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”.

A Year On, How Coronavirus Changed Sweden

A policy downplaying lockdowns and mask-wearing may have buoyed infection rates and deaths, but Swedes disagree on how the long term will look. How the world we knew has changed – the first in a series.

Published in "Haaretz": https://www.haaretz.com/world-news/.premium.MAGAZINE-coronavirus-year-one-the-way-the-pandemic-has-changed-sweden-1.9511565

Scandiabadet, Malmö, summer 2020. Photo: News Øresund Johan Wessman

David Stavrou

Stockholm, Sweden

 Feb 5, 2021 13:10

STOCKHOLM – Håkan Frändén, 61, lives in Stockholm and normally works as a tour guide, but these aren’t ordinary times and tourists have been a very rare commodity in Sweden since the coronavirus broke out a year ago.

“Of course, the pandemic affected my professional life when the world closed down and the high tourist season ended before it even began,” he says. “In 2020 we had zero tourists and my wife, who’s a tourist guide too, and I lost all our income.”

But Frändén and his wife didn’t give up. She took a course and is now working as a personal trainer and yoga instructor, while Håkan got a part-time job via the national employment agency delivering groceries – plus he receives unemployment benefits for the days he doesn’t work.

.Malmö, 2021. Photo: Maria Eklind

"It’s true this has been a terrible year when it comes to the victims of the pandemic, but personally I had a good year,” he says. “We bought bicycles and made them our main means of transportation, we rediscovered our city – many times with our children and grandchildren – and we had more time for ourselves and our family.”

In the past year, few countries have attracted attention like Sweden. The fact that it didn’t impose lockdowns, didn’t force quarantines, didn’t close schools and didn’t require masks made it the subject of thousands of news reports and commentaries in the world media. Some called Sweden “the world’s control group,” others said it was carrying out “an experiment on people.”

As far as we know, COVID-19 reached Sweden in January 2020, carried by a passenger from Wuhan, China. Still, there’s a suspicion that already the month before people were infected in Sweden, without being traced due to a lack of testing.

Community transmission started in March, after a month earlier many infected people landed on flights from northern Italy, Iran and other countries. Already during the first stage of the pandemic the Swedish authorities were criticized for not assessing the danger and preparing accordingly.

On March 11, the day the World Health Organization declared a global pandemic, the first coronavirus patient died in Stockholm. April saw a significant wave of illness, and by mid-June dozens of infected people were dying every day in Sweden.

Heavy burden on health care

The country’s health care system withstood the heavy burden and didn’t collapse thanks to the great efforts of the medical staff, as well as budgetary and logistics efforts by the government and local authorities. But in nursing homes for the elderly the situation was completely different. A government committee has determined that Sweden failed to protect this population, citing neglect and poor management by the current government and its predecessors.

In the first wave, the Swedish strategy for halting the infection was unique. The authorities simply asked people who developed symptoms and people in risk groups to show responsibility and stay home. Also, everyone was asked to work from home if possible and  forgo unnecessary travel.

Instead of the thorough system of testing, tracing and quarantining established in many countries, the Swedes did coronavirus testing during the first stage only in hospitals and in care for the elderly.

Anders Tegnell, the chief epidemiologist and the person most identified with Sweden’s management of the virus, explained this policy in April in an interview with Haaretz. He said that Sweden had limited testing capacity and that regardless of the test results, the recommendation would be to stay home. The Swedish policy was based on a high level of public trust in the authorities and long-term thinking, he added.

Hagaparkern, north of Stockholm, 2021. Photo: Guillume Baviere

Despite the reliance on public trust, the government and the local authorities, the Swedes took a number of restrictive steps due to the virus. They switched over to online learning at universities and high schools, limited public gatherings to 50 people, prohibited visits to hospitals and nursing homes, and imposed restrictions on serving food in bars and restaurants.

'The long-term social consequences will probably turn out greater in countries that seemed to be succeeding at the beginning'

During the summer the pandemic waned in Sweden and the hospitals’ coronavirus wards emptied out. But this was temporary; in November a more deadly wave began. Once again there were dozens of deaths every day and the hospitals were overburdened. So the authorities tightened the restrictions: They limited gatherings to eight people, banned the sale of alcohol after 8 P.M. and closed movie theaters, museums and libraries.

