Forced Organ Harvesting in China: The Facts and the Law
(Remarks prepared for presentation to two fora at Harvard University, one at the East Asia Library March 7th, 2024 and a second at the Medical School March 8th)
By David Matas
I am a lawyer in Winnipeg, Manitoba, Canada in private practice. My clients have been primarily refugee claimants seeking protection in Canada. I have been engaged in this professional work for almost all of my professional career.
I am also heavily engaged in international human rights work through non-governmental organizations and as a member of Government of Canada delegations to international conferences. My focus in all this work has been mass atrocities.
I have become familiar through my work with the human rights situation in many countries, including China. I try, as best I can, not only to assist my refugee clients in obtaining protection, but also, through my NGO and Canadian Governmental delegation work, to combat the human rights violations which caused them to flee. In addition to tribunal and court work for individual clients, I have become involved in research, writing, advocacy and activism addressing mass atrocities.
A woman with the pseudonym Annie made a public statement in Washington DC in March 2006 that her ex-husband had been harvesting corneas of Falun Gong practitioners in Sujiatun Hospital in Shenyang City in Liaoning province from 2001 to 2003. Other doctors had been harvesting other organs. The Falun Gong practitioners were killed through the organ extraction and their bodies were cremated.
The Chinese government immediately denied what Annie said. Shortly after, a Washington based NGO, the Coalition to Investigate Persecution against the Falun Gong asked me and the late David Kilgour to investigate whether what Annie said was true.
It is common for me to be asked to assist in human rights work. This request though was unusual though because of the difficulties it posed.
Because of my work on human rights and refugees, I knew that Falun Gong was a set of exercises with a spiritual foundation, started in 1992 with the teachings of Li Hong Zhi, a Chinese equivalent of yoga. I knew that the practice was initially encouraged by the Communist Party as beneficial to health but then repressed by Party decree without being legally banned in 1999 after it got too popular for the Party’s liking. That repression, wrongful though it was, did not mean that Falun Gong practitioners were being killed for their organs.
The Coalition who asked us to do the research did not give us any data, any money or any instructions. For my part, I had no idea whether what Annie said was true or not.
Annie’s story presented a conundrum. How was it possible to know whether what Annie was saying was true or not? The question was not just, how do we prove what Annie said if it was true? The question was also, how do we disprove what Annie said if it was not true?
What Annie was saying meant that there were no victims to interview because the victims were all killed. There were no bodies to autopsy because the bodies were cremated. There was no crime scene to visit, since the crime scene, an operating theatre, would have been cleaned up immediately afterwards. There were no accessible records, since what records there are belong to Chinese hospitals and prisons, labour camps and detention centres, none of which are publicly available. The sole witnesses available were perpetrators who were unlikely publicly to confess to crimes that they had committed.
The question whether what Annie said was true was difficult enough that it was unlikely, I concluded, to get much of a response either from human rights NGOs or inter-governmental organizations or the media. Human rights NGOs, though they have some research capacity, are for the most part campaign organizations. They look for the easily verifiable, not just because it makes research easier, but also because it makes campaigning easier. Inter-governmental organizations have little internal research capacity and tend to rely on the work of NGOs. As for the media, they cater to readers, listeners and viewers with short attention spans. If a story can not be told quickly and simply, it normally can not be told at all.
Yet, addressing a claim of human rights violations with little or no evidence is a situation to which I had become quite accustomed. That, in fact, has been my daily work as a refugee lawyer. Refugee claimants would come to my office with stories of horror, the clothes on their backs and little else. They of course have this advantage that they are witnesses to what happened to them. Yet, they are often faced with skeptical refugee tribunal members who suspect that the claimants are economic migrants making up stories in order to move from a poor country to a rich country.
Are the stories these clients tell true or not true? Answering that sort of question is not that different form assessing the truth of the story Annie told.
Often when victims or their representatives come to me for general assistance to combat a human rights situation abroad, I can send them off to the media or the local Member of Parliament or a human rights NGO or a UN human rights mechanism. I realized though that, for what Annie said, that would not do. If something was going to be done, David Kilgour and I were going to have to do it ourselves.
But the question was what was that something to be? I began constructing imaginary evidentiary trails, trails that would either prove or disprove what Annie said. In doing so, I followed four principles.
One was never to rely on rumour or hearsay. If someone told me what someone else told him or her, I put the information to one side.
Second, I refused to rely on information from perpetrators until the initial conclusion was made. In the course of our initial work, some perpetrator whistleblowers did come forward to offer testimony, subject to various conditions. I turned all such offers aside, because I have in the past found, in addressing other human rights violations, that some perpetrator information to be sometimes self-exonerating and unreliable.
Third, I insisted that all information I saw anyone else could see. No one, after our work was done, had to rely on our conclusions. Anyone who wanted to do so could look at the information we considered and come to his or her own conclusions.
Fourth, I determined not to draw conclusions either one way or the other based on one bit of evidence only. Rather I intended to have regard to all the evidence before coming to any conclusion.
The conclusion of our research was that Falun Gong practitioners had been and were being killed for their organs, not just in Sujiatun, but throughout China, not just in the period when Annie’s husband was organ harvesting, from 2001 to 2003, but from 2000 to the date of our report.
The evidence on this issue is voluminous. David Kilgour and I produced three version of our report, in 2006, 2007 and 2009 in book form, under the title – Bloody Harvest. Ethan Gutmann, an American journalist who interviewed us and then wrote his own book on the subject, published in 2014, titled The Slaughter coming to the same conclusion David Kilgour and I did, that this abuse was happening. Torsten Trey and I co-edited a book of essays on the subject titled State Organs. There are several academic articles on the subject from a variety of independent researchers all supporting our conclusions.
