Volume Indicators

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Expanding Capacity

To meet the ever-increasing demand for transplants, most hospitals have expanded their transplant wards and even constructed new buildings that often include VIP-style amenities to cater to transplant recipients from other countries.

Case Study: Asia’s largest-scale surgery building at Wuhan Union Hospital

The new surgery building at Wuhan Union Hospital opened in September 2006. It has 32 stories above ground and 2 underground. The integrated surgery ward building has 1,050 beds and 42 operating rooms.⁴ It can accommodate 200 surgeries per day, a volume equivalent to that of five medium and large-scale hospitals.⁵

Its Urologic Surgery Department enjoys high academic status in China and has now become one of the largest kidney transplant centers in the region.⁶ The Liver Transplant Center is a main component of its General Surgery Department. Its heart transplantation and combined heart-lung transplantation are ‘state of the art’. The Cardiovascular Surgery Department once completed 4 heart transplants concurrently on the same day and claimed to have completed the most heart transplants in the country during 2014.⁷

Case Study: Surgery Building Busy 24 Hours a Day

The Urology Department of Shanghai Renji Hospital established a new wing and renal transplant ward in the Pudong district in November 1999. It has expanded from its original 29 beds to 70 beds. Its new medical team and distribution system allowed its number of surgeries to increase by 300%⁸ and performs over 5,000 surgeries per year, with over 60% being large and extra-large operations. The average hospitalization time is five days.⁹

“There are too many, too many patients! We have surgeries here overnight, nonstop for 24 hours a day,” Dr. Cheng Zheying told a Wenhui Daily reporter in March 2016.¹⁰ As many as 120 surgeries are performed here in a day. The most difficult and advanced surgeries, including robotic surgeries, are all performed here. This does not include liver transplants, as liver sources coming from other areas are often brought back to the hospital late at night, so it is quite common to conduct surgeries until early morning.

“The operating room is like a secret garden in the hospital. We have no time to be in contact with the outside world. The lights are on 24 hours a day here. Seven or eight o’clock at night is the same as in the morning. One can’t tell day from night,” Chen Zheying said.

In 2005, Renji Hospital’s east surgical building was put into use. It has 1,000 beds.¹¹ The number of operating rooms has increased from 24 to 38.¹² The Liver Transplant Center is located on the 14th and 15th floors of this new building.¹³ Before this, the Liver Transplant Center had increased its bed count from the original 13 at the end of September 2004 to 23 beds less than 10 days later. And later in June 2007, it increased to 90 beds¹⁴ and 110 beds in 2014.¹⁵ Its utilization rate and transplant volume also continued to hit new highs.

Continued Growth Despite Exposure

After 2006, when international attention was brought to bear on allegations of abusive organ harvesting in China, hospitals deflated and removed public disclosure of their transplant numbers. The Party/government used its spokespeople, media, and agents to create a false impression for the international community that the number of transplants in China was gradually decreasing.

In fact, the Party simply adjusted its strategy to be less public. Furthermore, the Ministry of Health’s new approval system implemented in 2007 contributed to the illusion that most hospitals had stopped performing transplants.

To the contrary, there was a spike in transplant volume between March 2006 and May 2007 in a rush to clear the donor bank inventory, after which the industry continued to grow steadily. We observed that some smaller institutions that did not receive approval either reduced or stopped performing transplants, while others that could still obtain organs continued to operate. However, large, approved institutions achieved even greater development with decreased competition and full government support.

Since 2000, organ transplantation has assumed a high priority in the government’s national strategy and as an emerging strategic industry to drive China’s future global development. It has continuously been incorporated in the National Five-Year Plan for multiple industries.^{16 17 18 19 20} National, military, and civilian agencies have invested heavily in research, development, and promotion of organ transplantation.