Still, the overall strategy didn’t change. The country’s leaders continued to rely on public trust and eschewed a general lockdown; they left the schools, restaurants and malls open. Stores and other businesses remained open, but with restrictions on the number of people allowed inside. Also, there was no requirement to wear a mask; Swedes were recommended to wear one only on public transportation at peak hours.

Around the world, people had the impression that while many countries were isolating and suffering a harsh economic blow, in Sweden it was business as usual. But the reality was different. “At first I thought we’d work from home for a month and then return to the office,” says Erik Numan, a 56-year-old art director from Stockholm. “By now, 10 months later, I’ve been in the office for only one day.”

'Even though I work in many fields, everything disappeared and I still can’t plan anything even a year later'

A shopping mall in Stockholm, December 2020. Photo: TT News Agency via Reuters

Numan says he has stopped exercising at a gym, doesn’t visit his parents and rarely meets with friends. Although he says he isn’t very worried about the virus personally, he feels solidarity with others who are likely to become infected and is concerned about the overburdened health care system.

“Nobody checks on me and the police won’t arrest me if I don’t observe the recommendations,” he says. “But I think most Swedes do what’s necessary when there’s a crisis.”

Numan’s 16-year-old daughter contracted the virus, developed mild symptoms and was in quarantine for two weeks. “When she meets girlfriends now they hug as usual, at a time when we adults have completely stopped shaking hands,” Numan says.

Like the Frändéns, Linnéa Sallay, a 60-year-old singer and violinist who lives in Stockholm, saw her professional life racked by the virus. “All the jobs disappeared overnight in mid-March,” she says. “Even though I work in many fields, perform in concerts, guide tours and produce events, everything disappeared and I still can’t plan anything even a year later.”

Sallay notes, however, that the past year has also provided a welcome time-out. She's surviving financially thanks to her savings, she has launched a YouTube channel and is developing her digital skills. She has also spent a lot of time with her family and friends, even if not at restaurants and cafes. And she’s now rehearsing and preparing for digital concerts.

Vaxholm, Sweden, summer of 2020. Photo: Bengt Nyman

Entering the crisis with disadvantages

Sweden has several disadvantages regarding COVID-19. Twenty percent of the population is over 65, it’s cold, its borders are open to other countries, its population is very diverse and it’s not used to emergency situations. But it also had advantages: a universal, quality health care system, stable and well-financed government services, and many single-person households.

Considering its starting conditions a year ago, it’s hard to estimate the real effect of the Swedish policy on illness rates and mortality. Compared to its Nordic neighbors – Finland, Denmark and Norway – Sweden’s mortality has been very high. The country of 10 million people has suffered about 12,000 deaths, with this figure per million people high at 1,444. In Denmark, Finland and Norway the number is 363, 121 and 104, respectively.

It’s not a competition and there’s no point saying who the winner is. It’s far too early and too dangerous to compare week-by-week mortality rates

Swedish Health Minister Lena Hallengren

Swedish Health Minister Lena Hallengren at a press conference in Stockholm in November 2020. Photo: Henrik Montgomery / TT News Agency via Reuters

But compared to many other European countries, including those that imposed lockdowns, closed schools and halted the economy, the mortality rate is modest. In Britain, Spain and Italy, for example, the number of deaths from COVID-19 per million inhabitants is 1,591, 1,254 and 1,473, respectively.

Some experts believe that the shunning of lockdowns has brought Sweden better results in metrics that have yet to be measured such as rates for depression, excessive weight gain, addiction, violence and illnesses from diabetes to heart attacks and strokes. In Sweden you could also hear the claim that the country’s high mortality rate in 2020 stemmed from the low mortality rates from the flu in 2019.

Fiasco at the nursing homes

Swedish Health Minister Lena Hallengren told Haaretz in September that it was too early to judge the Swedish policy because this was a marathon, not a sprint.