In 2016 David Kilgour, Ethan Gutmann and I produced a joint update to our separate works. An independent people’s tribunal, the China Tribunal, in 2020 came to the conclusion that the mass killing of Falun Gong for their organs is happening beyond any reasonable doubt.
The 2016 joint update runs to almost seven hundred pages and almost 2,400 footnotes, each providing citations to verifiable supporting information. The China Tribunal judgment, with its appendices, runs to almost six hundred pages. The list of relevant academic articles is long.
The problem that this accumulation presents is not too little evidence of the mass killing of Falun Gong for their organs but rather too much evidence. It takes a lot of time to go through all this evidence. Many do not have the patience to do so. Yet, if they do not do so, they can not claim that the abuse has not been proven.
The Chinese Communist Party and its fellow travelers have denied that this abuse is happening, mostly through insults directed at myself and the other researchers. Yet, the evidence itself is irrefutable.
Given the volume of the evidence, it would take days, if not weeks, for me to go through it all. Allow me to summarize some of the evidentiary trails which supported this conclusion.
Investigators made calls to hospitals throughout China, claiming to be relatives of patients needing transplants, asking if the hospitals had organs of Falun Gong practitioners for sale on the basis that, since Falun Gong through their exercises are healthy, the organs would be healthy. We obtained on tape, transcribed and translated admissions throughout China. These interviews are posted on the internet and, if you know Mandarin, you can hear them yourselves.
Falun Gong practitioners and non-Falun Gong practitioners alike who were detained and who then got out of detention and out of China told us that
a) Falun Gong practitioners were systematically blood tested and organ examined while in detention. Other detainees were not. The blood testing and organ examination could not have been for the health of the Falun Gong practitioners since they had been tortured; but it would have been necessary for organ transplants.
b) Falun Gong practitioners who came from all over the country to Tiananmen Square in Beijing to appeal or protest were systematically arrested. Those who revealed their identities to their captors would be shipped back to their home localities. Their immediate environment would be implicated in their Falun Gong activities and penalized.
To avoid harm to people in their locality, many detained Falun Gong practitioners declined to identify themselves. The result was a large Falun Gong practitioner population in detention whose identities the authorities did not know. As well, no one who knew them knew where they were. This population was a remarkably undefended group of people, even by Chinese standards. This population provided a ready source for harvested organs.
c) The Party has engaged in a prolonged, persistent, vitriolic national and international campaign of incitement to hatred against Falun Gong. The campaign has prompted their marginalization, depersonalization and dehumanization in the eyes of many Chinese nationals. To their jailors, Falun Gong are not human beings entitled to respect for their human rights and dignity.
Patients we interviewed who went to China for transplants told us that
a) Waiting times for transplants of organs in China are days and weeks. Everywhere else in the world waiting times are months and years. Appointments could be made for transplants of vital organs -liver, lung and heart – at fixed times. A short waiting time for a deceased donor transplant and fixed appointments for vital organs means that someone is being killed for that transplant.
b) There is a heavy militarization of transplantation in China. Hospitals with a ready supply of available organs are often military hospitals. Even in civilian hospitals, the doctors performing operations are often military personnel. The military have a common culture with prison guards and readier access to prisoners as organ sources than civilian hospitals and civilian personnel do.
In China, the military is a conglomerate business and the sale of organs is a prime source of funds. Military hospital web sites used to boast this fact before we started quoting them. This and all other information we cited is archived and can be viewed by researchers even if no longer on official Chinese websites.
c) There is an inordinate secrecy surrounding transplantation in China. The names of doctors are not identified. Patients are not allowed to bring their own doctors with them. Before our 2006 report came out, Chinese doctors used to provide letters to patients indicating the treatment given and counselled. The letters ceased after the publication of our report.
There is no other explanation for the transplant numbers than sourcing from prisoners of conscience. China is the largest transplant country in the world by volume. Yet, until 2010 China did not have a deceased donation system and, even today, that system produces donations which are relatively small. Until 2013, China did not have an organ distribution system. The living donor sources are limited in law to relatives of donors and officially discouraged because live donors suffer health complications from giving up an organ.
The Government of China until 2005 took the position that all organs came from donations, even though at the time they did not have a donation system. They then acknowledged that the overwhelming proportion of organs for transplants in China came from prisoners but asserted that the prisoners who are the sources of organs are all sentenced to death who donated their organs to atone for their crimes.
The number of prisoners sentenced to death and then executed that would be necessary to supply the volume of transplants in China is far greater than even the most exaggerated death penalty statistics and estimates. Moreover, in recent years, death penalty volumes have gone down, but transplant volumes, except for a short blip in 2007, remained constant or increased. The Government of China has refused to provide death penalty statistics on the basis that they are state secrets.
The Government of China since 2015 has gone back to its original narrative that all organs are coming from donations. Yet, any independent verification of donation numbers from donation centres continues to produce tiny numbers.
The Government of China claims that donations registered at donation centres are augmented by donations from family members of accident victims, brain dead but cardiac alive. Yet, in China, patients tell us, transplants are booked in advance. But accidents can not be booked in advance. As well, many brain dead accidented people have their organs damaged by the accidents.
The update David Kilgour, Ethan Gutmann and I did in 2016 was conceptually a simple exercise, focusing only on transplant total by adding up transplant volumes from individual hospitals. We produced a figure ten times what Beijing said was Chinese transplant volumes, going from 60,000 organs transplanted in the early 2000s to 100,000 by the date of our study. If we extrapolate the organ prices posted before our 2006 study came out and taken down from the internet since and apply them to current volumes, we arrive at a figure of 8.9 billion dollars a year being made in China from the sale of organs.
