform “extraordinarily closely to a simple mathematical function, and because of numerous artefacts throughout the data sets that are indicative or otherwise inexplicable except for human manipulation.”

According to Robertson, there’s a direct connection between the mass incarceration of Uighurs in Xinjiang and the rise in organ transplants. “Over the last couple of years – during the same period organ transplants from ‘volunteers’ are claimed to have grown rapidly – over a million Uighurs have been incarcerated in detention camps and prisons,” he says. 

At the same time, he adds, “reports have emerged of Uighurs being subjected to blood tests and other medical examinations consistent with those required to assess organ health, which is a prerequisite for organ matching and transplantation. There’s a history of the use of prisoners, including non-death row prisoners, for their organs. So in the end, it’s very much about where the burden of proof should reside,” Robertson says.

Robertson and Gutmann aren’t the only ones to suspect the Chinese regime. An international tribunal based in London and headed by leading British human rights prosecutor Sir Geoffrey Nice published a report last year declaring that China’s campaign of forced organ harvesting against innocent victims was a “crime against humanity,” constituting one of the world’s “worst atrocities committed” in modern times. 

Like the tribunal, law-makers and politicians in countries such as Canada, The US and the UK have begun to shed a light on China's Xinjiang policies, as well as Uighur leaders abroad who are trying to raise awareness. Dolkun Isa, President of the World Uyghur Congress, said: "We have real fears that the Chinese government may be cremating the bodies of detainees to hide evidence of torture, execution, and organ harvesting. We are also deeply disturbed by reports of the Chinese authorities collecting blood samples from the entire Uighur population in East Turkestan (Xinjiang), and establishing a DNA database from these samples. We do not know its purpose. But it could be used to match prisoners’ organs with patients who need transplants".

According to Rushan Abbas, the founder and executive director of "Campaign for Uyghurs", China has established “organ farms,” where millions of people are forced to undergo DNA testing and are “prepped for slaughter”, she said in a 2019 speech, “In the beginning of the Holocaust, countries around the world continued to do business with Germany, enabling their economies while millions of innocent people were being attained and held in concentration camps,” she added, “I don’t know what it takes to get the attention of world leaders for action. Don’t let it come to mass executions and gas chambers.”

Xinjiang Camp, photo: Ng Han Guan/AP

‘Something wild’

In the 1990s, Envar Tohti was a young surgeon in a hospital north of the city of Ürümqi, the capital of Xinjiang. He tells Haaretz that in 1995, two senior surgeons asked him if he “wanted to do something wild.” In a phone interview from his home in London, Tohti recounts: “They asked me to pick up the largest mobile operation kit and bring assistants, nurses and anesthesiologists to the hospital gate at 9:30 the next morning and join an ambulance, which was in fact just a van with a bed in it. 

“The next morning, we assembled at the gate and the chief surgeons told us to follow them in a convey. We drove toward our branch hospital in the western mountain district, but halfway through our journey, we turned left and our driver said we were going to the western mountain execution ground.” 

At that moment, he says, “I felt chilly even in the hot summer.” There was a hill at the site, Tohti recalls, and the surgeons told him “to wait there, ‘and come around when you hear gun shots.’ I was scared, wondering why we were here.”

Tohti says he then heard gunshots. “We jumped into the van and drove toward the entrance to the field. There were between 10 to 20 corpses. They had shaved heads and were dressed in prison uniform. Their foreheads were blown up. They were shot in the back of the head. A police officer – I think he was one of the executioners – shouted at us: ‘The one on the far right is yours.’ I was confused. I moved to the location and our surgeons held me and told me: ‘Hurry up, extract the liver and two kidneys.’”

Tohti says he did as he was told. “I turned into a robot trained to carry out its duty,” he says. “The officers and my assistants put the body on the bed already inside the van. The victim was a man in his 30s.” 

The senior surgeons apparently kept an eye on Tohti and when he asked to administer anesthesia, he was told there was no need because the man was already dead. “So I started my insertion, a cut designed as an upside-down ‘T’ shape to expose internal organs as wide as possible. My scalpel found its way cutting his skin. Blood could be seen, which implies that his heart was still pumping blood. He was alive! My chief surgeon whispered to me: ‘Hurry up!’”

The operation took some 30 to 40 minutes. When it ended, Tohti says, “The chief surgeons happily put the organs into a weird-looking box and said ‘OK, now take your team back to hospital. And remember – nothing happened here today.’ This was a command. No one talked about it ever since.” The events Tohti recounted happened 25 years ago. But researchers say the situation in Xinjiang has grown much worse since then. 

‘Like a monkey’

Abduweli Ayup, 46, is a linguist who now dedicates his life to the education and preservation of the Uighur language and culture, and lives in Europe. He was arrested in August 2013 and incarcerated for 15 months at three different prisons in Ürümqi. Though it’s widely claimed that the “reeducation camps” were only established in 2017, Ayup says the prisons in Xinjiang were operating the same way for years beforehand. “They were at the same places, the same conditions, the same uniform and the same rules,” he tells Haaretz, adding that when he was arrested in his hometown of Kashgar he was gang-raped by other prisoners who were ordered to do so by Chinese officers. 

