Update on Numbers – Organ Transplants & Sources in China
International Coalition to End Organ Pillaging in China
AUGUST 7, 2014
by David Matas
Remarks prepared for a parallel and poster presentation to the World Trade Congress, San Francisco, California, USA, 29 July, 2014)
How many organ transplants are there each year in China? What are the sources of these organs?
David Kilgour and I, in a report published first in July 2006 and then January 2007 , concluded that there were 41,500 transplants in the six year period 2000 to 2005 where the only explanation for the sourcing was Falun Gong practitioners. In November 2009, in our book Bloody Harvest, we concluded that, since our report, matters got worse, that there had been an increase in sourcing of organs from Falun Gong practitioners.
The Government of China has acknowledged that organs for transplants done in China has come overwhelmingly from Chinese prisoners. The claim of the Government of China has been that these prisoners who are the sources of organs harvested for transplants are convicted criminals sentenced to death and then executed who consented before execution to the use of their organs for transplants.
In July of 2005 Huang Jiefu, then Chinese Deputy Minister of Health, indicated as high as 95% of organs derive from execution. Speaking at a conference of surgeons in the southern city of Guangzhou in mid November 2006, he said: “Apart from a small portion of traffic victims, most of the organs from cadavers are from executed prisoners”. In October 2008, he said “In China, more than 90% of transplanted organs are obtained from executed prisoners”. In March 2010, he stated that: “… over 90% of grafts from deceased donors are from executed prisoners”.
As one can see, at some points, Huang Jiefu refers to deceased donor sources and at other points to all sources. The questions then become, how many live donors are there and how many persons are sentenced to death and then executed? Answering the second question, how many persons are sentenced to death and then executed is not that easy, since the Chinese State and the Communist Party which runs the State consider this information to be a state secret. We are left with external estimates. I and David Kilgour concluded, in our report and book, that the bulk of prisoners who are the source of organs for transplants are Falun Gong practitioners who do not consent, who are killed by the organ harvesting operation and who are not sentenced to death.
Falun Gong is a set of exercises with a spiritual foundation banned by the Communist Party and then the Government of China in 1999 out of jealousy at its popularity and fear that its spirituality, rooted in ancient Chinese traditions, would undermine the ideological supremacy of Western imported Communism. After the banning, Falun Gong practitioners were arrested in the hundreds of thousands. Those who recanted spontaneously or after torture were released.
Those who refused to recant disappeared into arbitrary detention. David Kilgour and I drew the figure of 41,500 by looking at volumes of transplants and volumes of executions before and after the persecution of Falun Gong began. After the persecution of Falun Gong began transplant volumes shot up, but executions remained steady. So we attributed the difference in transplant sources to Falun Gong. After the release of the second version of our report and before the publication of our book, executions decreased and transplant volumes, after an initial dip, returned to traditional levels. So we concluded that sourcing from Falun Gong practitioners had increased.
In a chapter I contributed to the book State Organs: Transplant Abuse in China, a book I co-edited with Torsten Trey, published in August 2012, I revisited the numbers issue . There have been, since the reports and book I co-authored with David Kilgour, a number of developments. There have been further developments since the publication of State Organs.
For our book, David Kilgour and I were able to garner useful information about transplant volumes from the China Liver Transplant Registry in Hong Kong . In one development, the China Liver Transplant Registry shut down public access to statistical aggregate data on its site. Access is available only to those who have a Registry issued login name and password.
Even after public access to the aggregates was denied, there remained for a time as part of the public record the names and location of transplant hospitals reporting to the registry. That listing told us that military as well as civilian hospitals were reporting. The registry listed 35 national hospitals including 9 military and 45 provincial hospitals including 11 military. Public access to that list has now gone. There is instead a map which gives the viewer the name of a hospital at each location, if one clicks on that location.
At The Transplantation Congress in Vancouver in August 2010, Haibo Wang, then assistant director of the China Liver Transplant Registry, presented at the same session I did. I asked him why public access to the data on the Registry website was shut down and if it could be restored. His answer was that public access was shut down because people were misinterpreting the data. If anyone is to get access now, the Registry has to know first the purpose for which the data is being used and some confidence that the data will not be misinterpreted.