Jay Lavee, Matthew Robertson and Ramond Hinde published a study in January 2019 which showed that the Chinese official transplant yearly volume figures conformed almost precisely to a mathematical formula. The analysis suggested data manufacture and manipulation.(1)
Jay Lavee and Matthew Robertson published a study in October 2021 which examined Chinese-language transplant publications and concluded that 71 of these publications provided evidence that the removal of the heart during organ procurement must have been the proximate cause of the donor’s death. The conclusion was that physicians in the People’s Republic of China have participated nationwide in executions by organ removal.(2)
Practitioners of Falun Gong are not the only prisoners of conscience victims of forced organ harvesting. Tibetans, House Christians, Uyghurs and other Xinjiang/ East Turkestan minorities have also been victims. The primary, but not the only, Christian victims have been Eastern Lightning or the Church of Almighty God.
Ethan Gutmann, currently a Senior Research Fellow for the Victims of Communism Memorial Foundation, at a hearing of the Tom Lantos Human Rights Commission in May 2022 stated that witnesses from approximately twenty camps in Xinjiang/ East Turkestan provided evidence that, from 2017, between 2.5% to 5% disappeared annually in the 28-year-old age group. With approximately a million Uyghurs, and other minorities in the camps, Gutmann estimated that 25,000 to 50,000 camp detainees are being organ harvested every year.(3) The organ harvesting of Uyhgurs and other minorities in Xinjiang/ East Turkestan is a particularly visible form of the abuse in China since there are visibly dedicated lanes in Xinjiang/ East Turkestan airports for the transport of organs.
Also particularly visibly has been the explosion in transplant infrastructure in China shortly after the repression of Falun Gong began. Coincident with that repression was a boom in the building of transplant hospitals, transplant wings of general hospitals, as well as a huge increase in transplant beds and transplant staff. The transplant system has been constructed on the assumption of an inexhaustible supply of organs.
I am going to stop here my reference to the facts, though I could, of course go on. If anyone is inclined to want more, almost all of the evidence to which I have referred and then some is posted on the internet and accessible without cost.
The Law
a) Chinese law
There is a 1984 law which explicitly allows for the sourcing of organs from prisoners without their consent or the consent of their families, provided their bodies are unclaimed.(4) That law remains unrepealed.
Chinese hospitals, before our first report came out in 2006, advertised globally for transplant tourism, posting high prices for organs in many languages on demand. A 2007 law set hospital and medical fees for transplants far below the publicly advertised amounts.(5) Research showed that the posted exorbitant fees continued to be charged.(6)
The 2007 law also requires consent from the sources for the sourcing of organs.(7) But the new law did not repeal the 1984 law that allowed for sourcing of organs from prisoners or their families, as long as their bodies were unclaimed.(8) A 2011 sets out specific penalties for the prohibitions in the 2007 law, also leaving the 1984 law untouched.(9)
A law adopted in October, 2023 to come into force in May 2024(10) addresses procedures for obtaining cadaveric and living organs. However, there is nothing requiring openness about the functional operation of the procedures or the results.
The concepts of transparency, traceability and openness to scrutiny are not mentioned in the new Regulation. Yet these are all essential components of the World Health Organization Guiding Principles on Human Cell, Tissue and Organ Transplantation.(11) There is no prohibition in the 2023 Regulation against sourcing organs from prisoners.
China is not subject to the rule of law. The Communist Party runs the legal system and does not enforce the law against itself. Anything institutionalized by the Party, as is the mass killing of prisoners of conscience for their organs, is above the law.
b) Law outside China
A Council of Europe Convention against Trafficking in Human Organs obligates states parties to prohibit complicity by nationals or permanent residents in transplant abuse abroad. The Convention was open for signature March 25th, 2015.
There are 15 states which have ratified the Convention. The most recent was France, ratifying on May 1st, 2023. The Convention is not limited to Council of Europe states. Any state who wants can sign and ratify the Convention provided the Council of Europe agrees.
There are also six jurisdictions which have not ratified the Convention and which have legislated against extraterritorial complicity in organ transplant abuse – Israel, Taiwan, Italy, South Korea, the United Kingdom and Canada.
The United States has before Congress a bill, titled Stop Forced Organ Harvesting Act of 2023, requiring revocation of passports of those complicit in forced organ harvesting, reports on that complicity, and sanctions on the complicit. The Bill has passed the House of Representatives and is now before the Senate.(12)
Texas has legislation prohibiting health benefit plan issuers from covering a human organ transplant or post-transplant care if the transplant operation is performed in China or another country known to have participated in forced organ harvesting, as designated by the commissioner of state health services.(13) Four other states – Utah(14), Arizona(15), Massachusetts, Idaho(16) and Missouri(17) – have similar legislation proceedings towards enactment.
c) Enforcing the law
The legislation that is in place has to be enforced. How can that happen?
Simply legislating against complicity in forced organ harvesting abroad does not get us very far. The twenty states members of the United Nations which have legislated against transplant tourism are a small number compared to the 193 member states of the United Nations. Yet, even for those states with legislation more needs to be done.
Transplant abuse occurs under cover in darkness. Perpetrators give out as little information as possible. Participants in the abuse are typically willfully blind. Shining a light on the abuse is an important aid to ending it.
Without knowledge of transplant tourism, we get caught in a vicious circle. We do little about the problem because we do not know how big it is. We do not know how big it is, because we do little about the problem. Without awareness of transplant tourism, the black market in organs will continue to be pitch dark.
Customs reporting
The Australian Parliament now has before it proposed legislation requiring persons entering Australia to provide answers to these questions:
(a) Have you received an organ transplant outside Australia within the last 5 years?