New Ministry Approval System Brought Stable Growth

After allegations were made in March 2006 that Falun Gong practitioners were being killed for organs in a death camp in Sujiatun, the Chinese regime remained silent for three weeks before its foreign ministry spokesman denied the existence of the camp.²¹ Then, the Ministry of Health attributed the illicit transplants to a chaotic market and announced that it would enact a new qualification system in July 2007 that would limit transplant operations to only the largest hospitals after approval.²²

In the interim year, hospitals around the country rushed to clear their donor bank inventory, resulting in a spike in transplants.²³ For example, Hunan People’s Hospital advertised on April 28, 2006 that it would offer 10 liver and 10 kidney transplants free of charge.²⁴ The Jilin Heart Disease Hospital offered promotions for heart transplant operations with reduced fees for a “quick sale”—the first five heart recipients were charged only 50,000 RMB.²⁵

That year, more than 1,000 transplant hospitals in China applied for permits under this new system.^{26 27} Among them, 164 eventually received permits.²⁸ Under this system, large transplant centers faced less competition and achieved even greater development 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.”²⁹

Some transplant centers operated with bed utilization rates between 100% and 200%. This growth could 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 specializes in heart and kidney transplants. It had 200 beds upon its establishment.³¹ It was the first in Henan Province to perform an allogeneic kidney transplant.³² Its urology department is designated as the Zhengzhou City Kidney Transplantation and Blood Purification Center.^{33 34}

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.”³⁵

According to an August 2016 report, its kidney transplant department had multiple techniques reach international standards over the past twenty-plus years. The hospital’s kidney transplant quantity and quality consistently led the province, performing the first combined liver-kidney transplant and the first pancreas-kidney transplant in Zhengzhou City. Its 60+ medical personnel have “long been used to being on-call 24 hours a day. In 30 years of work, Director Wang Changan has not taken any public holidays off, traveled, or even entered a movie theater.”³⁶

The hospital built two new wards, the first of which entered construction in 2006 with 600 open beds.³⁷ 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 another new riverside ward with 1,000 beds,³⁸ increasing its total capacity to 1,800 beds.

In March 2015, an internal communication indicated a 130% bed utilization rate in its kidney transplant department.⁴⁰ However, it reportedly had only 46 beds and 50 kidney transplants, a figure that is most likely deflated by an order of magnitude given the growth trends outlined above.

Despite having approval for only kidney transplants, the Affiliated Hospital of Zunyi Medical College has also performed liver, bone marrow, cornea, stem cell, and other types of transplants. 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%.⁴¹ The department has since been expanded to 100 beds.⁴²

The Tianjin Medical University General Hospital’s website showed in 2016 that its general surgery department had a subordinate organ transplant research institute, which conducts liver, small intestine, and other abdominal organ transplants. The department has 208 beds and averages a 115% utilization rate.⁴³ Its lung cancer surgery department contains the Tianjin Lung Transplant Center, which has 110 beds for its professional clinical team and admits an average of over 160 inpatients per month.⁴⁴ Its urologic surgery department conducts kidney transplants, has 96 beds, and admits up to 150 inpatients per month.⁴⁵ Its ophthalmology center carries out corneal transplants, has 42 beds, and admits more than 100 inpatients each month on average.⁴⁶

Furthermore, many unapproved hospitals did not, in fact, stop performing organ transplants. We list 75 hospitals that did not receive permits in 2007 yet continued to perform transplants and 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.^{47 48}

Many hospitals have increased their number of transplant beds and opened new wards and buildings since 2006. 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 will continue into the foreseeable future.

Demand Outstripping Capacity

The increased capacity of transplant centers still could not meet the demand driving high bed utilization and transplant volume. For example, the Third Xiangya Hospital of Central South University had over 1,000 people waiting for an organ.⁴⁹ The First Affiliated Hospital of Xi’an Jiaotong University also had over 1,000 patients waiting for transplants.⁵⁰ As of 2013, the No. 309 Hospital’s PLA Organ Transplant Research Institute has had 5,000 to 6,000 patients waiting for transplants each year.⁵¹

A People’s Daily Online report on January 20, 2011 stated, “In a ward in the First Affiliated Hospital of Zhejiang University, where Zheng Shusen is located, currently lay more than 50 patients who urgently need liver transplants … At the Tianjin First Center Hospital Oriental Organ Transplant Center, there are no fewer than a thousand late-stage liver disease patients registered on the waiting list for liver transplants…”⁵²

Limiting Factors for Transplant Volume

The high bed and staff utilization mentioned above and the continued expansion of existing transplant centers and plans to qualify so many new ones suggest that the number of transplant operations are constrained by medical facilities and personnel rather than organ sources.