“It’s not a competition and there’s no point saying who the winner is,” she said. “It’s far too early and too dangerous to compare week-by-week mortality rates. Different countries were hit differently; they have different structures and relations with their authorities, they test in different ways and have different kinds of data and information. In the long run, we all need well-functioning societies. We should learn what there is to learn from others, point fewer fingers and try to keep up with long-term recommendations.”

Uppsala, Sweden, last month. Photo: Guillaume Baviere

But there’s considerable evidence of failures in Sweden’s handling of the pandemic. The Swedish media has reported on cases where nursing home residents did not see a doctor and were not evacuated to hospitals despite their serious condition. The nursing home staffs were unequipped and not trained at all to deal with a pandemic.

The Public Health Agency of Sweden has been harshly criticized too. Critics say that during the pandemic’s early days, the agency was complacent and didn’t assess the danger correctly. Later, the prime minister himself, Stefan Löfven, said the agency had downplayed the second wave. At various stages, key people in academia and the medical system demanded that the agency make more stringent recommendations to curb the spread of the virus.

Regarding vaccines in Sweden, signs also attest to delays and complications, though here the shortcoming is mainly on the European level. Like many countries, Sweden has bought vaccines as part of an EU transaction, but the supply has been slow, one reason being a hitch in the manufacture and supply of AstraZeneca’s vaccine.

As of now, Sweden has vaccinated 256,978 people with the first dose and 28,279 with the second. That means 3.13 percent of the population over 18 has received one dose and only 0.34 percent two.

Although Swedish politicians in general have backed the government over the past year, other voices have been heard in recent weeks. “We have to respond differently now,” Ebba Busch, the leader of the opposition Christian Democratic Party, told the daily Aftonbladet. “If the government lacks the courage to lead, it should resign.” Nonetheless, the ruling Social Democratic Party is leading in the polls and received 28.5 percent support in a survey last month, a 2-point rise over November.

'I hope we’ll appreciate each other more when all this is over, and I hope we’ll go back to meeting up again. The hell with Zoom'

A nurse vaccinating a nursing home resident in Mjölby, Sweden, in December 2020.Photo: Stefan Jerrevang / TT News Agency via Reuters

“I think we’ve dealt pretty well with the pandemic,” says Frändén, the tour guide. “I wouldn’t want to be anywhere else. But there have been failures too, mainly the spreading of the virus in old age homes. In recent decades there has been unrestrained privatization in our care system, and that’s one reason for the negligence in preparing and training staff.”

Frändén says the virus spread within another marginalized group too. “In 2014 and 2015 Sweden was one of the countries in Europe that opened its doors to the most refugees,” he says.

“As a result, many refugees settled in Stockholm’s suburbs and we saw social phenomena that we didn’t have before – crowded living conditions in large families, large family gatherings including elderly people, and less access to the authorities’ information. Our authorities failed here, and that may be an explanation for the differences in the virus’ spread between Sweden and Denmark, Norway and Finland, which hardly took in any refugees.”

‘Every country has its own conditions’

Sallay, the singer and violinist, also criticizes the authorities’ handling of the pandemic, especially the economic aspect, so she and a colleague launched a protest by the self-employed.

“We, the small independent workers who don’t have employees, have been discriminated against,” she says, noting that large companies in Sweden furloughed employees and received government funding for expenses, while small businesses are only now beginning to receive help.

And indeed, in an interview with TheMarker in June, Swedish Finance Minister Magdalena Andersson said the national priority is to help salaried workers and large companies. During the crisis the Swedish government has invested large sums to buoy employment while providing payments to furloughed workers, compensation and guarantees, while strengthening companies’ liquidity and providing professional training and retraining for the unemployed.

“I think it’s too early to know whether we chose the right path,” says Numan, the art director. “Every country has its own conditions, and the long-term social consequences will probably turn out greater in countries that seemed to be succeeding at the beginning.”

As he puts it, “I hope we’ll appreciate each other more when all this is over, and I hope we’ll go back to meeting up again. The hell with Zoom.”