(b) if so, what is the country and city and the name of the medical facility at which you received the transplant?
The proposed legislation further requires the Government to prepare and table in Parliament a yearly report on the number of affirmative answers to these question and on the medical facilities specified including the number of times each facility was specified.(18)
Inspection
The Israeli Organ Transplant Act provides that Transplant Coordinators, the Inspecting Physician and the Quality Control Board, all appointed under authority of the Act, may examine medical records maintained by any approved medical center relating to organ removal and transplant, including material on the medical condition of an organ recipient, and also obtain any other pertinent information they require.(19)
Mandatory reporting
In Canada proposed legislation passed the Senate with a provision imposing a reporting obligation. The provision required that any medical practitioner
“who treats a person in relation to an organ transplant must, as soon as reasonably practicable, report to the authority designated by order of the Governor in Council for that purpose the name of that person, if known, and the fact that the person has received an organ transplant.”(20)
The House of Commons, in adopting the Bill in 2019, amended it to remove the reporting obligation, partly on the basis that enacting a reporting obligation fell within provincial jurisdiction. The Bill went back to the Senate for adoption in the same form as adopted by the House of Commons. No province in Canada to date has legislated mandatory reporting.
A 2010 private member’s bill in the National Assembly by Valerie Boyer in France proposed a reporting obligation.(21) The bill required doctors to report all transplants to a health agency and the health agency to report to the Government those transplants where there were reasonable grounds to believe that the organs were purchased.
Australian proposed legislation in 2015 in the state of New South Wales included within it a reporting obligation.(22) The proposal required reporting from health practitioners to government of any transplant where there was a reasonable belief that the organ transplanted was harvested under a commercial transplant arrangement, or without consent.
The College of Physicians and Surgeons of Ontario in Canada has a long list of compulsory reporting requirements.(23) Mandatory reporting is imposed for child abuse or neglect, impaired driving ability, long-term care and retirement homes, sexual abuse of a patient, facility operators: duty to report, incapacity, incompetence and sexual abuse, terminating or restricting employment, privileges and partnerships, births, still-births and deaths, communicable diseases and diseases of public health significance, controlled drugs and substances, community treatment plans, gunshot wounds, pilots or air traffic controllers, maritime safety, railway safety, occupational health and safety, correctional facilities, preferential access to health care, health card fraud, privacy breaches, offences, professional negligence and malpractice, findings by another professional regulatory body, and charges and bail conditions. Other jurisdictions have similar reporting requirements.
Conclusion
The standards and mechanisms which should be in place to prevent Chinese cross border organ transplant abuse are mostly not in place, neither in China nor abroad. International organ transplant abuse ideally should be treated like international child sex tourism, an offence with extraterritorial effect. However, so far that is not the case.
We have a deadly combination – organ transplant abuse without legal consequences; huge money to be made from this abuse; and desperate patients in need of transplants. This combination is a recipe for victimization of the vulnerable. Standards to prevent the abuse need to be introduced and, where legislated, made enforceable.
This Forum is titled Forced Organ Harvesting: A Threat to Humanity. Forced organ harvesting is a threat not just to Falun Gong. Because the mass killing of Falun Gong for their organs was not stopped earlier, it later spread in large numbers to Uyghurs and other minorities in Xinjiang/ East Turkestan from 2017. In Busan Korea, at a symposium in November 2022, The 1st Asian Organ Donation International Symposium in Korea, China and Japan, a couple of speakers endorsed in Asia a replication of the Eurotransplant system,(24) that is to say, a cross border allocation of organ donations. The speakers showed no awareness that such a system would mean the allocation to Japan and Korea of organs sourced from prisoners of conscience in China killed through organ extraction.
Human rights violations are a spreading stain. The Chinese mass killing of innocents for their organs has become, for China, an institutional necessity on which large components of the health system depend. Unless stopped the organ transplant abuse we now see in China will spread to other victims and other countries. The threat the Chinese organ transplant system presents is global. We need to make every effort to counter this threat.
REFERENCES
- https://pubmed.ncbi.nlm.nih.gov/31722695/
- https://pubmed.ncbi.nlm.nih.gov/35377533/
- https://chrissmith.house.gov/uploadedfiles/gutmann_-_witness_testimony_template.pdf
- https://web.archive.org/web/20070504184856/http://www.laogai.org/news/newsdetail.php?id=2397
- “Regulations on Human Organ Transplantation” adopted at the 171st executive meeting of the State Council of the People’s Republic of China on March 21, 2007, in effect on May 1, 2007, articles 3 and 21
https://www.gov.cn/zwgk/2007-04/06/content_574120.htm - See for instance, “South Korean TV Documentary Confirms Organ Harvesting Still Occurring in China”, November 2017 https://www.youtube.com/watch?v=nwGa-GWNCvUce
- 2007 law, Articles 7 and 8
- Provisional Regulations of the Supreme People’s Court, The Supreme People’s Procuratorate, Ministry of Public Security, Ministry of Justice, Ministry of Public Health and Ministry of Civil Affairs on the Use of the Dead Bodies or Organs of Condemned Criminals, October 9, 1984 https://web.archive.org/web/20070504184856/http://www.laogai.org/news/newsdetail.php?id=2397
- https://www.cecc.gov/resources/legal-provisions/eighth-amendment-to-the-criminal-law-of-the-peoples-republic-of-china
- https://www.lawinfochina.com/display.aspx?id=42425&lib=law
- https://apps.who.int/gb/ebwha/pdf_files/A62/A62_15-en.pdf
- https://www.congress.gov/bill/118th-congress/house-bill/1154#:~:text=This%20bill%20imposes%20sanctions%20on,crimes%20related%20to%20organ%20trafficking.