Ayup says that in the first prison, he was the “victim of a cruel prison hierarchy orchestrated by the regime.” There were 17 prisoners in his cell, he says, explaining that he was one of the 12 “low-status” political prisoners forced to wear a yellow uniform. “There was no room for us on the beds, so we slept on the floor close to the toilet, which was a bucket covering a hole in the floor exposed to all. When we slept, the other prisoners’ pee drops fell on us,” he says.

The higher-status prisoners were drug dealers and murderers, Ayup reports. “One was in charge and he could decide to violently punish the others; another would execute the punishments, while a third and a fourth would guard and document them.” He says he witnessed and suffered countless acts of violence, humiliation, torture and sexual abuse. 

Abdewali Ayup photo: Issa Shaker

With lights on 24/7, cameras on the ceiling, a never-ending stench from the toilets and a strict schedule of indoctrination, this was just the first of the three camps where Ayup was imprisoned. 

In the second prison, he had an encounter he will never forget. “A man called Abdul Rahman was brought into the cell,” he says. “He was a political prisoner too, accused of separatism. I was shocked because he had a red uniform – the uniform of the people who are sentenced to death. His legs were chained and one of his hands was chained to his legs. Someone told me he has been held like that for two years. He slept in our cell, and I couldn’t sleep that night. The next morning, he requested that after his death his body be cleansed according to Uighur tradition, but the guards refused. When his arms and legs were finally freed, he couldn’t stand up so he had to walk with his hands. Like a monkey.” 

Ayup says that later, when he was finally released and fled to Turkey, he met Abdul Rahman’s wife and a couple of his friends. “His wife said that after the execution, the family was notified but she was only allowed to see his face, not his body,” he recounts. “The family was not allowed to wash the body and they were allowed to visit the grave only a month after the execution. 

“Even then, they were told that they were not allowed to plant a flower in the soil beside the grave, as is customary in Uighur tradition, for at least a year,” Ayup continues. “The family were told by workers at the ‘burial administration’ that organs are usually removed from executed prisoners, and that’s why families are not allowed to see the bodies.”

This part of Ayup's account matches the account of Jiang Li whose father was arrested as a Falun Gong practitioner in 2008 and sent to a labor camp in Chongquing in central China. In January 2009, a day after Li visited him and found him healthy, the family was notified that he had died.

"After my father died in prison", says Li, "we were allowed to go and see him. We were only allowed to see the head, not the body. We were not allowed to enter the room with cell phones or cameras. After a physical search, my sister entered first. They opened the refrigerator where they kept the body and opened it just enough to see the head. My sister touched the head and felt it was still warm. She shouted 'he's alive!' and we immediately ran inside, we were able to take out the body and touch the chest. It was still warm. Then about 10 policemen ran in and pulled us out. My sister tried to revive my father but she was pushed away. The whole thing only took five minutes and we never saw our father again".

Top secret files

Dr. Alim (not his real name) worked as a physician at the university hospital in Ürümqi for a decade, before leaving China. “In 2016,” he tells Haaretz, “a new department was opened at the hospital. It was a liver transplantation coordinating department and the department head’s office was close to mine.” 

When the department head was out, Alim says, “some of the patients who came to see him stepped over to my office and we sometimes chatted. These were wealthy people, they weren’t local – I remember some of them being from Shanghai, Beijing and even South Korea. When I asked them what they were doing here, they said they were patients in need of a liver transplant and that it took 24 hours between the time they had their checkup and DNA test until a matching organ was found for them.” (The waiting period in most countries is at least a few months.)

Alim says he recalled at least two instances in which he came across files of transplant patients. “In one case, all the information about the person who received the liver was in place – name, age, medical status, and so on,” he recalls. “But in the file of the so-called donor, there was no identifying information and instead of a name there was just ‘XXX.’” 

According to Alim, all of the transplant files at the hospital were kept secret and most of the doctors were not given access to them. “In another case, I noticed there was a name on a consent form – but the name didn’t match the name of the person who signed the form. Medical forms don’t include prices, but it was common knowledge that a liver costs a minimum of 100,000 RMB [about $15,000].”  

The Uighur doctor also believes there’s a connection between what’s happening in Xinjiang and the hospital transplants. “Many Uighurs disappeared after the massacre of July 5,” he says, referring to violent clashes between rival Uighur and Han Chinese protesters in Ürümqi in 2009, which resulted in hundreds of deaths and injuries. 

“Since then, the number of transplants at my hospital grew dramatically,” Alim says. “In 2007-08, there were about 60 to 70 transplants a year. I first saw patients from outside of Ürümqi in 2009, and since then it was around 200 transplants a year. The new coordinating department finally opened in 2016. That was also when I remember all Uighurs in Ürümqi being summoned to local clinics, in order to provide blood and DNA samples and medical data.”

In response to questions for this story, the Chinese Embassy in Israel told Haaretz: “Vocational education and training centers operate legally, and citizen donations are the only legal source for organ transplants,” in China.

A 2014 Chinese hospital add which has since disappeared from the internet.