The Chinese health system runs four transplant registries, one each for liver, kidney, heart and lung. The other three are located in mainland China kidney and heart in Beijing and lung in Wuxi. The data on the other three sites is also accessible only to those who have registry issued login names and passwords.
The World Health Organization Guiding Principle 11 requires transparency of sources, open to scrutiny, while ensuring that personal anonymity of donors and recipients are protected. Hiding aggregate data from the public which were previously available directly contradicts this principle. Aggregate date from all four transplant registries should be publicly accessible without the need for a login name and password.
The implementation of the liver transplant registry has been sponsored by the pharmaceutical company Astellas. The kidney registry was established by a cooperation contract with the pharmaceutical company Roche. Novartis had access to the kidney registry for a study completed in 2013. The liver transplant registry has a host of cooperation partners including the World Health Organization and The Transplantation Society. Those drug companies and partners should insist on public access to aggregate data on the registries.
Murder of innocents is harder in broad daylight. The darkness cast by data coverup makes organ transplant abuse easier to perpetrate. One factor which leads to the conclusion that Falun Gong are being killed for their organs is that the mechanisms which should be in place to prevent such an abuse were not in place. That conclusion is even more true now than when David Kilgour published our reports and book, because data publicly available then through the China Liver Transplant Registry which indicated the extent of the abuse are no longer available.
A second development is a series of presentations by Chinese officials disclosing episodically the aggregate data from the transplant registries. One statistical snapshot came in 2008 from Haibo Wang. A second came in March 2010 when then Chinese Deputy Health Minister Huang Jiefu gave a speech to a transplant conference in Madrid . A third came from an article published in 2013 which Haibo Wang and five others contributed to a journal.
i) The March 2010 Madrid Huang Jiefu presentation
The speech of Huang Jiefu at the Madrid conference is internally inconsistent. He Jiefu produced, in a slide show presentation, one slide showing the number of kidney and liver transplants in China over the past decade. He produced a second slide showing living donor vs. deceased kidney transplantation from 2003 to 2009. The second slide produced totals for living and deceased donations (non heart beating donations NHBD). So there were two slides which have kidney transplant totals for the period 2003 to 2009.
The figures are these:
The first slide shows kidney transplants for 2009 to be 6,458. The second shows the figure 6,485. There is presumably a transposition error here. However, because we cannot check the original figures, we do not know which is correct.
For 2008, the figure for both slides is 6,274. This is useful information because it shows we are not considering two different types of data.
For 2007, the figure for the first slide is 7,700 and for the second slide is 3,974. This is a significant difference, without explanation.
For 2006, the difference is also large, 8,000 for first slide, 3,021 for the second slide. Similarly for 2005, we have 8,500 for the first slide and 3,441 for the second. For 2004, we have an astonishing figure of 10,000 for the first slide and 3,461 for the second. For 2003, we have 5,500 for the first slide and 3,171 for the second.
Because, for 2007 and earlier years, for the first slide we have rounded numbers and for the second slide precise numbers, it appears that, for the earlier years for the second slide we are not looking at totals but rather a subset. The first slide, it seems, presents estimates. The second set presents, it would seem, the subtotal of reported kidney transplants which provide the necessary differentiated information to allow the construction of the second table.
The second Huang Jiefu table differentiates between living and deceased donor kidney transplants. Kidney transplant information which does not distinguish between living and deceased sources would be useless for the construction of this table. So, presumably, it was just pushed aside.
Huang Jiefu, mind you, says none of this. He just blithely presents contradictory information without explanation and hides the data sets from the public on which he based his tables.
If the analysis here is correct, then the larger totals of the first table are the better ones. The larger though the totals, the more that is needed to explain the sources.
Huang Jiefu talks, in his Madrid speech, about how organ transplantation was initially an unregulated business. He does not say this, but the overall impression he leaves is that any hospital which wanted got into the business of transplants and sold transplants to whomever they wanted, getting organs from whatever source on which they could lay their hands. It is apparent that this sort of system would not produce reliable statistics, that any information about volumes would just be estimates.