- https://capitol.texas.gov/tlodocs/88R/analysis/html/SB01040F.htm#:~:text=1040%20amends%20current%20law%20relating,participated%20in%20forced%20organ%20harvesting.&text=This%20bill%20does%20not%20expressly,officer%2C%20institution%2C%20or%20agency.
- https://le.utah.gov/~2024/bills/static/SB0262.html
- https://legiscan.com/AZ/text/HB2504/id/2947898
- https://legiscan.com/ID/text/H0670/id/2942461
- https://legiscan.com/MO/text/HB2624/id/2911772
- https://www.aph.gov.au/Parliamentary_Business/Bills_LEGislation/Bills_Search_Results/Result?bId=s1384
- Section 12(b)
- https://www.parl.ca/DocumentViewer/en/42-1/bill/S-240/third-reading
- Bill no. 2797 Assemblée nationale treizième législature Enregistré à la Présidence de l’Assemblée nationale le 16 septembre 2010. Proposition de loi visant à lutter contre le tourisme de transplantation d’organes
http://www.assemblee-nationale.fr/13/pdf/propositions/pion2797.pdf - Parliament of New South Wales, Human Tissue Amendment (Trafficking in Human Organs) Bill 2015, Progress
https://www.parliament.nsw.gov.au/bills/Pages/bill-details.aspx?pk=2953 - https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Mandatory-and-Permissive-Reporting
- https://www.eurotransplant.org/
Forced Organ Harvesting in China: The Facts and the Law
(Remarks prepared for presentation to two fora at Harvard University, one at the East Asia Library March 7th, 2024 and a second at the Medical School March 8th)
By David Matas
I am a lawyer in Winnipeg, Manitoba, Canada in private practice. My clients have been primarily refugee claimants seeking protection in Canada. I have been engaged in this professional work for almost all of my professional career.
I am also heavily engaged in international human rights work through non-governmental organizations and as a member of Government of Canada delegations to international conferences. My focus in all this work has been mass atrocities.
I have become familiar through my work with the human rights situation in many countries, including China. I try, as best I can, not only to assist my refugee clients in obtaining protection, but also, through my NGO and Canadian Governmental delegation work, to combat the human rights violations which caused them to flee. In addition to tribunal and court work for individual clients, I have become involved in research, writing, advocacy and activism addressing mass atrocities.
A woman with the pseudonym Annie made a public statement in Washington DC in March 2006 that her ex-husband had been harvesting corneas of Falun Gong practitioners in Sujiatun Hospital in Shenyang City in Liaoning province from 2001 to 2003. Other doctors had been harvesting other organs. The Falun Gong practitioners were killed through the organ extraction and their bodies were cremated.
The Chinese government immediately denied what Annie said. Shortly after, a Washington based NGO, the Coalition to Investigate Persecution against the Falun Gong asked me and the late David Kilgour to investigate whether what Annie said was true.
It is common for me to be asked to assist in human rights work. This request though was unusual though because of the difficulties it posed.
Because of my work on human rights and refugees, I knew that Falun Gong was a set of exercises with a spiritual foundation, started in 1992 with the teachings of Li Hong Zhi, a Chinese equivalent of yoga. I knew that the practice was initially encouraged by the Communist Party as beneficial to health but then repressed by Party decree without being legally banned in 1999 after it got too popular for the Party’s liking. That repression, wrongful though it was, did not mean that Falun Gong practitioners were being killed for their organs.
The Coalition who asked us to do the research did not give us any data, any money or any instructions. For my part, I had no idea whether what Annie said was true or not.
Annie’s story presented a conundrum. How was it possible to know whether what Annie was saying was true or not? The question was not just, how do we prove what Annie said if it was true? The question was also, how do we disprove what Annie said if it was not true?
What Annie was saying meant that there were no victims to interview because the victims were all killed. There were no bodies to autopsy because the bodies were cremated. There was no crime scene to visit, since the crime scene, an operating theatre, would have been cleaned up immediately afterwards. There were no accessible records, since what records there are belong to Chinese hospitals and prisons, labour camps and detention centres, none of which are publicly available. The sole witnesses available were perpetrators who were unlikely publicly to confess to crimes that they had committed.
The question whether what Annie said was true was difficult enough that it was unlikely, I concluded, to get much of a response either from human rights NGOs or inter-governmental organizations or the media. Human rights NGOs, though they have some research capacity, are for the most part campaign organizations. They look for the easily verifiable, not just because it makes research easier, but also because it makes campaigning easier. Inter-governmental organizations have little internal research capacity and tend to rely on the work of NGOs. As for the media, they cater to readers, listeners and viewers with short attention spans. If a story can not be told quickly and simply, it normally can not be told at all.
Yet, addressing a claim of human rights violations with little or no evidence is a situation to which I had become quite accustomed. That, in fact, has been my daily work as a refugee lawyer. Refugee claimants would come to my office with stories of horror, the clothes on their backs and little else. They of course have this advantage that they are witnesses to what happened to them. Yet, they are often faced with skeptical refugee tribunal members who suspect that the claimants are economic migrants making up stories in order to move from a poor country to a rich country.
Are the stories these clients tell true or not true? Answering that sort of question is not that different form assessing the truth of the story Annie told.
Often when victims or their representatives come to me for general assistance to combat a human rights situation abroad, I can send them off to the media or the local Member of Parliament or a human rights NGO or a UN human rights mechanism. I realized though that, for what Annie said, that would not do. If something was going to be done, David Kilgour and I were going to have to do it ourselves.
But the question was what was that something to be? I began constructing imaginary evidentiary trails, trails that would either prove or disprove what Annie said. In doing so, I followed four principles.
