This official figure is surpassed by just a few transplant centers out of more than one thousand. Our estimate, based on minimum government-imposed capacity requirements, is that China performs between 60,000 and 100,000 transplants per year.

Two distinct organ sources have been blurred: one is prisoners sentenced to death, and the other is the extrajudicial killing of innocents. The latter occurs at a far larger scale but has never been acknowledged, much less stopped, by the Chinese regime.

Since 2000, China’s transplant volume has increased dramatically, including by thirty-fold between 1999 and 2005. Based on government-imposed minimum capacity requirements, the 169 approved transplant hospitals in China could have conducted 60,000 to 100,000 transplants per year. However, international organizations estimate the number of death-row executions in China at thousands each year, a rate that has decreased since 2000. Furthermore, the government announced that it would stop using organs from death-row prisoners beginning in 2015.

A wide variety of sources indicate that death-row executions in China have decreased over the last two decades. Meanwhile, the number of organ transplants in China grew rapidly starting in 2000. This divergence widened in 2007, when the number of transplants continued to grow while death penalty numbers fell further due to new judicial review procedures. Given that the number of voluntary donors remains low, this trend leaves a large gap of transplants not accounted for by the official organ sources.

Fact: In 2006, the domestic immunosuppressant market was nearly 10 billion RMB, and there were more than 100 manufacturers and nearly 30 varieties. This market could have supported over 300,000 total patients, or an average of 50,000 to 60,000 per year since 2000, far more than the official claim of 10,000 transplants per year.

Transplant hospitals in China mostly use domestic products instead of imported drugs. International drug sales data, such as IMS, also only reflects partial size of China’s drug market.

After receiving international attention in 2006, the government and hospitals in China deflated public transplant data and created an impression that the number of transplants and transplant hospitals were gradually decreasing.

However, our research found that the industry has continued to grow steadily since 2006. Organ transplantation has continuously been incorporated into national strategy since 2000. National, military, and civilian agencies have invested heavily in research, development, and promotion of organ transplantation. Hospitals have added transplant beds, opened new wards, and moved into larger buildings. Medical teams worked around the clock to perform the number of transplants demanded of them. This growth was also reflected in transplant center revenues. Huang Jiefu, a top transplant official, has announced plans to increase the number of qualified transplant hospitals from 169 to 300 and even 500 within a few years.

Organ transplantation in China began in the 1970s, but by 2003, the number of voluntary donations remained at zero. There was no organ donation system in China before 2010, and the national organ donation system started in 2014. As of the end of 2015, China’s trial organ donation and allocation systems still have not produced donations on any meaningful scale.

As of 2006, living relative kidney transplants were extremely rare. The Ministry of Health has repeatedly proposed restrictions on living organ donations rather than encouraging the practice. Among relative-donor organ transplant surgeries, the majority were falsified.

We find that the number of voluntary donors is only a small fraction of the huge volume of transplants performed in China.

The Chinese regime advertised in its state-run media that one donor’s organs were used in several transplants in certain cases. China’s health officials sometimes use the potential to procure multiple organs from the same donor to explain the gap between the number of organ sources (including voluntary donors and death-row prisoners) and its official number of transplants.

We find that this efficiency cannot be applied in most cases. The utilization of organs in China’s transplant centers are much lower than those of well-established organizations in other countries. Until the end of August 2013, China did not have a national organ sharing network. Tissue matching was mostly done within specific hospitals or regions. Until recently, very few institutions in China were capable of procuring and transplanting multiple organs from a single donor. The use of multiple organs from one donor cannot account for the annual transplant volume.

Under communist rule in China, prisoners of conscience are labeled as “enemies of the state” and systematically demonized and dehumanized. Their bodies are treated as property of the state to be used at will.

China started performing transplants with organs harvested from executed prisoners on a small scale in the 1970s. In the years that followed, it also used organs from prisoners of conscience, Uyghurs, Tibetans and House Christians in captivity. The large-scale development of China’s transplantation system starting in 2000 coincided with the Communist Party’s campaign to wipe out Falun Gong.