This can also be seen in the following examples of the regime’s push to export organ sources and promote China’s transplantation to markets outside of China.

In December 2014, Huang Jiefu went to Taiwan to propose the establishment of a “cross-strait organ exchange platform” to export human organs from the mainland to Taiwan, such that “patients would no longer need to travel from Taiwan to mainland China to undergo transplants.”⁵³

During a conference held in Guangzhou on August 22-23, 2015 by China’s Organ Procurement Organization Alliance, Huang Jiefu promoted China’s organ transplantation to the world during an interview by Peng Pai News, stating, “… The future transplant costs in China will still be the cheapest and most accessible in the world, and [the transplants will be] of high quality.”⁵⁴

Huang Jiefu addressed the limiting factors of organ transplantation in China during a televised interview on January 12, 2015:⁵⁵

“The first is an economic reason. A 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. Only the third is that there are not that many donor bodies; even though donor bodies are abundant right now, there aren’t that many hospitals and that many doctors that can [perform transplants].”

Above, Huang indicated that the availability of organs was not the main limitation.

Ambitious Plans for Growth

In October 2015, Huang Jiefu told Beijing Youth Daily that China had only 169 hospitals with permits to perform one or more types of transplant operations. He expressed a desire to increase the number of qualified transplant hospitals from 169 to 300 and train 400 to 500 young doctors.⁵⁶

China Daily later reported on May 15, 2016 that, according to Huang, “China will increase the number of hospitals conducting organ transplants to 300 in the next five years.”⁵⁷

In his latest statement on January 2, 2017, Huang told People’s Daily, “We’re currently short of doctors, short of hospitals, short of coordinators … We’re calling to grow [from 169] to 300 to 500 hospitals.”⁵⁸

Overworked Doctors and Nurses

We observed that a number of medical teams and individual doctors routinely struggled to carry out the volume of transplants demanded of them, including in recent years. Surgeons work overtime to procure organs and conduct transplants with surgical departments frequently carrying out multiple transplants simultaneously. One hospital even resorted to training almost all its general surgeons to conduct organ transplants.

It was common to see accounts of surgeons performing transplants for 20 hours without rest and getting little sleep each day.⁵⁹ Doctors were so busy procuring kidneys that they are “often unable to go home for one or two weeks at a time.”⁶⁰

Case Study: Working Around the Clock

At the Second Xiangya Hospital of Central South University, the director of the Urological Transplant Department, Peng Longkai, has completed more than 2,000 kidney transplants.⁶¹

One can infer the volume of transplants at this hospital from how busy its doctors have been:

“Transplant surgeons often have to work for over 20 consecutive hours performing surgeries. They will start another round of operations after they rest for three or four hours. The surgeons are still at the operating table, while the scrub nurses have changed several shifts. They often conduct a dozen operations over a period of 2 to 3 days. They once performed 9 kidney transplants in one day.”⁶²

Case Study: Kidney Supply Chain Overwhelmed

“If I’m not at the hospital, I’m at the kidney procurement location. If I’m not at the kidney procurement location, I’m on the way between the hospital and the kidney procurement location.” This was the portrayal of the busy lifestyle of the transplant team at Qilu Hospital of Shandong University. Members of the team were often unable to go home for one or two weeks at a time. On December 26, 2010, a report on its official website stated:⁶³

“Due to the current international criticism of organ sourcing in China, the number of usable cadaveric donor kidneys has decreased significantly, causing an increase in uncertain factors and intense competition. However, due to the tireless efforts of Director Dong Laidong of the Organ Transplant Supply Department and Director Tian Jun, of the Blood Purification Department, the number of cadaveric kidney transplants well surpassed that of last year, and the wait time for kidney transplants has not increased noticeably.”