A law which took effect on May 1, 2007 required that transplants take place only in registered hospitals . The law set up a registration system for hospitals. The statistics we see for 2008 and 2009 come, presumably, from the registered hospitals which is why we get precise figures in both slides for those years. From 2009, estimates from a hospital free for all became unnecessary.
a) Shi Bingyi corroboration
Shi Bingyi, another Chinese health official, corroborated this 10,000 figure. Dr. Shi said in an article posted on Health Paper Net in March 2006 that there were about 90,000 transplants in total up until 2005. The text stated, in part, in translation: “Professor Shi said that in the past 10 years, organ transplantation in China had grown rapidly; the types of transplant operations that can be performed were very wide, ranging from kidney, liver, heart, pancreas, lung, bone marrow, cornea; so far, there had been over 90,000 transplants completed country wide; last year alone, there was close to 10,000 kidney transplants and nearly 4,000 liver transplants completed.”
David Kilgour and I referred to this total and this article in our reports and book, Bloody Harvest. Manfred Nowak, the United Nations Rapporteur on Torture, asked the Government of China to explain the discrepancy between volume of organ transplants and volume of identified sources, relying, in part, in our report and its reference to the article quoting Shi Bingyi. The Chinese government, in a response sent to the Rapporteurs by letter dated March 19, 2007 and published in the report of Professor Nowak to the UN Human Rights Council dated February 19, 2008, stated that “Professor Shi Bingyi expressly clarified that on no occasion had he made such a statement or given figures of this kind, and these allegations and the related figures are pure fabrication.”
Shi Bingyi was interviewed in a video documentary produced by Phoenix TV, a Hong Kong media outlet. That video shows Shi Bingyi on screen, wearing a military uniform, saying what the Government of China, in its response to Nowak, indicates he said, that the figures we quote from him he simply never gave. He says on the video: “I did not make such a statement because I have no knowledge of these figures I have not made detailed investigation on this subject how many were carried out and in which year. Therefore I have no figures to show. So I could not have said that.”
Yet, the actual source, the Health News Network article, in June 2008, remained on its original Chinese website, though it has been taken down since. The original source of the information remained available within China through the internet at the time Shi Bingyi denied the information. It is still available for anyone outside China to see through the Wayback Machine Internet Archive.
b) Living donors
Where in the world did 10,000 kidneys and 2,265 livers come from in 2004? It was not from living donors. Then Deputy Health Minister Huang Jiefu, in his March 2010 Madrid presentation shows sixty four living donor kidney transplantations. He also shows that living donor liver transplantations in 2004 were .4% of total liver transplantations.
Another table Huang Jiefu presents is living vs. deceased donor liver transplantation. That table shows significant living donor sources starting from 2007. Living donors are 23.5% of liver transplants in 2007, 19.1% in 2008 and 13.6% in 2009. However, for 2004, living donors are a mere .4% of total donations.
Living donations, according to the Huang Jiefu text, are given to “related or kinship recipients”. The Madrid presentation shows a significant increase in living donations from 2006 to 2007. There were 300 kidneys from living donors in 2006 and 1720 in 2007. 3.2% of transplanted livers came from living donors in 2006 and 23.5% in 2007. What caused this big jump?
The current law allows for living donor sourcing from relatives. The State Council of the People’s Republic of China Regulations on Human Organ Transplant effective as of May 1, 2007 states “The recipient of a living organ must be the donor’s spouse, lineal descent or collateral relative by blood within three generations, or they must prove they have developed a family like relation with the donor.”
The Government of China is trying to discourage sourcing from living donors, because of the risks to the donors. In an article in the China Daily, Chen Shi, an organ transplant expert with the institute of transplantation at Shanghai based Tongji Hospital, is quoted as saying “Living organ donations, which can cause health risks for the donor, should always be the last resort when no suitable organ from a deceased donor is available.”
There has been fraud in the use of living relative donor exception which the authorities have been trying to control. Identities of donors have been disguised to pretend that they are relatives when they are not. This has led to a clampdown on living donor sourcing.
In Dongguan, doctor Zhou Kaizhang and seven others were prosecuted in August 2012 for this type of fraud. According to the Chinese Medical Doctor’s Association, Dr. Zhou had performed 1,000 kidney transplants. The prosecution related to 51 kidneys transplanted between March and December 2010.
The large increase in live donations from 2006 to 2007 is likely the product of the corrupt black market system which in theory China is trying to discourage. In an interview dated September 18, 2012, then Deputy Health Minister Huang Jiefu stated that 65% of organs come from prisoners and 35% from living donors. He added that live donations should be a last resort and not advocated.Living donations can cause damage to healthy donors and violates the “no harm” principle of medical ethics. Chinese medical insurance does not provide long term coverage to donors for complications from living donor transplants.