Constructing crematoria 

Gutmann wanted to look more deeply into claims of organ harvesting in Xinjiang, so he went to Kazakhstan earlier this year and looked for people who had been released from the “reeducation camps.” Once there, he says he drove around in an old car and refrained from using the internet or electronic devices that could reveal his identity. 

“I disappeared, and this gave me the freedom to do confidential interviews with witnesses who still had family in the camps,” he says. Gutmann spoke with approximately two dozen people, who all indicated a clear pattern. “Every year, about 2.5 to 5 percent of healthy individuals in the camps simply disappear in the middle of the night. On average, they’re 28 – Beijing’s preferred age for harvesting.” This, he says, explains the “health checks” that Uighurs undergo in Xinjiang.

Gutmann believes at least 25,000 people are murdered every year in Xinjiang and their organs harvested. To streamline the process, he says, the Chinese created “fast lanes” for the movement of human organs in local airports, while crematoria have recently been constructed throughout the province. 

One of these was discovered by chance thanks to a job ad in a local Ürümqi newspaper, seeking 50 security guards for work at a crematorium, on a salary of about $1,200 a month – “a small fortune in that part of the world,” Gutmann says. “I don’t know about you, but the presence of 50 security guards in a single crematorium sends a chill up my spine,” he adds. 

The majority of the clients for these organs are wealthy Chinese people, according to Gutmann. But the big profit margins come from medical tourists: Japanese, South Koreans, Germans – and Muslims from the Gulf states. “The theory is that they have a preference for organs taken from people who don’t eat pork,” he explains.

Gutmann says the Chinese themselves have admitted that until 2015, they harvested organs from death row prisoners after execution, though they never released precise numbers or admitted that these were political prisoners. He adds that the Chinese have taken advantage of their power on the world stage to silence criticism, and that international institutions such as the World Health Organization chose in 2016 to present the Chinese transplant industry as a case of successful reform. 

The problem, Gutmann concludes, is that “they never saw the human rights catastrophe in Xinjiang coming. Now they’re left in an indefensible position.” Anyhow, the researcher says, the phenomenon of organ harvesting is known, but the Chinese have extensive influence in the international medical establishment. Only a handful of doctors and physicians came out as opposers to these Chinese practices, one of them being the Israeli Dr. Jacob Lavee, Director of Sheba's Heart Transplantation Unit, who was the force behind the Israeli transplant law which blocks "organ transplant tourism" from Israel to China.

“Every major media that I can think of in the West has reported on this crime during the last four years,” he says. “Not on the front page perhaps, but as I’m sure your readers are aware, The New York Times didn’t put the Holocaust on the front page until after 1945 either.”

China's Embassy in Israel's responce:

Firstly, regarding the Vocational Education and Training Centers. From 1990 to 2016, separatists, religious extremists and terrorists have plotted and carried out several thousand violent terrorist attacks in Xinjiang. Many innocent people were killed and several hundred police officers died while performing their duty. Terrorism and extremism are the common scourge confronting the humanity. It is for the purpose of counter-terrorism, deradicalization and saving those who were deceived by extremist ideas that Vocational Education and Training Centers were built in China, and their operation has always been in strict accordance with the law. In essence, the Education and Training Centers are no different from the deradicalization centers in many countries around the world, and they do not target any specific region, ethnicity and religion.

 The Vocational Education and Training Centers fully protect the personal dignity and freedom of trainees in accordance with the basic principles of the Chinese Constitution and the laws on respecting and protecting human rights. These Centers are education and training institutions that deliver the curriculum including standard spoken and written Chinese, laws and regulations, vocational skills, and deradicalization. Trainees can have home visits, ask for leave to attend to private affairs and have freedom of communication. The relatives of the trainees are fully aware of their training through telephone or video chat as well as visiting the trainees.

 The number of people participating in Vocational Education and Training programs is not fixed, some in and some out from time to time. It is purely fabricated and baseless to say that there are “around one million or even two million trainees” by some media. Vocational Education and Training centers are special efforts in special times. By the end of 2019, all the trainees of the Vocational Education and Training Centers have reached the training requirements and graduated. Most of them have obtained vocational qualification certificates or vocational skill level certificates and found decent jobs.

 In the future, Xinjiang will provide regular and open educational training programs to meet the needs of local people to improve their skills, based on principles of respect for their will, independent decision, categorized training programs and freedom to join or leave.

Secondly, regarding the question about organ transplantation. The Chinese government has consistently followed the WHO guidelines on human organ transplantation. In recent years China has further strengthened the management of organ transplantation. In 2007, the State Council of China promulgated and implemented the Regulations on Human Organ Transplantation, which stipulates that organ donation should follow the principle of being voluntary and for free. The sale of human organs is strictly prohibited in China. Since January 1st 2015, the use of death row prisoners’ organs as a source for transplantation has been completely banned and citizen donation is the only legal source for organ transplantation.

 Last but not least, I would like to emphasize that some international forces with ulterior motives have fabricated some lies distorting facts, smeared and attacked China’s policy of governing Xinjiang, in an attempt to contain China’s development. We hope our Israeli friends keep your eyes open and not be deceived by those lies.