Case Study: All Hands On Deck

This fervor in pushing transplant volume is not limited to national-level hospitals. We have found that transplantation has become a major business activity for municipal hospitals and subsidiary hospitals of state-owned enterprises, as exemplified by the case below.

The Dongfeng Company Hospital is operated by an automaker in Shiyan, a small industrial city in central China. In less than ten years, the explosive growth in this hospital’s transplantation activities “caused the local economy to prosper,” “elevated the city’s reputation,” and gradually replaced the Dongfeng vehicle as the new “business card of Shiyan.”⁶⁴

As early as in August 2000, it had conducted 10 kidney transplants, one thyroid transplant, and 3 corneal transplants in the same day. The hospital also performs liver, corneal, in situ parathyroid, bone marrow, and other types of organ and tissue transplants.⁶⁵

The hospital’s vice president Yuan Fangjun stated in 2009, “Kidney transplantation is now a routine surgery. Almost all surgeons at our hospital can independently complete kidney transplants.”⁶⁶

According to the hospital’s website, it has 10 surgical departments and more than 100 surgeons. How many transplants is the hospital performing to necessitate training almost all its surgeons in this procedure?

In addition, the hospital has a breast transplant department with more than 40 beds, 3 chief physicians, 2 associate chief physicians, 4 attending physicians, and 3 residents.⁶⁷ These doctors’ web pages are no longer accessible.

Case Study: “A Decade of Memories”

Xi’an High-Tech District Hospital is a joint venture with a British hospital management company. Its organ transplant center was established in 2003. The Ministry of Health has not approved this Class 3 Grade B hospital for transplants.

In September 2012, during the tenth anniversary of its Urological Surgery Department, the hospital published an article describing the department’s efforts in achieving annual revenues of 10 million RMB. This “glorious achievement” came just five years after its establishment.”⁶⁹

“Thinking about those days, we would leave before dawn for the train station, airport, or another hospital to pick up one patient after another. Regardless of the summer heat or the winter chill, 4 or 5 people were crammed into an old, dilapidated van, excising [source] organs. Thinking of the 7 or 8 transplant surgeries done in one day and one night, thinking about watching over critically ill patients and not leaving the hospital for one or two weeks…”

Case Study: “Addicted” Transplant Surgeon

According to an online posting, “Renji Hospital Liver Transplant Center was officially established on September 20, 2004. The hospital recruited Xia Qiang as its lead surgeon. Although he had already completed several hundred liver transplants successfully, Xia was still relatively inexperienced within the Chinese transplant community at the time.”⁷⁰

In a report by Jiefang Daily on January 26, 2005, Xia said, “I’m obsessed with liver transplants. It’s like I’m addicted to it. I would feel uncomfortable if I don’t go to the ward to see patients for one day. I do at least two to five liver transplants a week. I’m not afraid of failures. I would carefully analyze and summarize and continue to do it the next day.” Exactly how many liver transplants had he done? Xia had lost count. He remembers only his record of six liver transplants in one day.⁷¹ Even now, a classical liver transplant takes four to six hours to complete; in 2005, the operation time was even longer.

Xia said, “The management of my team is militarized. Every medical staff member must keep their cell phone turned on 24 hours a day because liver transplants may require going out for graft procurement or preparing for surgery at any time. We doctors must be on standby at all times.”⁷² In 2013, a Wenhui Daily article stated, “Renji Hospital conducts liver transplants surgeries continuously and doctors could not get out of the hospital all night long.”⁷³

Hospitals Perform Multiple Transplants Simultaneously

Another common pattern we observed were hospitals routinely performing multiple transplants a day. No longer a special achievement, one department conducted more than 10 or even 20 kidney transplants within 24 hours.

Case Study: Wuhan Union Hospital Reinstalls 4 Hearts in One Afternoon

According to a 2013 report by the Wuhan Evening News,⁷⁴ on the morning of June 20, Union Hospital’s Cardiac Surgery Department received notice that 4 donor hearts were available for transplant.