He noted that a living donor black market has emerged, inducing the poor to sell organs to wealthy people willing to pay high prices. This practice, he added, violates the principles of health care reform. The Ministry of Health issued a policy directive that live organ donor transplants must be approved by a provincial health department.
ii) August 2013 presentation Haibo Wang and others
A second statistical glimpse came from an article published by six Chinese authors including Haibo Wang in August 2013 titled “Liver transplantation in mainland China: the overview of CLTR 2011 annual scientific report”. The actual report is not publicly available and not cited in the article. The article has neither footnotes nor endnotes. It cites three references, all foreign.
The article makes no reference to sourcing of organs from prisoners. It distinguishes between sources as either China category donors or non China category donors. The article defines the China category in this way: “The classification was designed to be consistent with international classification standard for deceased organ donation and respect the current cultural and societal value of Chinese people.”
The “current cultural and societal value of the Chinese people” is a euphemism for Communist Party values. The official name of China after all is “The People’s Republic of China”. The constitution of China states
“Article 2. Power belongs to the people
All power in the People’s Republic of China belongs to the people.
The National People’s Congress and the local people’s congresses at various levels are the organs through which the people exercise state power.”
The constitution refers to “the Chinese people of all nationalities led by the Communist Party of China” or “under the leadership of the Communist Party of China” six different times, making the point crystal clear. The voice of the people is the voice of the Communist Party.
The Government of China in March 2010 set up an organ donation system in 11 provinces and municipalities which has since expanded. This system is limited to deceased donation. It does not contemplate living donation.
What does the Communist Party of China say are “the current cultural and societal value of Chinese people” when it comes to organ donations? According to Huang Jiefu, it is this: “we will regulate the issue [inappropriate handling of organ donations from executed prisoners] by including voluntary organ donations by executed prisoners in the nation’s public organ donation system”. He added “Judicial bodies and local health ministries should establish ties, and allow death row prisoners to voluntarily donate organs and be added to the computer organ allocation system”.
Lest there be any doubt about what he meant, he elaborated on March 4, 2014 more specifically when asked about the commitment of the leaders of 36 transplant centres to stop sourcing organs from executed prisoners. Huang Jiefu stated that the commitment from these 36 transplant centers “is not about not using organs from executed prisoners, but not allowing hospitals or medical personnel to engage in private transactions with human organs.”
Huang Jiefu made this statement before the publication of the names of the 36 centres in April 2014, thus preventing the public from getting the mistaken impression that these 36 centres were actually going to stop sourcing organs from prisoners.
Huang Jiefu in this interview added:
“Executed prisoners are also citizens having the right to donate organs. We are not against organ donation of prisoners which would deprive them of this right. … Given the willingness of death row prisoners to donate organs, once entered into our unified allocation system then they are counted as voluntary donations of citizens. The so called death row organ donation doesn’t exist any longer.”
So, one should not be under the impression that China category donors are voluntary donors. They include prisoners killed for their organs. The difference is just that China category donors are prisoners whose organs are sourced through the regulatory system Huang Jiefu runs and excludes organs sourced from prisoners outside that system.
The China category donors have increased as a percentage of total donors over the years, starting from nothing in 2005 to 4.53% in 2011. Living donors for 2011 were 4.90%. So deceased donors altogether were over 95%. Deceased donors which were not China category donors were over 90%.
The difficult of reconciling figures becomes ever greater each time new figures are released. The figures in the 2013 article are not consistent with the figures in the Madrid 2010 speech and, again because the sources are not available, there is no way of determining which of the contradictory figures is right.
Huang Jiefu in Madrid in 2010 said that there 16,961 liver transplants in China from 1993 to 2009. The 2013 article shows a total of 20,877 liver transplants performed from 1980 to 2011. The difference between the two figures is 3,916. The 2013 article shows the liver transplants for 2010 to be 2,171 and for 2011 to be 1,897, for a total of 4,068. So there is a difference between the two presentations of 152 transplants. There is no explanation for this difference.
iii) 2008 Haibo Wang presentation
A third set of figures generates even more confusion. The third set comes from a presentation by the same Haibo Wang in 2008. In the 2008 presentation, he states that there were 11,179 liver transplantations as of March 8, 2008. If one compares that with the 2013 article, with its total of 20,877 transplants up to and including 2011, we can calculate that there were 9,698 transplants between the two dates. Yet, the 2013 article shows that the total liver transplants for 2008 to 2011 was the number 8,588.
