Myth: The number of transplants in China gradually decreased after forced organ harvesting was brought to light in 2006

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After allegations of abusive organ harvesting received international attention in 2006, hospitals in China removed and deflated the number of transplants they performed.¹ The Chinese government waged a public relations campaign through its spokespeople, media, and agents to create a false impression that the number of transplants in China had gradually decreased. The Ministry of Health implemented a new approval system in 2007, which contributed to the illusion that most hospitals had stopped performing transplants.

However, our research found that, while some smaller unapproved institutions either reduced or stopped transplant operations, others that could still obtain organs continued to operate. Large, approved institutions achieved even greater growth with decreased competition and full government support. Thus, the industry as a whole has continued to grow steadily since 2006.

Since 2000, organ transplantation has assumed a high priority in China’s national strategy and has continuously been incorporated into the national Five-Year Plans. National, military, and civilian agencies have invested heavily in research, development, and promotion of organ transplantation.

In recent years, Huang Jiefu has repeatedly expressed a desire to increase the number of qualified transplant hospitals from 169 to 300² and even 500 within a few years.³

New Ministry Approval System Brought Stable Growth

The government blamed chaotic market conditions for the emergence of live organ harvesting in China. To “recertify and regulate” the market, the Ministry of Health started issuing permits to transplant centers, forbidding hospitals without permits to conduct organ transplants after July 1, 2007.⁴

In July 2007, more than 1,000 transplant hospitals in China applied for permits under this new system.⁵ Among them, 164 eventually received those permits.⁶ As a result, large transplant centers faced less competition and achieved even greater growth than before.

For example, the Liver Transplant Center of the First Affiliated Hospital of Zhejiang University stated on February 28, 2011, “Our country`s liver transplantation business has entered a period of stable development. Under the leadership of academician Zheng Shusen, the liver transplant business at First Affiliated Hospital of Zhejiang University is flourishing. It moved into a new building in 2007. Liver transplantation has become more systematic, professional, and large-scale.”⁷

Furthermore, we observed that many unapproved hospitals did not, in fact, stop performing organ transplants. At least 75 hospitals that were refused permits in 2007, continued to perform organ transplants. Some of these were later admitted into a pilot program for donations after cardiac death (DCD) starting in 2011. By January 2014, the approval list had been expanded to 169 hospitals.^{9 10}

Expanding Capacity

Many hospitals have invested heavily since 2006 to increase transplant capacity, increasing the number of beds, wards and buildings dedicated to transplantation. Some transplant centers operate with bed utilization rates between 100% and 200%. This growth can be seen even at relatively small-scale hospitals that did not meet the Ministry’s requirements at the time for obtaining transplant approval, as listed below.

Zhengzhou No.7 People’s Hospital is a specialist heart and kidney hospital. It was the first in Henan Province to perform an allogeneic kidney transplant.¹¹ It has 200 beds.¹² Its urology department is designated as the Zhengzhou City Kidney Transplantation and Blood Purification Center.¹³

Despite being a Class 2 hospital (with Class 3 being the highest), Zhengzhou No.7 was a “big player” in kidney transplantation in the province. When learning that only Class 3 Grade A hospitals would qualify for Ministry approval to perform transplants, the hospital’s vice president, Wei Yan, said that kidney transplantation accounted for “a majority” of its business. “If we’re not allowed to do these [transplant] surgeries, that means half of the hospital’s business can’t be done anymore. It would cause enormous impact to the hospital’s development.”¹⁴

According to an August 2016 report by Dongfang Jinbao, the hospital continued conducting transplants without a permit. It was reported that over the past twenty-plus years, under the leadership of Wang Changan, the kidney transplant department had multiple techniques reach international standards. Its kidney transplant quantity and quality consistently led the province. It also performed the first combined liver-kidney transplant and the first pancreas-kidney transplant in Zhengzhou City. Its 60+ member medical personnel had “long been used to being on-call 24 hours a day. In 30 years of work, Wang Changan had not taken any public holidays off, traveled, or even entered a movie theater.”¹⁵

The hospital built two new wards, the first of which began construction in 2006 with 600 open beds.¹⁶ On December 29, 2010, the entire hospital moved to its new site with 800 open beds. After becoming a Class 3 Grade A hospital in 2014, it started to construct a new riverside ward with 1,000 beds,¹⁷ increasing its total capacity to 1,800 beds.