The same afternoon, the hospital’s vice president Hu Yu gave the order to perform 4 heart transplants simultaneously. More than 200 medical personnel, including 13 professors and 17 associate professors from the Cardiac Surgery Department, split into 4 teams, each of which independently completed donor selection, procurement, matching, and transplantation.

On June 21 at 10:43, four hearts were simultaneously transported to operating rooms at Union Hospital. At 11:50, led by Professor Dong Nianguo, Director of the Cardiac Surgery Department, four specialist teams began performing four heart transplants at the same time. In the 22 minutes between 13:47 and 14:09, four hearts were beating again in four end-stage heart disease patients.

At the First Affiliated Hospital of Sun Yat-Sen University in March 2006, a Guangzhou Daily reporter witnessed 5 liver and 6 kidney transplants being conducted simultaneously. The center’s record for kidney transplants was 19 in one day. It has also performed 6 liver transplants and one multi-organ transplant in one day.⁷⁵

The hospital stated on its news website that it has had “tens of thousands” of liver or kidney recipients.⁷⁶ Professor Zheng Keli, who directed the organ transplant department, has led more than 3,000 kidney transplants.⁷⁷ The department’s current director, He Xiaoshun, has reportedly completed 1,300 liver transplants.⁷⁸

Xinqiao Hospital, affiliated with the Third Military Medical University in Chongqing, once carried out 24 kidney transplants in one day and had conducted 2,590 kidney transplants by 2002.⁷⁹

On December 1, 2008, Qilu Evening News reported that the General Hospital of Jinan Military Command was capable of performing 6 kidney transplants simultaneously. It set a record of 16 kidney transplants within 24 hours. Its annual transplant volume has ranked among the nation’s top 10 for ten consecutive years.⁸⁰

The Liver Transplant Center at West China Hospital has five full sets of imported liver transplant equipment, allowing five liver transplant operations to be performed simultaneously.⁸¹ The Center once performed seven liver transplants in one day, setting a national record.⁸²

On February 18, 2014, sixteen doctors of the Hepatology Center at Fuzhou General Hospital of the Nanjing Military Command simultaneously carried out five liver transplants within seventeen hours.⁸³

At Wuxi People’s Hospital, Chen Jingyu, “the No.1 Lung Transplant Surgeon in China,” often completed four or five lung transplants a day.⁸⁴ The Xiangya Hospital of Central South University completed one liver, 6 kidney, and 8 corneal transplants on May 26, 2005.⁸⁵ On September 3, 2005, it performed 7 heart, liver, and kidney transplants.⁸⁶ On April 28, 2006, the organ transplant center conducted 17 transplants in one day, including 7 advanced-stage uremic patients simultaneously. On the same day, it also completed two liver transplants and 8 corneal transplants.⁸⁷

Beijing Chaoyang Hospital reportedly conducted 21 transplant surgeries in one day around 2000.⁸⁸ The founder of the transplant center at the Second People’s Hospital of Shanxi, Wu Xiaotong, often spent 12 hours a day performing transplant surgeries, one after another. In August 2006, the center recorded over 100 patients waiting for transplants at any given time. It conducted 11 kidney transplants on August 15th alone.⁸⁹

Most Prolific Institutions and Individuals

Over the past decade, the Chinese authorities have not released the annual volume of individual hospitals and only claimed that a total of about 10,000 organ transplants are performed each year.⁹⁰ However, even from the data scattered on hospital websites, it is clear that just a few hospitals and individual surgeons would easily surpass this number.

Much transplant data previously published have been actively removed and deflated in China, especially after illicit organ harvesting first gained international attention in 2006. For example, some transplant departments’ official annual figures account for less than 10% of their bed and personnel capacity. Nevertheless, in some cases, we have been able to compare numbers between different types of data from a variety of sources to get a sense of an institution’s true scale and its surgeons’ transplantation activities, some of whom have individually led thousands of transplant surgeries.

