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.
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.”
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.
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.'
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.
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.
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.
‘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”.