One was never to rely on rumour or hearsay. If someone told me what someone else told him or her, I put the information to one side.
Second, I refused to rely on information from perpetrators until the initial conclusion was made. In the course of our initial work, some perpetrator whistleblowers did come forward to offer testimony, subject to various conditions. I turned all such offers aside, because I have in the past found, in addressing other human rights violations, that some perpetrator information to be sometimes self-exonerating and unreliable.
Third, I insisted that all information I saw anyone else could see. No one, after our work was done, had to rely on our conclusions. Anyone who wanted to do so could look at the information we considered and come to his or her own conclusions.
Fourth, I determined not to draw conclusions either one way or the other based on one bit of evidence only. Rather I intended to have regard to all the evidence before coming to any conclusion.
The conclusion of our research was that Falun Gong practitioners had been and were being killed for their organs, not just in Sujiatun, but throughout China, not just in the period when Annie’s husband was organ harvesting, from 2001 to 2003, but from 2000 to the date of our report.
The evidence on this issue is voluminous. David Kilgour and I produced three version of our report, in 2006, 2007 and 2009 in book form, under the title – Bloody Harvest. Ethan Gutmann, an American journalist who interviewed us and then wrote his own book on the subject, published in 2014, titled The Slaughter coming to the same conclusion David Kilgour and I did, that this abuse was happening. Torsten Trey and I co-edited a book of essays on the subject titled State Organs. There are several academic articles on the subject from a variety of independent researchers all supporting our conclusions.
In 2016 David Kilgour, Ethan Gutmann and I produced a joint update to our separate works. An independent people’s tribunal, the China Tribunal, in 2020 came to the conclusion that the mass killing of Falun Gong for their organs is happening beyond any reasonable doubt.
The 2016 joint update runs to almost seven hundred pages and almost 2,400 footnotes, each providing citations to verifiable supporting information. The China Tribunal judgment, with its appendices, runs to almost six hundred pages. The list of relevant academic articles is long.
The problem that this accumulation presents is not too little evidence of the mass killing of Falun Gong for their organs but rather too much evidence. It takes a lot of time to go through all this evidence. Many do not have the patience to do so. Yet, if they do not do so, they can not claim that the abuse has not been proven.
The Chinese Communist Party and its fellow travelers have denied that this abuse is happening, mostly through insults directed at myself and the other researchers. Yet, the evidence itself is irrefutable.
Given the volume of the evidence, it would take days, if not weeks, for me to go through it all. Allow me to summarize some of the evidentiary trails which supported this conclusion.
Investigators made calls to hospitals throughout China, claiming to be relatives of patients needing transplants, asking if the hospitals had organs of Falun Gong practitioners for sale on the basis that, since Falun Gong through their exercises are healthy, the organs would be healthy. We obtained on tape, transcribed and translated admissions throughout China. These interviews are posted on the internet and, if you know Mandarin, you can hear them yourselves.
Falun Gong practitioners and non-Falun Gong practitioners alike who were detained and who then got out of detention and out of China told us that
a) Falun Gong practitioners were systematically blood tested and organ examined while in detention. Other detainees were not. The blood testing and organ examination could not have been for the health of the Falun Gong practitioners since they had been tortured; but it would have been necessary for organ transplants.
b) Falun Gong practitioners who came from all over the country to Tiananmen Square in Beijing to appeal or protest were systematically arrested. Those who revealed their identities to their captors would be shipped back to their home localities. Their immediate environment would be implicated in their Falun Gong activities and penalized.
To avoid harm to people in their locality, many detained Falun Gong practitioners declined to identify themselves. The result was a large Falun Gong practitioner population in detention whose identities the authorities did not know. As well, no one who knew them knew where they were. This population was a remarkably undefended group of people, even by Chinese standards. This population provided a ready source for harvested organs.
c) The Party has engaged in a prolonged, persistent, vitriolic national and international campaign of incitement to hatred against Falun Gong. The campaign has prompted their marginalization, depersonalization and dehumanization in the eyes of many Chinese nationals. To their jailors, Falun Gong are not human beings entitled to respect for their human rights and dignity.
Patients we interviewed who went to China for transplants told us that
a) Waiting times for transplants of organs in China are days and weeks. Everywhere else in the world waiting times are months and years. Appointments could be made for transplants of vital organs -liver, lung and heart – at fixed times. A short waiting time for a deceased donor transplant and fixed appointments for vital organs means that someone is being killed for that transplant.
b) There is a heavy militarization of transplantation in China. Hospitals with a ready supply of available organs are often military hospitals. Even in civilian hospitals, the doctors performing operations are often military personnel. The military have a common culture with prison guards and readier access to prisoners as organ sources than civilian hospitals and civilian personnel do.
In China, the military is a conglomerate business and the sale of organs is a prime source of funds. Military hospital web sites used to boast this fact before we started quoting them. This and all other information we cited is archived and can be viewed by researchers even if no longer on official Chinese websites.
c) There is an inordinate secrecy surrounding transplantation in China. The names of doctors are not identified. Patients are not allowed to bring their own doctors with them. Before our 2006 report came out, Chinese doctors used to provide letters to patients indicating the treatment given and counselled. The letters ceased after the publication of our report.
There is no other explanation for the transplant numbers than sourcing from prisoners of conscience. China is the largest transplant country in the world by volume. Yet, until 2010 China did not have a deceased donation system and, even today, that system produces donations which are relatively small. Until 2013, China did not have an organ distribution system. The living donor sources are limited in law to relatives of donors and officially discouraged because live donors suffer health complications from giving up an organ.