Wang in 2008 showed that there were 240 liver transplants between January 1 and March 8, 200. So the two figures show a discrepancy of 1,350 transplants, a large number. How do we explain the discrepancy? Without access to the original figures, an explanation is impossible.
Inconsistency is more the rule than the exception. The year by year comparison for the volume of liver transplantations in the three presentations is this:
The figures in the three presentations did not coincide, not even once. Two of the three presentations produced the same figure only one year, 2000. It may be that the registered reporting hospitals are constantly revising their data. Yet, the figures do not consistently increase from earlier to later data. Why registered hospitals would be revising reported data downward, if that is what is happening, is not clear.
A third development since the publication of Bloody Harvest has been the work of Ethan Gutmann and Jaya Gibson. Their work, first announced in June 2010, tells us that the killing of innocents for their organs has spread from Falun Gong to Tibetans, Eastern Lightning house Christians and Uighurs. They glean this information from interviewing members of these victim groups who got out of Chinese detention centres and then out of China. Those interviewed tell them of blood testing and organ examination of the sort that Falun Gong practitioners endured.
This phenomenon means we cannot ascribe the difference between transplant volumes and death penalty volumes to Falun Gong practitioners alone. Some of the sources will be these other victim groups.
The Death Penalty
A fourth development is changes to the death penalty. Vice President Zhang Jun of the Supreme People’s Court in January 2011 stated that China’s Supreme People’s Court would overturn death sentences in cases where evidence was collected by illegal means. The judge said that the move was intended to limit the application of capital punishment and pressure local courts to check evidence more thoroughly.
The China National People’s Congress Standing Committee amended the Criminal Law in February 2011 to decrease the number of death penalty offences from 68 to 55. In a second change, the death penalty could no longer be imposed on those 75 years or older at the time of trial, except for a person who has committed a murder with “exceptional cruelty”. The new law came into effect May 1.
The Supreme People’s Court (SPC) wrote, in its annual report released in May 2011, that the death penalty should only be applied to “a very small number” of criminals who have committed “extremely serious crimes.” In fact, the Supreme People’s Court did just that, overturning in a number of cases death penalties imposed by provincial courts. Chinese courts were told to pronounce a two year suspension of execution for condemned criminals if an immediate execution is not deemed necessary; capital punishment reprieves should be granted as long as they are allowed by law.
This downward slide in the death penalty continues a previous trend. The most significant prior development was the requirement, which took effect on January 1, 2007 that all death sentences had to be approved by the Supreme People’s Court. That change alone led to a reduction of an estimated 30% to 40% in the imposition of the death penalty.
In the abstract, from a human rights perspective, the reduction in the death penalty is good news. The news ceases though to be good if the decrease in the death penalty leads to an increase in the killing of Falun Gong for their organs. While the decrease in the death penalty has occurred at the same time as the increase living donor transplants, the increase in living donor transplants has come nowhere near the estimated decrease in the death penalty.
Amnesty International had stopped publishing death penalty statistics. It used to provide a death penalty log, setting out individual cases. The last log, published in 2002 set out executions for 2000. Amnesty International continued with yearly estimates after 2002 of persons sentenced to death and then executed, but its last statistics, for 2008 of 1,718 executions, was published in Bloody Harvest. There are no statistics for 2009 or 2010. The organization gave no explanation for stopping either the log or the statistics.
The NGO Dui Hua provides year by year estimates the number of executions in China. Their figures are:
One can see a marked downturn over the years. Executions in 2012 are one quarter of those in 2002. Yet transplant volumes, one can see, after the steep rise when the persecution of Falun Gong began, have, other than the odd blip, remained constant.
Where does this leave us? Our figure of 41,500 was generated by comparing transplant volumes before and after the persecution of Falun Gong began. Death penalty statistics from Amnesty International, though almost certainly an underestimate because based on media reports alone, were reliable indicators of multi year trends, if not yearly totals. Multi year averages of executions, according to Amnesty International figures, remained constant before and after the persecution of Falun Gong began. The difference between transplant volumes before and after the persecution of Falun Gong could then reasonably be attributed to Falun Gong sourcing.
