Written evidence from the medical association
Doctors Against Forced Organ Harvesting (CHI0013)

Executive summary

• Implausible increase of transplant numbers in China between 1999 and 2004.
• Increased transplant numbers cannot be attributed solely to executed prisoners.
• Implausible growth of China’s organ donation numbers.
• Discrepancy between officially reported transplant numbers and other transplant infrastructure parameters.
• Inexplicable medical exams in Chinese detention camps.
• DAFOH estimates that more than 150,000 Falun Gong practitioners have become victims of forced organ harvesting in China in the past 16 years.
• Conclusion: DAFOH recognizes that over the past 16 years China has maneuvered itself into a dilemma: the lack of transparency and absence of independent scrutiny and critical inspections over its transplant practices now prevents the international community from verifying China’s announced reforms. While China claims to have ended its practice of unethical organ harvesting from executed prisoners, there is no evidence that China has actually done so. Due to its refusal to allow independent scrutiny, China's response to allegations of forced organ harvesting from Falun Gong practitioners has merely been assurances that it has implemented reforms. However, China has provided no evidence that it has ended forced organ harvesting from executed prisoners and prisoners of conscience. Allowing for independent scrutiny would risk revealing what independent researchers have already discovered: that the practice of forced organ harvesting of prisoners of conscience continues in China.

Introduction

The medical ethics advocacy association Doctors Against Forced Organ Harvesting (DAFOH)[1] was founded by medical doctors in 2007. It voluntarily and independently serves the medical community as well as society. The association’s Advisory Board lists leading professors and doctors in the transplant field. DAFOH aims to provide the medical community and society with objective findings of unethical and illegal organ harvesting practices. In its mission statement DAFOH understands the practice of forced organ harvesting as the coerced removal of organs from a donor, without obtaining prior, free, and voluntary consent.

DAFOH members have published in medical journals, written books and presented at medical conferences. DAOFH members have organized a global petition to the UN High Commissioner for Human Rights, which over the past four years has garnered more than 2.2 million signatures, with 300,000 signatures coming from the United Kingdom. In 2016, DAFOH was nominated for the 2016 Nobel Peace Prize.