The Government of China until 2005 took the position that all organs came from donations, even though at the time they did not have a donation system. They then acknowledged that the overwhelming proportion of organs for transplants in China came from prisoners but asserted that the prisoners who are the sources of organs are all sentenced to death who donated their organs to atone for their crimes.
The number of prisoners sentenced to death and then executed that would be necessary to supply the volume of transplants in China is far greater than even the most exaggerated death penalty statistics and estimates. Moreover, in recent years, death penalty volumes have gone down, but transplant volumes, except for a short blip in 2007, remained constant or increased. The Government of China has refused to provide death penalty statistics on the basis that they are state secrets.
The Government of China since 2015 has gone back to its original narrative that all organs are coming from donations. Yet, any independent verification of donation numbers from donation centres continues to produce tiny numbers.
The Government of China claims that donations registered at donation centres are augmented by donations from family members of accident victims, brain dead but cardiac alive. Yet, in China, patients tell us, transplants are booked in advance. But accidents can not be booked in advance. As well, many brain dead accidented people have their organs damaged by the accidents.
The update David Kilgour, Ethan Gutmann and I did in 2016 was conceptually a simple exercise, focusing only on transplant total by adding up transplant volumes from individual hospitals. We produced a figure ten times what Beijing said was Chinese transplant volumes, going from 60,000 organs transplanted in the early 2000s to 100,000 by the date of our study. If we extrapolate the organ prices posted before our 2006 study came out and taken down from the internet since and apply them to current volumes, we arrive at a figure of 8.9 billion dollars a year being made in China from the sale of organs.
Jay Lavee, Matthew Robertson and Ramond Hinde published a study in January 2019 which showed that the Chinese official transplant yearly volume figures conformed almost precisely to a mathematical formula. The analysis suggested data manufacture and manipulation.(1)
Jay Lavee and Matthew Robertson published a study in October 2021 which examined Chinese-language transplant publications and concluded that 71 of these publications provided evidence that the removal of the heart during organ procurement must have been the proximate cause of the donor’s death. The conclusion was that physicians in the People’s Republic of China have participated nationwide in executions by organ removal.(2)
Practitioners of Falun Gong are not the only prisoners of conscience victims of forced organ harvesting. Tibetans, House Christians, Uyghurs and other Xinjiang/ East Turkestan minorities have also been victims. The primary, but not the only, Christian victims have been Eastern Lightning or the Church of Almighty God.
Ethan Gutmann, currently a Senior Research Fellow for the Victims of Communism Memorial Foundation, at a hearing of the Tom Lantos Human Rights Commission in May 2022 stated that witnesses from approximately twenty camps in Xinjiang/ East Turkestan provided evidence that, from 2017, between 2.5% to 5% disappeared annually in the 28-year-old age group. With approximately a million Uyghurs, and other minorities in the camps, Gutmann estimated that 25,000 to 50,000 camp detainees are being organ harvested every year.(3) The organ harvesting of Uyhgurs and other minorities in Xinjiang/ East Turkestan is a particularly visible form of the abuse in China since there are visibly dedicated lanes in Xinjiang/ East Turkestan airports for the transport of organs.
Also particularly visibly has been the explosion in transplant infrastructure in China shortly after the repression of Falun Gong began. Coincident with that repression was a boom in the building of transplant hospitals, transplant wings of general hospitals, as well as a huge increase in transplant beds and transplant staff. The transplant system has been constructed on the assumption of an inexhaustible supply of organs.
I am going to stop here my reference to the facts, though I could, of course go on. If anyone is inclined to want more, almost all of the evidence to which I have referred and then some is posted on the internet and accessible without cost.
The Law
a) Chinese law
There is a 1984 law which explicitly allows for the sourcing of organs from prisoners without their consent or the consent of their families, provided their bodies are unclaimed.(4) That law remains unrepealed.
Chinese hospitals, before our first report came out in 2006, advertised globally for transplant tourism, posting high prices for organs in many languages on demand. A 2007 law set hospital and medical fees for transplants far below the publicly advertised amounts.(5) Research showed that the posted exorbitant fees continued to be charged.(6)
The 2007 law also requires consent from the sources for the sourcing of organs.(7) But the new law did not repeal the 1984 law that allowed for sourcing of organs from prisoners or their families, as long as their bodies were unclaimed.(8) A 2011 sets out specific penalties for the prohibitions in the 2007 law, also leaving the 1984 law untouched.(9)
A law adopted in October, 2023 to come into force in May 2024(10) addresses procedures for obtaining cadaveric and living organs. However, there is nothing requiring openness about the functional operation of the procedures or the results.
The concepts of transparency, traceability and openness to scrutiny are not mentioned in the new Regulation. Yet these are all essential components of the World Health Organization Guiding Principles on Human Cell, Tissue and Organ Transplantation.(11) There is no prohibition in the 2023 Regulation against sourcing organs from prisoners.
China is not subject to the rule of law. The Communist Party runs the legal system and does not enforce the law against itself. Anything institutionalized by the Party, as is the mass killing of prisoners of conscience for their organs, is above the law.
b) Law outside China
A Council of Europe Convention against Trafficking in Human Organs obligates states parties to prohibit complicity by nationals or permanent residents in transplant abuse abroad. The Convention was open for signature March 25th, 2015.
There are 15 states which have ratified the Convention. The most recent was France, ratifying on May 1st, 2023. The Convention is not limited to Council of Europe states. Any state who wants can sign and ratify the Convention provided the Council of Europe agrees.
There are also six jurisdictions which have not ratified the Convention and which have legislated against extraterritorial complicity in organ transplant abuse – Israel, Taiwan, Italy, South Korea, the United Kingdom and Canada.