Another methodological approach, used by researcher H. Li, is to take the highest estimate of death penalty execution volumes and work from there. The high estimate to which he refers is 10,000 yearly published in 2004. This 2004 10,000 yearly estimate came from Chen Zhonglin, a National People’s Congress delegate who, with others, was urging a review of all death sentences by the Supreme People’s Court , a reform which eventually happened in 2007. The Chen estimate is similar to the Dui Hua estimate and may have been its source.
Chen made clear that his estimate was not an official figure and was based on tabulations . In other words, he was guessing in a context where a high figure helped to support the reform he advocated. In any case, even if we take Chen’s estimate at face value, it reduces to 7,000 by the time the reforms he advocated were implemented, since they generated at least a 30% reduction in volume of executions.
Since we do not know with precision the number of executions, another tack is trying to figure out the volume of executions which would support the volume of transplants, a figure which we have. The volume of executions has to be a multiple of the number of transplants for a variety of reasons.
One reason is the absence, until 2013, of a national organ distribution system. Individual hospitals make arrangements with individual prisons for organs. There is substantial organ wastage in China. The organ distribution system in place today is limited to the China category sources.
A second reason is that transplanting several organs at once from the same donor contradicts the recipient information. Everywhere else patients wait for donors. In China, sources wait for patients. Once the patients are ready, the sources are killed.
Given the short waiting times for transplants and the absence of national organ distribution system, sourcing several organs from the same donor would require recipient coordination. Yet, our interviews with recipients show no such coordination.
A third reason relates to the Chinese government claim that donors consent. While there is no proof of this consent, let us take the Chinese government claim at face value, that persons sentenced to death actually do consent. Then consider the limited numbers in the national donor system before it started incorporating prisoners into the system.
One newspaper report showed 37 consents in a year throughout 11 cities . A Journal of the American Medical Association Commentary shows around 200 consents till May 2011 . This low rate of consent is attributed to cultural aversion to donations. Yet prisoners sentenced to death in China come from the same culture as other Chinese and would have the same cultural aversion to donation. There is no reason to believe that their consent, if freely given, would occur at any different rate than consents outside of prison.
So we are left with a choice. Either consents of persons in prison sentenced to death, like consents of persons outside of prison, are statistically insignificant. Or the notion of prisoner consent is just a sham, one more piece of Communist propaganda.
The prison environment and impending execution may induce consents which would otherwise not be forthcoming. However, consents at a higher rate than the non prison population because of these factors are indicators of the coercive impact of prison on voluntariness and not indicators of true consent.
As well, though the prison coercive environment may induce rates of nominal consent higher than that of the general population, it is implausible to suggest that the rate of nominal consent would be near or close to 100%, given the almost total reluctance of the non prison population to consent. Even within a prison atmosphere, there will be, in light of Chinese cultural aversion to donation, a significant proportion of prisoners who will not even nominally consent.
A fourth reason the volume of executions has to be a multiple of the number of transplants is the Criminal Procedure Code of China requirement that a convict sentenced to death to be executed seven days after sentence. The Code allows the sentence to be executed by either injection or shooting.
The interviews David Kilgour and I have had with patients tell us that, if the source of the organ was a prisoner sentenced to death and then executed, the seven day rule was not being respected. For, if it were, then patients would have had at most seven days notice of the availability of a transplant and would have been told that the organ would have been available at a precise date.
However, patients were not being told that. They were told, and hospitals were advertising this on their websites, that organs would be available at any time, at the convenience of the patients.
It would be reasonable to assume that the seven day rule for execution was often, even if not universally, applied. That would mean that many prisoners sentenced to death and then executed were not sources of organs for transplants.
Even in a country like China, where there is no rule of law, no independent judiciary, no free media, no democracy, where human rights defenders are repressed, there is some scope for the presumption of legality. Corruption undermines the presumption, but does not replace it altogether.
For prisoners sentenced to death, the corrupt would be tempted to ignore the seven day rule, where there was money to be made from transplants. However, it is reasonable to assume that at least some Chinese officials are not corrupt.