Key issues about forced organ harvesting in China

1. Implausible increase of transplant numbers in China between 1999 and 2004:  According to official figures from Chinese officials, the transplant numbers increased by 300 percent from about 3,000 transplants in 1999 to more than 13,000 transplants in 2004[2]. The Global Observatory on Donation and Transplantation (GODT) monitors transplant numbers globally[3]; the annual average increase of transplantations globally is between two and three percent per year, or ten to fifteen percent over five years. In comparison with the global increase of transplantation numbers, the People’s Republic of China’s increase by 300 percent is seen nowhere else in the world. Given that their first official pilot program for organ donations started in 2010, the increase of performed transplants in China cannot be reasonably explained.
2. Executed prisoners' organs cannot explain the transplant numbers: Traditionally, the Chinese population is reluctant to donate organs. The donation rate is reported as 0.6 donors per million population[4]. If organs procured from executed prisoners represent 90 percent of the transplant organs procured from deceased donors, and are considered the main source of organs, then the number of executions must either be very large, or the organ donation behaviour of the death row prisoners has drastically departed from the Chinese society’s donation behaviour of 0.6 donors per million. The latter would confirm the statement of the World Medical Association (WMA) that prisoners, deprived of their freedom, are not in the position of giving free consent[5]. Human Rights Organizations observed a decline in executions in China since 2000[6]. It is either implausible, or indicative of extreme unethical circumstances, that executed prisoners' organs could explain the large transplant numbers reported in the period between 1999 and 2004.
3. Implausible course of China’s organ donation numbers: About ten years after China’s unprecedented increase in transplant numbers, and the creation of its public organ donation system, the official numbers reported from China again show unprecedented, artificial characteristics. Publications about China’s organ donation system report donation numbers that have increased by 100 to 200 percent per year after 20104. The GODT reports that the donation numbers globally increase only between five to ten percent annually3. The discrepancy of steeply increasing transplant (1999-2004) and organ donation numbers (2010-2015) in China in comparison with global statistics is striking. The artificial character of these numbers becomes obvious: DAFOH monitored the website of China’s Organ Donation Administrative Center for 18 months. Between December 30, 2015 and December 31, 2015, the number of registered organ donors jumped by exactly 25,000 within one day[7]. While an increase of registered donors of this magnitude on one day is unusual, it is even more unusual that the increase would be such a round number. We also note that during the 18 months of monitoring no other sudden increase has been observed. Both the transplant numbers between 1999 and 2004 and the organ donation numbers after 2010 display characteristics that are unprecedented and not observed in other countries.
4. According to Chinese officials, the numbers of kidney transplants from living donors was low before 2006. Then, within one year, the number of living donor kidney transplants jumped from 300 in 2006 to 1,720 in 2007, an increase of 470 percent, followed by a smaller increase in 2008, then zero growth from 2008 to 2009.[8] An increase of 470 percent followed by no growth is implausible.
5. Discrepancy between officially reported transplant numbers and other transplant infrastructure parameters: For more than a decade official transplant numbers from China amounted to about 10,000 transplants per year between 2004 and 2016. Investigative reports show a robust growth of China’s transplant system and infrastructure during the same time frame[9]: transplant centers expanded and increased their bed counts, the number of transplant teams increased, investments in the modernization of transplant centers occurred, and transplant centers reported significant revenue increases[10].
6. The seemingly strong and profitable expansion of the transplant infrastructure in China stands in stark contrast to the transplant numbers, which stagnated on a plateau of around 10,000 transplants per year for more than a decade. This discrepancy aligns with previous observations that officially reported transplant and organ donation numbers appear artificial, manipulated and implausible. DAFOH therefore strongly recommends against reliance on officially reported transplant numbers from China, and for independent investigation.
7. Implausible medical exams in detention camps: DAFOH has performed pilot research on medical examinations among the Falun Gong prisoner cohort[11]. There are significant numbers of witness reports of treatment of detained Falun Gong practitioners that suggest systematic medical exploration of Falun Gong prisoners of conscience. It is unprecedented and implausible for detention camps that impose torture, brainwashing and forced labor on Falun Gong inmates, while at the same time performing large scale medical exams and blood tests on the same victim group. The number of such examinations is estimated to be in the hundreds of thousands, requiring a budget that a detention camp is not expected to have, unless there is a financial return for such measures.
8. DAFOH has interviewed previously detained Falun Gong practitioners. Female inmates were forced to the ground by groups of police guards for blood tests; on one day, 200 inmates were transported to a medical facility for such tests; in other cases practitioners were taken to operating rooms, but no operation was performed; in other cases, Falun Gong practitioners showed surgical scars on their abdomen. There is an undeniable presence of medical examinations of Falun Gong prisoners of conscience without a reasonable, verifiable explanation. The nationwide, systematic medical examinations of Falun Gong detainees are only really explicable in a context of large-scale, systematic transplant practices.
9. DAFOH estimates that more than 150,000 Falun Gong practitioners have been victims to forced organ harvesting in the past 16 years[12]. This conservative figure was arrived at by the combination of (1) reported and estimated transplant numbers, (2) the routine, instant availability of organs within two to four weeks, (3) the reported transplant numbers from some individual transplant centers, (4) the unsuitability of death row prisoners as donors (ill health, infectious diseases, age, drug abuse), (5) the difficulties of coordinating transplant surgeries with capital punishments as the law requires sentence to be carried out very shortly after the verdict, and (6) the lack of a national allocation system before 2013, requires a standing organ pool that is ready to be matched and organ harvested on demand. This pool of organ donors needs to be large enough to allow for a routine, large-scale, systematic transplant practice. As we have said, the use of executed prisoners as donors cannot explain the large transplant numbers in China reported since 1999. Criminal organ trafficking rings which are sometimes used by Chinese officials to explain transplant activities are scattered and do not have systematic access to matching organs that would explain wait times of two to four weeks on a large scale basis. The specific characteristics of China’s transplant market require another undisclosed organ source, ready to be matched and harvested on short notice.
10. In combination with the implausible medical exams of detained Falun Gong prisoners of conscience, the large amount of diverse and independent eye witness reports of Falun Gong practitioners, the size of the detained group of Falun Gong practitioners, and other factors, it is more than certain that Falun Gong practitioners are the primary and main target group of the state-organized forced organ harvesting from prisoners of conscience in the People’s Republic of China.