However, in March 2015, its website showed that its kidney transplant department had only 46 beds, a figure that is most likely deflated by an order of magnitude given the growth trends outlined above. An internal communication indicated a 130% bed utilization rate.¹⁸

Despite being authorized to perform only kidney transplants, the Affiliated Hospital of Zunyi Medical College also performed liver, bone marrow, corneal, stem cell, and other types of transplants. Its urologic surgery department started conducting kidney transplants in 2000 and has carried out the most of this type in Guizhou Province as of 2007. In 2012, its urologic surgery department reportedly had 51 beds and maintained a level of 100 patients, resulting in a utilization rate of around 200%.²⁰ The transplant department has since been expanded to 100 beds.²¹

The transplant business in China has developed with not only an abundance of available organs since around the year 2000, but also, evidently, with a confidence that this abundance would continue into the foreseeable future.

Overworked Medical Teams

We found that many medical teams and individual doctors struggle to carry out the volume of transplants demanded of them. The scale of the problem can be seen in the extent to which many surgeons work overtime to procure organs and conduct transplants. Additionally, some departments carry out multiple transplants simultaneously.²² One hospital even resorted to training almost all of its general surgeons to perform organ transplants.²³

In addition, there are accounts of surgeons performing transplants for 20 hours without rest and getting little sleep each day,²⁴ doctors who are so busy procuring kidneys that they are “often unable to go home for one or two weeks at a time,”²⁵ and medical teams struggling under the pressure of performing several transplants each day.²⁶

Thousands Waiting for Transplants at Individual Hospitals

Despite the increased capacity of transplant centers, there is still a backlog of patients waiting for transplants at the hospitals we analyzed. This high demand drives the high bed utilization rates and number of transplants performed.

For example, there were over 1,000 people waiting for organ transplants at the 3rd Xiangya Hospital of Central South University in 2012.²⁷

In April 2015, the organ transplant center at the First Affiliated Hospital of Xi’an Jiaotong University had over 1,000 patients waiting for organ transplants.²⁸

A September 2013 interview indicated that the No. 309 Hospital’s PLA Organ Transplant Research Institute had five to six thousand patients waiting for transplants each year.²⁹

Growth in Revenues

People’s Liberation Army (Chengdu Air Force) Hospital No. 452 jumped from a “township-scale” practice to that of a large-scale urban hospital in just a few years. In 2000, the troubled hospital had more than 6 million RMB of debt. In 2002, this hospital “borrowed a hen to lay eggs” and found an entrepreneur, who invested 8 million RMB in the hospital. Its kidney transplantation operation soon “came back to life.” Years later, it performed the most kidney transplants among all hospitals in Sichuan Province. The hospital grew from its original 210 beds to more than 1,000 beds. Other military hospitals followed suit.³⁰

At Hospital No. 309, the People’s Liberation Army Organ Transplantation Center’s revenue rose from 30 million RMB in 2006 to 230 million RMB in 2010, a nearly 8-fold increase, in 4 years.³¹
The annual income of Daping Hospital, affiliated with the Third Military Medical University, also increased from 36 million RMB at the end of the 1990s, when it began organ transplantation, to over 900 million RMB in 2009³²—a nearly 25-fold increase.

Civilian hospitals have also profited from performing transplants. For example, the Second People’s Hospital of the Shanxi Occupational Disease Prevention and Control Center (in reality a kidney transplant center) charged approximately 100,000 RMB for a kidney transplant. Its revenue for 2005 was approximately 250 million RMB.³³

Limiting Factors for Transplant Volume

On January 12, 2015, Huang Jiefu appeared on Phoenix Television and highlighted the factors that limit growth in the organ transplant industry in China:

“The first is an economic reason. Transplant surgery is very expensive, and not many citizens can afford the medical costs. The second is that, even though we have such well-qualified hospitals, there aren’t that many experienced and skilled doctors. The fact that there are not that many donor bodies is only the third limiting factor; even though donor bodies are abundant right now, there aren’t that many hospitals and doctors that can [perform transplants].”³⁴

Huang made clear that the availability of organs was not the main limitation. This statement, along with the persistent demand, bed utilization rates, expansion of transplant centers, and Huang’s plans to authorize new transplant centers, indicates that the transplant industry is primarily constrained by a lack of medical facilities and personnel rather than organ availability.

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