The fifth reason the volume of executions has to be a multiple of the number of transplants is the form of execution. Until 2006, the majority of death penalty prisoners were executed by shooting. In a 2006 article for USA Today , Liu Renwen, death penalty researcher at the Chinese Academy of Social Sciences, is quoted as saying that the “majority (of executions) are still by gunshot… But the use of injections has grown in recent years, and may have reached 40%.”
Until January 2008, execution by shooting was common. That month Jiang Xingchang, the vice president of the Supreme People’s Court, announced to the China Daily an expansion of lethal injections to replace shootings.
Once a person is shot and killed, there is almost immediate organ deterioration. Organ transplants can be sourced from those shot and killed, if the sourcing is done immediately. Injection offers the luxury of time. The bulk of the anecdotal evidence we have, except for the period when China began transplants, is that organ sources are injected and not shot. Many of those executed by shooting, because of the practical reality of immediate organ deterioration and the inability to organize on the spot harvesting, are not organ sources.
A sixth reason is the need for blood type and ideally tissue type compatibility between the donor and the recipient. Not every donor is available as a source for every patient. Moreover, since sourcing is local, each detention centre with ties to a local hospital has to have its own group of prisoners waiting for execution, its own organ donor bank. The notion that at any one time at all major prisons in China there are large numbers sentenced to death and awaiting execution runs contrary to observed experience.
Then UN Rapporteur on Torture Manfred Nowak, on his visit to China in November 2005, found in prisons persons sentenced to death at first instance awaiting appeal, but none sentenced to death awaiting execution . When he asked to see such prisoners, he was told that there were none, because all prisoners sentenced to death whose appeals had been exhausted were executed immediately.
A seventh reason the volume of executions has to be a multiple of the number of transplants is blood disease which renders transplantation unsuitable. The most common such blood disease is hepatitis B, which is endemic in China. One study estimated 50 to 60 % of the Chinese population carries hepatitis B markers. Another study focused on four Chinese cities found the infection rate to be 62.6%.
If we look just at this last reason alone we would need 267 prisoners for every 100 organ recipients. If we put the other factors into the mix, we are looking at a vast figure. An article published in the American Journal of Transplantation states that, if we assume that prisoners donate organs voluntarily and that they consent at the same rate as those outside of prison, then “the average consent rate of the Chinese populace would require millions of executions each year to ensure a sufficient amount of donor organs for the 10,000 transplants performed annually”.
The bottom line is that the volume of prisoners sentenced to death and then executed necessary to sustain the current rate of transplantation is so out of whack with every death penalty estimate in China, by far, as well as Chinese death penalty execution procedures that organ sourcing, preponderantly, must be coming from other sources than prisoners sentenced to death and then executed. And what would those other sources be?
Tibetans, Uighurs and Eastern Lightning house Christians, sources Ethan Gutmann and Jaya Gibson have identified, are unlikely to come anywhere near the necessary volume. Uighurs and Tibetans are detained in specific geographical locations in China, not throughout China. Eastern Lightning house Christians suffer nowhere near the rate of detention nor extremes of vilification of Falun Gong. Falun Gong practitioner prisoners remain the most plausible source for the bulk of transplants in China.
A report of a meeting held between foreign and Chinese transplant professionals in Hangzhou China October 29, 2013 states that “At the time of the meeting with the Minister, there had been 1161 deceased organ donors (not involving the use of organs from executed prisoners) resulting in more than 3175 organ transplants – and combined with the experience of living donor transplantation, these deceased and living donor transplants now constitute 49.4% of organ transplantation in China in 2013.”
The figures 1,161 and 3,175 appear to be cumulative. The start date is not indicated. Presumably it is 2010 when the donation system began. There is no breakdown amongst the four years. The figure of 49.4% has no time indication. The report just says “now”. Does “now” mean today, last week, last month, this past year or some other figure? We are left to guess. The living donor figure is not given. Nor is the total of transplants given. These figures provide so little information that they tell us almost nothing.
An article published in China in March 2014 gave a glimpse of more recent figures. The article states: “The numbers newly unveiled showed that in 2012, out of the 2,026 liver transplantations cases conducted in mainland China, 1,587 cases used organs from sentenced to death prisoners, 131 cases used live organs donated by relatives and 308 cases used organs donated by deceased citizens.”
The numbers of course are not newly unveiled or unveiled at all. They are still veiled. We can not see them. All we can see, as with past statements, is the reproduction by the official Chinese spokespersons, which may or may not be an accurate reflection of the sources.