Conclusion

11. DAFOH recognizes that over the past 16 years China has maneuvered itself into a dilemma: the lack of transparency and blocking of independent scrutiny and critical inspections of its transplant practices now prevents the international community from verifying China’s announced reforms. While China claims to have ended its practice of unethical organ harvesting from executed prisoners, there is no evidence that it actually has. Additionally, when China announced an end to organ harvesting from executed prisoners in January 2015, it did not include ending organ harvesting from prisoners of conscience.
12. While China announced its intent to implement a new transplant law in 2015, one, which it said would prohibit the use of organs from executed prisoners, there has been no visible sign of this legislation. In contrast, the 1984 provisions that permit the use of organs from executed prisoners have not been abolished. Therefore, and in contrast to the announced reforms, the legal framework in China continues to permit organ harvesting from executed prisoners. On January 18, 2017, the Financial Times writes that China’s top judge Zhou Qiang, President of the Supreme People’s Court, “denounced the idea of judicial independence.”[13] According to the Financial Times, the Chinese Communist Party (CCP) is formally above the constitution. This shifts the accountability of unlawful forced organ harvesting practices to the CCP. China’s multiple attempts to evade scrutiny have led the country into a labyrinth of fabricated numbers and impossible explanations creating a situation that is more and more difficult to oversee and conceal.
13. Among the victim groups of forced organ harvesting are Falun Gong, Tibetans and Uighurs. According to the report of UN Special Rapporteur on Torture Manfred Nowak, 66 percent of alleged torture victims in China’s detention camps were Falun Gong practitioners[14]. While Tibetans and Uighurs face a more geographically focused persecution, the persecution of Falun Gong through the ‘610 office’ is nationwide. A comparison of the population provides further insights: there are an estimated six million Tibetans, fifteen million Uighurs and 70-100 million Falun Gong practitioners in China. While no difference in importance between the victim groups is implied, these figures indicate that Falun Gong practitioners are likely to be the largest victim group of forced organ harvesting in China.
14. The implications for the UK are obvious: China continues to expand its transplant infrastructure; it was announced that the number of transplant centers will increase from the current 169 to 300 licensed hospitals in the next few years. Chinese transplant officials have stated that few Chinese citizens can afford transplants; then, who exactly will be paying for the projected increase in transplants? Transplant tourists have fueled the profitable transplant market in China and will likely keep growing. Given China’s attempts to be acknowledged by the international transplant community, the bypassing of independent international scrutiny of its transplant reforms, and the bypassing of accountability for any past wrong doings, it is to be expected that China will become the global center of transplant tourism, attracting UK residents to China for transplantations.

Recommendations:

15. To take legislative steps to restrict UK medical teaching institutions to accept transplant trainees only from countries that permit independent, impartial inspections of their transplant systems.
16. To initiate the prohibition of any UK teaching hospital to train Chinese doctors in transplant surgery until China facilitates independent, impartial inspections of its transplant infrastructure in order to prevent collusion in crimes against humanity.
17. To promote internationally the gathering and reporting of annual transplant numbers at the level of individual transplant hospitals, which would establish the conditions for improved transparency and scrutiny and help to monitor and prevent transplant abuse and organ trafficking.
18. To be aware that a government that is able to resort to the gruesome practice of killing its own law-abiding, peaceful citizens through forced organ harvesting, and is able to violate basic standards of human dignity of the global community in the 21st century, is likely to be an unpredictable partner in any treaties with foreign nations. The implementation of independent inspections, accountability, and the termination of forced organ harvesting would lay the groundwork for establishing open, fair and peaceful interactions.
19. In this regard we recommend addressing and resolving the issue of forced organ harvesting from Falun Gong practitioners in China. It is a necessary precondition to the establishment of healthy relations between the UK, or any other country, and China.

January 2017