The United States has before Congress a bill, titled Stop Forced Organ Harvesting Act of 2023, requiring revocation of passports of those complicit in forced organ harvesting, reports on that complicity, and sanctions on the complicit. The Bill has passed the House of Representatives and is now before the Senate.(12)
Texas has legislation prohibiting health benefit plan issuers from covering a human organ transplant or post-transplant care if the transplant operation is performed in China or another country known to have participated in forced organ harvesting, as designated by the commissioner of state health services.(13) Four other states – Utah(14), Arizona(15), Massachusetts, Idaho(16) and Missouri(17) – have similar legislation proceedings towards enactment.
c) Enforcing the law
The legislation that is in place has to be enforced. How can that happen?
Simply legislating against complicity in forced organ harvesting abroad does not get us very far. The twenty states members of the United Nations which have legislated against transplant tourism are a small number compared to the 193 member states of the United Nations. Yet, even for those states with legislation more needs to be done.
Transplant abuse occurs under cover in darkness. Perpetrators give out as little information as possible. Participants in the abuse are typically willfully blind. Shining a light on the abuse is an important aid to ending it.
Without knowledge of transplant tourism, we get caught in a vicious circle. We do little about the problem because we do not know how big it is. We do not know how big it is, because we do little about the problem. Without awareness of transplant tourism, the black market in organs will continue to be pitch dark.
Customs reporting
The Australian Parliament now has before it proposed legislation requiring persons entering Australia to provide answers to these questions:
(a) Have you received an organ transplant outside Australia within the last 5 years?
(b) if so, what is the country and city and the name of the medical facility at which you received the transplant?
The proposed legislation further requires the Government to prepare and table in Parliament a yearly report on the number of affirmative answers to these question and on the medical facilities specified including the number of times each facility was specified.(18)
Inspection
The Israeli Organ Transplant Act provides that Transplant Coordinators, the Inspecting Physician and the Quality Control Board, all appointed under authority of the Act, may examine medical records maintained by any approved medical center relating to organ removal and transplant, including material on the medical condition of an organ recipient, and also obtain any other pertinent information they require.(19)
Mandatory reporting
In Canada proposed legislation passed the Senate with a provision imposing a reporting obligation. The provision required that any medical practitioner
“who treats a person in relation to an organ transplant must, as soon as reasonably practicable, report to the authority designated by order of the Governor in Council for that purpose the name of that person, if known, and the fact that the person has received an organ transplant.”(20)
The House of Commons, in adopting the Bill in 2019, amended it to remove the reporting obligation, partly on the basis that enacting a reporting obligation fell within provincial jurisdiction. The Bill went back to the Senate for adoption in the same form as adopted by the House of Commons. No province in Canada to date has legislated mandatory reporting.
A 2010 private member’s bill in the National Assembly by Valerie Boyer in France proposed a reporting obligation.(21) The bill required doctors to report all transplants to a health agency and the health agency to report to the Government those transplants where there were reasonable grounds to believe that the organs were purchased.
Australian proposed legislation in 2015 in the state of New South Wales included within it a reporting obligation.(22) The proposal required reporting from health practitioners to government of any transplant where there was a reasonable belief that the organ transplanted was harvested under a commercial transplant arrangement, or without consent.
The College of Physicians and Surgeons of Ontario in Canada has a long list of compulsory reporting requirements.(23) Mandatory reporting is imposed for child abuse or neglect, impaired driving ability, long-term care and retirement homes, sexual abuse of a patient, facility operators: duty to report, incapacity, incompetence and sexual abuse, terminating or restricting employment, privileges and partnerships, births, still-births and deaths, communicable diseases and diseases of public health significance, controlled drugs and substances, community treatment plans, gunshot wounds, pilots or air traffic controllers, maritime safety, railway safety, occupational health and safety, correctional facilities, preferential access to health care, health card fraud, privacy breaches, offences, professional negligence and malpractice, findings by another professional regulatory body, and charges and bail conditions. Other jurisdictions have similar reporting requirements.
Conclusion
The standards and mechanisms which should be in place to prevent Chinese cross border organ transplant abuse are mostly not in place, neither in China nor abroad. International organ transplant abuse ideally should be treated like international child sex tourism, an offence with extraterritorial effect. However, so far that is not the case.
We have a deadly combination – organ transplant abuse without legal consequences; huge money to be made from this abuse; and desperate patients in need of transplants. This combination is a recipe for victimization of the vulnerable. Standards to prevent the abuse need to be introduced and, where legislated, made enforceable.
This Forum is titled Forced Organ Harvesting: A Threat to Humanity. Forced organ harvesting is a threat not just to Falun Gong. Because the mass killing of Falun Gong for their organs was not stopped earlier, it later spread in large numbers to Uyghurs and other minorities in Xinjiang/ East Turkestan from 2017. In Busan Korea, at a symposium in November 2022, The 1st Asian Organ Donation International Symposium in Korea, China and Japan, a couple of speakers endorsed in Asia a replication of the Eurotransplant system,(24) that is to say, a cross border allocation of organ donations. The speakers showed no awareness that such a system would mean the allocation to Japan and Korea of organs sourced from prisoners of conscience in China killed through organ extraction.
Human rights violations are a spreading stain. The Chinese mass killing of innocents for their organs has become, for China, an institutional necessity on which large components of the health system depend. Unless stopped the organ transplant abuse we now see in China will spread to other victims and other countries. The threat the Chinese organ transplant system presents is global. We need to make every effort to counter this threat.
REFERENCES
https://www.gov.cn/zwgk/2007-04/06/content_574120.htm
http://www.assemblee-nationale.fr/13/pdf/propositions/pion2797.pdf
https://www.parliament.nsw.gov.au/bills/Pages/bill-details.aspx?pk=2953