Myths Behind Organ Sources

The Chinese government has changed its statements on organ sourcing several times, claiming that the vast majority of organs came from death-row prisoners, and later, voluntary donations.

Death-Row Prisoners

Although the Chinese regime treats the number of executions as a state secret, international organizations have attempted to estimate this number over the years using various sources.

Among them, Amnesty International counted death-row executions published in media reports and official databases. There were 8,401 executions between 1995 and 1999 with an average of 1,680 annually followed by an average of 1,616 annually between 2000 and 2005¹ and 1,066 between 2006 and 2008.^{2 3 4} Since January 2007, when the law was changed to require that all death penalty cases be reviewed by the Supreme People’s Court of China, the number of executions has decreased further. For example, in 2007, 15% of death penalty cases were dismissed after review.⁵

Amnesty stopped providing such estimates after 2008. Its 2017 report stated, “hundreds of documented death penalty cases are missing from a national online court database,” which “contains only a tiny fraction of the thousands of death sentences that Amnesty International estimates are handed out every year in China.”⁶

The international community generally believes that the number of death-row executions in China has decreased the estimate made in 2000 of 10,000 per year.^{7 8 9}

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 transplants continued to grow while death penalty numbers fell further due to new judicial review procedures. Given that the number of voluntary donors remained low and flat throughout this period, this trend leaves a large gap of transplants for which organ sources are not accounted for by official reports.

Furthermore, the government promised to stop using organs from death-row prisoners beginning in 2015.¹⁰

At the same time, China’s transplant numbers increased dramatically, He Xiaoshun, a member of the Expert Committee of the Human Organ Donation Commission, stated in March 2010, “The year 2000 was a watershed for the organ transplant industry in China…the number of liver transplants in 2000 reached 10 times that of 1999; in 2005, the number tripled further [since 2000].”¹¹

The decline in the number of death-row prisoners stands at variance with the increase in organ transplants in China since 2000.

In 2013, the Director of Hepatobiliary Surgery at Peking University People’s Hospital said, “Our hospital conducted 4,000 liver and kidney transplant operations within a particular year, and all of the organs are from death-row prisoners.”¹²

Considering that many convicted death-row prisoners are not suitable candidates for organ sourcing due to health reasons, it is unlikely that there were sufficient death-row prisoners to serve as this hospital’s true organ source for its 4,000 transplants.

While Chinese officials claim that the country performs about 10,000 transplants a year, based on government-imposed minimum capacity requirements, the 169 approved transplant hospitals could have conducted 60,000 to 100,000 transplants per year.¹³

It is clear that death-row prisoners, whatever the exact number may be, could account for only a small fraction of the total number of transplants performed in China.

Continued reliance on prisoner organs, including death-row executions

In July 2005, after years of denial, former Deputy Minister of Health Huang Jiefu acknowledged for the first time that the majority of transplant organs came from death-row prisoners.¹⁴ After live organ harvesting was exposed in March 2006, Chinese officials returned to the initial denial.^{15 16} Then, starting in January 2007, Huang has consistently said that organs are sourced from executed prisoners.¹⁷

In August 2013, the National Health and Family Planning Commission issued Notice on Management Regulations for Human Organ Procurement and Distribution (Trial), requiring all approved transplant centers to use the new “Chinese organ distribution and sharing system.” Patients on the waiting list should be entered into this national database, and donated organs should also go through this centralized distribution system.¹⁸

At the China Organ Transplant Conference in November 2013, Huang Jiefu announced the “Hangzhou Resolution,” which promises to discontinue the use of organs from death-row prisoners by June 2014. Among the 169 registered transplant hospitals, 38 signed the resolution.¹⁹

In March 2014, Huang explained to Beijing Times that transplant reform “is not about not using organs from death-row prisoners, but not allowing hospitals or medical personnel to engage in private transactions with human organs.”²⁰ “We will regulate the issue by including voluntary organ donations by death-row prisoners in the nation’s public organ donation system.”²¹ “Once entered into our unified allocation system, they are counted as voluntary donations of citizens. The so-called death row organ donation doesn’t exist any longer.”²²

In December 2014, one year after the “Chinese organ distribution and sharing system” was announced, Chinese state-owned media declared that China would stop using death-row prisoners’ organs for transplants from January 1, 2015 onwards, and that citizens’ voluntary organ donations after death would be the only source for organ transplants.²³

The Chinese regime has used this system to classify previously unidentified organ sources as voluntary donations.