Huang Jiefu in his Madrid presentation of 2010 showed that in 2007 there were 1,944 liver transplants and 23.5% were living donors. Again the figures do not quite jibe because 23.5% of 1,944 is 456.84, that is to say not a whole number. It may be that the figure 23.5% is a rounding off, but Huang Jiefu does not say that.
If one compares the 2007 figures with the 2012 figures one can see that the totals are roughly the same. Live organ donations have gone down, which is consistent with the crackdown on live organ donor fraud. There were 326 fewer live donations in 2012 than in 2007.
The decrease in live organ donations has been compensated for by an increase in deceased donations. The deceased donation system now in place did not exist in 2007. The 326 fewer live donations is roughly equivalent to the 308 new deceased donations. So the volume of sourcing from prisoners has remained roughly constant.
Yet, this same article acknowledges that the death penalty has decreased. The article states that “the number of death prisoners has decreased by 10% every year”. The article does not state when the 10% slide began, nor the total figure at any time. The article begins by stating that “before 2004, organs from death prisoners were the only source of organ donations in China.” So it seems that the 10% slide to which the article refers starts at least from 2004.
If we take live donors in 2007 at 457 from a total of 1,944, that leaves sourcing from prisoners at 1,487. 10% compounded annually over five years amounts to 16.11% 16.11% of 1,944 equals 313, rounded off. What is the source of these organs? The official sources provide no explanation.
The article, ironically, is an attempt to refute evidence that Falun Gong are being killed for their organs. There is a lot of propagandistic rhetoric in the article against Falun Gong and it is tempting to respond to it. However, if one keeps one’s eyes on the numbers alone, as this presentation attempts to do, they support the claim that there are large numbers of transplants for which there is no explanation for sourcing other than Falun Gong.
The current situation creates a presumption of wrongdoing even beyond the sourcing of organs from prisoners sentenced to death and then executed. In any case, the onus does not lie on me to establish the numbers. The onus lies rather on the Government of China to provide the numbers.
Organ transplant sourcing must be transparent and traceable. The Government of China admits that organs are sourced predominantly from prisoners. What then is it trying to hide by not providing numbers? One compelling answer is that it is trying to hide the killing of Falun Gong and other prisoners of conscience for their organs.
The claim that the sources have consented, as unpersuasive as it is for prisoners sentenced to death, would be impossible for innocent sources. The killing of innocents for their organs is murder. The killing of prisoners of conscience for their organs is a crime against humanity.
Criminals against humanity typically make every effort to cover up their crimes. The secrecy we see about numbers looks to be just that, a cover up of a crime against humanity.
David Matas is an international human rights lawyer based in Winnipeg, Manitoba, Canada.
 Chapter eight.
 The Congressional Executive Commission on China Annual Report 2006, p. 59, note 224, p.201: “Organ Transplants: A Zone of Accelerated Regulation” Caijing Magazine (Online), 28 November 05.
 http://news3.xinhuanet.com/english/2006 11/16/content_5335427.htm
 “Tomorrow’s Organ Transplantation Program in China”, Presentation delivered at the Madrid Conference on Organ Donation and Transplantation, Madrid 2010, by Prof. Huang Jiefu, Vice Minister of Health, P.R.C.
 Chapter seven.
 Liver Transplant Registry, www.cltr.org, Queen Mary Hospital, The University of Hong Kong, Hong Kong
 Kidney Transplant Registry, www.csrkt.org
 PLA No. 309 Hospital, Beijing, Heart Transplant Registry, www.cotr.cn, effective from April 2010, Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences, Beijing
 Lung Transplant Registry, www.cotr.cn, effective from April 2010, Wuxi People’s Hospital, Wuxi
HepatoBiliary Surgery and Nutrition, Vol 2, No 4 August 2013 189 www.thehbsn.org Hepatobiliary Surg Nutr 2013;2(4):188‑197
 Regulations on Human Organ Transplant
 http://www.transplantation.org.cn/html/2006 03/394.html (Health Paper Net 2006 03 02) Archived page:
 Slide 19
 Slide 18
 Article 10
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 http://www.theepochtimes.com/n2/china news/chinas organ trafficking crackdown increases forced organ harvesting 288008.html
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