One of the most prolific institutions is Tianjin First Central Hospital’s Oriental Organ Transplant Center, which expanded to 500 beds in 2006. It reached 90% bed utilization rates by 2009⁹¹ and 131% in 2013.⁹² The Center can simultaneously carry out nine liver transplants and eight kidney transplants. Based on its bed count, a 100% utilization rate and an average hospitalization time of 3 to 4 weeks for liver transplants, the Center would be able to perform 6,000 to 8,000 transplants per year. It claims to have completed just 10,000 transplants in total,⁹³ but this number would have easily been surpassed by just a few of its surgeons such as Shen Zhongyang whose biography says he had performed nearly 10,000 liver transplants by 2014.⁹⁴ It was reported that, under his guidance, each of his former student doctors has independently completed nearly 1,000 liver transplant surgeries.⁹⁵

A media report stated, “As a leader, Shen Zhongyang has virtually no time for himself. In the past ten-plus years, he has basically gone from one thing to the next, day and night, he hasn’t had a single meal at regular times, and he’s often at the operating table until midnight or the following morning.”⁹⁶

Other transplant doctors also have not rested: “The hospital’s transplant surgery division’s doctors hurriedly shuttle between wards and operating rooms, with no time to greet one another. They kept saying, ‘These few days are crazy busy, with more than a dozen surgeries a day.’ Some doctors were even “rushing surgeries all night long [and] did not sleep at all.” Doctors complain that the off-season is only a month after the New Year; they are busy until the end of the year and normally don’t go home.”⁹⁷

The People’s Liberation Army Organ Transplant Center at No. 309 Hospital has 231 medical and research personnel. It had 316 beds in 2010 and 393 beds in 2012,⁹⁸ though its website now says it has 330 beds. Its bed utilization rates reportedly lead that of similar military organizations. It once completed 12 kidney transplants overnight.⁹⁹

As of 2014, Tan Jianming, vice president of Fuzhou General Hospital of Nanjing Military Command, has led more than 4,200 kidney transplants. Tan was previously also part-time Director of the Urology and Transplantation Department at Shanghai Jiaotong University’s First People’s Hospital and its Shanghai Organ Transplant Center.¹⁰⁰

Shanghai Changzheng Hospital affiliated with the Second Military Medical University, hosts two prolific doctors. Zhu Youhua, who is considered a leader in the People’s Liberation Army on kidney transplantation, completed 3,680 kidney transplants by 2010.¹⁰¹

Fu Yaowen, founder of the First Hospital of Jilin University’s kidney transplantation program and blood purification center, completed 3,000 kidney transplants as of April 2009.¹⁰²

In a paper published in 2004, Yu Lixin, director of the transplant department at Nanfang Hospital of Southern Medical University, stated that the hospital had conducted 2,123 kidney transplants as of November 2001.¹⁰³

One particularly prolific institution is Xinqiao Hospital, affiliated with the Third Military Medical University. Its Renal Diseases Research Center claimed that it had “conducted 2,590 kidney transplants by 2002 … and once performed 24 kidney transplants in one day.”¹⁰⁴

According to an introduction published by sohu.com in 2005, Guan Delin at Beijing Huaxin Hospital (First Affiliated Hospital of Tsinghua University) had experience in “over 2,700 kidney transplants, over 40 kidney transplants from relative donors, and close to 20 combined kidney-pancreas transplants.”¹⁰⁵

The Guangdong No.2 Provincial People’s Hospital’s organ transplant department was established in 1999. Its director, Liu Dong, personally participated in more than 2,000 kidney and liver transplant surgeries by 2015.¹⁰⁶ Deputy director Wu Jiaqing revealed that, prior to August 3, 2006, the department performed “more than 10 organ transplant surgeries every day,” and that “beginning in August 2006, patients from 8-9 countries came to the hospital for organ transplants, including from Singapore, Cambodia, and France.”¹⁰⁷

The Navy General Hospital in Beijing “has helped thousands of end-stage liver cancer patients gain a second life through liver transplantation.”¹⁰⁸

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References