According to The New York Times article “China Bends Vow, Using Prisoners’ Organs for Transplants,” organs from prisoners, including those on death row, can still be used for transplants in China, and that this use has the backing of policymakers.²⁴

On October 8, 2015, the British Medical Journal published an article titled “China’s semantic trick with prisoner organs”²⁵ co-authored by five medical experts from the United States, Germany and Canada. It states, “The announcement of December 2014 itself is neither a law nor a governmental regulation.” The article asserts that the Chinese authorities are simply playing word games by “labelling prisoner organs as voluntary donations from citizens.”

Few Voluntary Donors as of the End of 2015

Traditional Chinese custom requires bodies to be preserved whole after death. Organ transplantation in China began in the 1970s, but by 2003, the number of voluntary donations remained at zero.²⁶ There was no organ donation system in China before 2010,²⁷ and the national organ donation system started in 2014.²⁸ As of the end of 2015, China’s trial organ donation and allocation systems still have not produced donations on any meaningful scale.²⁹

In March 2010, China piloted an organ donation program in Shanghai, Tianjin, Liaoning, Shandong, Zhejiang, Guangdong, Jiangxi, Fujian, Xiamen, Nanjing, Wuhan, and eventually in 19 provinces and cities.³⁰ The Ministry of Health and China Red Cross jointly ran this program.

A year after the launch of the Nanjing Organ Donation pilot program in March of 2010, not a single voluntary organ donation had been received. In the 20 years prior to that, only three people in Nanjing had donated their organs.³¹

New Beijing Paper reported in March 2012 that 207 voluntary donors had donated organs after death in two years nationwide.³²

When interviewed by Guangzhou Daily in 2013, Huang Jiefu stated that he performed more than 500 liver transplants in 2012, one of which was “the first voluntary citizen donation meeting Chinese standards.”³³

On February 25, 2013, the National Organ Donation Working Video Meeting reported that only 659 donations had occurred in total nationwide since March 2010.³⁴

In Shanghai, the first organ donation from a deceased organ donor was completed on August 21, 2013. There are 11 transplant centers in Shanghai approved by the Ministry of Health.³⁵

According to an article titled “Many Challenges in Organ Donation” published by Guangming Daily on September 3, 2013, donor organ coordinators stated that, among 100 potential organ donors, about half were ineligible because they could not meet the requirements for donation. Of the remaining donors, about 30 provided organs that were unusable because of delays in organ acquisition after death. Ten donations were overruled by relatives’ objections. In the end, there were fewer than five available donors.³⁶

The National Health and Family Planning Commission established a new “Chinese organ distribution and sharing system” at the end of August 2013. Patients on the waiting list would be entered into this database, and donated organs are required to go through this centralized distribution system.³⁷

Does this mean that all barriers to donation would be removed after the implementation of an “organ distribution and sharing system”?

At the Hangzhou Transplant Congress in November 2013, Dr. Ye Qifa, Executive Chairman of the China Organ Transplant Alliance and professor of organ transplantation at Central South University, expressed frustration that about 70% of the 165 approved transplant centers showed no interest in developing civilian organ donation programs. Doctors indicated that, no matter how well the computer matching and deployment system worked, it wouldn’t work without an organ supply. Even when a donated organ became available, it was often of poor quality and could not be used. According to Dr. Ye, there existed a large gap between supply and demand.³⁸

A China News Service report on March 11, 2015 stated that Mainland China had a voluntary organ donation rate of 0.6 per million people.³⁹ A World Health Organization study put Chinese citizens’ organ donation rate at 0.03 per million, only 1/20 of the above figure.⁴⁰

At the 2015 China Organ Transplant Congress held in Wuhan on August 6-8, 2015, Huang Jiefu declared that China had successfully realized the transformation from reliance on prison sources to voluntary organ donation from citizens. Dr. Ye Qifa reported that 4,626 citizens in China donated their organs after death between 2010 and August 2015, totaling 12,405 major organs. He projected that in 2015 the number of transplant surgeries in China would pass 10,000 and may surpass the historical record set in 2006.⁴¹

Yet, as of today, China’s trial organ donation and allocation systems still have not produced donations on any meaningful scale.⁴² Huang Jiefu indicated in an interview with Beijing Youth Daily on November 18, 2015 that the organ donation system in China does not function in practice because the Red Cross and the National Planning Commission, the two most important organizations in organ donation, did not actually coordinate with each other:

“The two departments jointly established a national organ donation and transplantation committee on March 1, 2014, but it exists in name only. So far, no meeting has been held yet.”

In 2015, most institutes for voluntary organ donations did not answer calls made by investigators from the World Organization to Investigate the Persecution of Falun Gong. The few offices that did answer the phone indicated that there were tiny numbers of people who had registered to donate, and that the number of successful donations was extremely low.⁴³

On December 6, 2015, staff at the Red Cross Society of Beijing (phone number 86-10-6355-8766) said that organ donation was still in the preparatory stage. The Beijing Red Cross did not even have a donation office at the time and had not yet begun organ donation.⁴⁴ Yet, there are 20 approved large transplant centers in Beijing, many of them having a capacity of thousands of transplants per year.

On December 17, 2015, a female staff member at the Shanghai Red Cross organ donation office in Huangpu District (86-21-63365880) said that the office began to carry out donation work at the beginning of the previous year. The entire city of Shanghai had only 5 successful organ donations since the donation system began.⁴⁵

On December 12, 2015, a Tianjin Red Cross worker (86-22-2731-1180) said that, since an organ donation database was created in 2003, there had been a total of 170 donated organs.⁴⁶ Yet, Tianjin’s Oriental Organ Transplant Center has over 500 transplant beds and an annual capacity of at least 5,000 transplants.

Wang Pei’an, a deputy minister at the National Health and Family Planning Commission, told the New York Times in April 2016, “For a long time we lacked an organ donation system … we will use Chinese methods to solve [the problem]. This is a resolute struggle.”⁴⁷

Compared to the huge volume of transplants performed in China, the number of voluntary donors is negligible.

Living Relative-Donor Transplants

Many hospitals now list living-donor transplants as signature services with relative donors as main organ sources. However, we found that the actual number of donations is extremely low.

According to a report published by Xinhua Daily on April 12, 2006, Jia Ruipeng, director of the Kidney Transplant Center at Nanjing Hospital No.1 said, “Between the first living relative kidney transplant in 1972 and the end of last year, there were only 700 living relative kidney transplants in the country, accounting for only about 1.5% of all renal transplants.”⁴⁸

China’s Ministry of Health has repeatedly proposed restrictions on living organ donations rather than encouraging the practice. According to a report published by China Network, Deputy Minister of Health Huang Jiefu said, in March 2008, that the National Human Organ Transplantation Clinical Application Committee (OTC) would strictly regulate and manage living organ transplantation. He said, “So far, the main source of organs is cadavers.”⁴⁹ During the Human Organ Donation Pilot Summary Conference held by Chinese Red Cross and the Ministry of Health in Hangzhou, on March 22, 2012, Huang Jiefu again said the State would gradually restrict living relative transplants.⁵⁰

On March 27, 2012, Xiao Jiaquan, the director of the Urologic Department of the People’s Hospital of Zhejiang Province, told the Today Morning Express that the Ministry of Health was restricting relative donation due to the adverse impact on donors’ health and to curb underground organ trafficking.⁵¹

On March 26, 2012, JCRB.com (managed by the Supreme People’s Procuratorate) published a case report regarding an underground kidney broker, Cai Shaohua (defendant), who said that doctors told them that the matching rate between relatives was very low; even if there is a marginal match, it could result in complications after surgery, which would only cause bigger losses for the patient’s finances and health. Cai said,

“Now [among relative-donor] organ transplant surgeries, nine out of ten are fake relatives. Those in the hospitals are well aware of the things that we [brokers] do.”⁵²

Multiple Organs from One Donor

The Chinese regime advertised in its state-run media that, in certain cases, one donor’s organs were used in several transplants. China’s health officials sometimes use the possibility of procuring 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. However, we find that this efficiency cannot be achieved in most cases. Factors affecting the usable ratio include organ life, geographic distance and limiting technical factors

Organ life: Human organs are a “non-reusable resource with an expiration time limit.” When an organ is removed from the donor, it must be kept in a preservation solution and the transplant operation must take place within a limited time. According to the Notice on Management Regulations for Liver, Kidney, Heart and Other Transplantation Technologies issued by the Ministry of Health, the time should not exceed 24 hours for kidneys, 15 hours for livers, and 6 hours for hearts.⁵³

Chen Jingyu, a lung transplant surgeon at the Wuxi People’s Hospital and a member of the National People’s Congress, appealed for more government support to ensure the speedy transport of organs to avoid waste.⁵⁴

Huang Jiefu said on May 6, 2016 that 20% of transported organs are wasted on the way.⁵⁵

Geography: Until the end of 2013, China did not have a national organ-sharing network. Tissue matching was mostly done within specific hospitals or regions.⁵⁶ Unavoidably, given the time limits involved in how quickly organs must be used after being extracted from a body, many organs in China were wasted as a result. In fact, for many bodies, only one organ was utilized.⁵⁷

It was not until October 2013 that the National Health and Family Planning Commission announced the “(Trial) Regulations for Obtaining Organs from Voluntary Donors and Organ Assignment,”⁵⁸ which required all 165 approved hospitals to use the new National Organ Sharing Network; it also required all donated organs to be allocated by this system. Since then, the National Health and Family Planning Commission has required all transplant centers to register their patients to build a national waiting list.

There is an unwritten rule that transplantable organs can only be allocated locally. Local hospitals have monopoly control over local organ sources. Some hospitals have abundant organ sources but cannot find suitable matching recipients, thus many organs are wasted. Hospitals in regions that are short on organ sources have to try to obtain them from hospitals in localities that control abundant organ sources.⁵⁹

Technical limiting factors: Strict limitations on ischemia times of transplanted organs place high technical demands on transplant centers when conducting transplants using multiple organs from the same donor. Until recently, very few institutions in China were capable of doing this successfully.

A December 2011 report said that more than 60 doctors carried out 6 transplant surgeries simultaneously at No. 303 Hospital of Guangzhou Military Command on that day. These included liver, lung, pancreas-kidney, and kidney transplants, as well as two corneal transplants.⁶⁰ Dr. Sun Xuyong, President of the hospital’s Transplantation Research Institute, revealed that the six organs were procured from the same donor. However, he did not reveal the source of the donor.

Lan Liugen, Deputy Director of the Surgery Division at No. 303 Hospital of Guangzhou Military Command, said that only two hospitals in China had this capability at the time. In addition to his hospital, the other was the Tongji Organ Transplant Research Institute of Huazhong University of Science and Technology.⁶¹

Reports in October 2015 indicated that the 2nd Affiliated Hospital of Harbin Medical University carried out multiple transplants simultaneously using organs from the same donor. The article emphasized that this was the very first case in Heilongjiang Province.⁶²

An August 2016 report indicated that the People’s Hospital of Jiangsu Province carried out heart and lung transplants for two patients using organs from the same donor. The article emphasized that it was the first such case in the country.⁶³

On November 23, 2015, Huang Jiefu said to Beijing Youth Daily that there were 2,500 organ donors in 2015 nationwide, which could theoretically allow 2,500 heart transplants and 5,000 lung transplants. However, he said there were only more than 100 heart and lung transplants completed in the whole country, and almost all the organs were wasted.^{64 65}

Based on the above, we conclude that the utilization rate of “donor organs” in China’s transplant centers is much lower than those of well-established organizations in other countries. In the past two years, the Chinese regime intentionally advertised in its state-run media that, in certain cases, one donor’s organs were used in several transplants. Our findings indicate that such cases are rare, and we believe that most reports serve to cover up actual organ sources.

Difficulties of Voluntary Donations

A report published online in December 2008 stated that almost all Chinese transplant doctors hold that voluntary organ donation would be “unachievable.” Li Leishi, an academician at the Chinese Academy of Engineering and founder of the PLA Institute of Nephrology, wrote in a paper, “In China, organ donation after a citizen’s death exists only theoretically. In actuality, it is not possible. There are no such conditions institutionally and legally … China has no standard for defining brain death, and organ donation has no legal protection.”⁶⁶

To date, these issues have not seen substantive changes or improvements. In recent years, official state media have reported a few high-profile cases of individual human organ sales.⁶⁷ The number of such reported transactions is miniscule.

An early 2006 report by Sanlian Life Weekly stated, “China currently has a voluntary organ donation rate from living relatives of 1.1%. The control of over 98% of organ sources originates from outside of the Ministry of Health system.”⁶⁸

References