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Organ transplantation in the People's Republic of China has taken place since the 1960s, and is one of the largest transplant programmes in the world, peaking at over 13,000 transplants a year in 2004. China is also involved in innovative transplant surgery such as face transplantation including bone. The government's transplant programme attracted the attention of international news media in the 1990s due to ethical concerns about the organs removed from the corpses of executed criminals being commercially traded for transplants. Further, in 2006, there were claims of harvesting of organs from live practitioners of the banned Falun Gong spiritual movement which led to a disputed report being compiled by former Canadian parliamentarian David Kilgour and human rights lawyer David Matas. Since 2007 Chinese authorities have introduced legislation to stop international trade in prisoners' organs, and to increase voluntary donation from the general public.

Involuntary organ harvesting is illegal under Chinese law; though, under a 1984 regulation, it became legal to remove organs from executed criminals with the prior consent of the criminal or permission of relatives. Growing concerns about possible ethical abuses arising from coerced consent and corruption led medical groups and human rights organizations, by the 1990s, to start condemning the practice. These concerns resurfaced in 2001, when The Washington Post reported claims by a Chinese asylum-seeking doctor that he had taken part in organ extraction operations. China issued regulations in 2007 banning the commercial trading of organs, and the Chinese Medical Association agreed that the organs of prisoners should not be used for transplantation, except for members of their immediate family.

In 2008, a liver-transplant registry system was established in Shanghai, along with a nationwide proposal to incorporate information on individual driving permits for those wishing to donate their organs. Despite these initiatives, the China Daily newspaper reported in August 2009 that approximately 65% of transplanted organs still came from death row prisoners. The condemned prisoners have been described as "not a proper source for organ transplants" by Vice-Health Minister Huang Jiefu, and in March 2010 he announced the trial of China's first posthumous organ donation scheme, jointly run by the Red Cross Society and the Ministry of Health, in 10 pilot regions. While not revealing exact figures, the Chinese authorities have not denied the practice of taking organs from executed prisoners, and have taken steps to address international concerns regarding both the State's reliance on executed prisoners for organ donation and the illegal trading of these organs which in 2005 they acknowledged had occurred. They have consistently denied the allegations of removing organs from living Falun Gong practitioners.

Background

Globally, pioneering experimental studies in the surgical technique of human organ transplantation were made in the early 1900s by the French surgeon Alexis Carrel, and successful transplants starting spreading worldwide after the Second World War. China herself began organ transplantation in the 1960s, which grew to an annual peak of over 13,000 transplants in 2004, and, despite some deaths from infection and hepatitis, the transplant programme has been successful in saving many lives. Though the number of transplants fell to under 11,000 annually by 2005, China still has one of the largest transplant programmes in the world, and explores innovative surgery, such as Professor Guo Shuzhong performing the world’s first face transplant that included bone. Organ donation, however, has met resistance as involuntary organ donation is illegal under Chinese law, and is against Chinese tradition and culture, which attach symbolic life affirming importance to the kidney and heart. China is not alone in encountering donation difficulties - demand outstrips supply in most countries, and the world wide shortage has encouraged some countries - such as India - to trade in human organs. Reports of organs being removed from executed prisoners in China for sale internationally had been circulating since the mid-1980s, when a 1984 regulation made it legal to harvest organs from convicted criminals with the consent of the family or if the body goes unclaimed, and the development of a drug, cyclosporine A, made transplants a more viable option for patients.

International concerns: 1985–2005

Concerns about some poorer countries exploiting the donor shortage and selling organs to richer countries led the World Medical Association (WMA) to condemn the purchase and sale of human organs for transplantation at Brussels in 1985, and at Stockholm in 1994. In Madrid in 1987, the World Health Organization (WHO) condemned the practice of extracting organs from executed prisoners due to the difficulty of knowing if they had given consent. Growing concern led other professional societies and human rights organizations to condemn the practice in the 1990s, and to question the way in which the organs were obtained. The WHO starting drafting an international guideline (WHA44.25) on human organ transplants in 1987, which resulted in the WHO Guiding Principles on Human Organ Transplantation being endorsed in 1991; however the wording did not allow the international community to draw up any laws preventing China from continuing to trade in human organs.

The United States Senate Committee on Foreign Relations convened a hearing in 1995 on the trade in human body parts in China; receiving evidence from various sources including statements from Amnesty International, a BBC news report, and government documents produced by Harry Wu, a campaigner for human rights in the People's Republic of China.

The WMA, the Korean Medical Association, and the Chinese Medical Association reached an agreement in 1998 that these practices were undesirable and that they would jointly investigate them with a view to stopping them; however, in 2000, the Chinese withdrew their cooperation. Amnesty International claimed to have strong evidence that the police, courts and hospitals were complicit in the organ trade, facilitated by the use of mobile execution chambers, or "death vans". Amnesty speculated that this profitable trade might explain China's refusal to consider abolishing the death penalty, which is used on between 1,770 (official figure) and 8,000 (Amnesty estimates) prisoners annually. Corpses are typically cremated before relatives or independent witnesses can view them, fuelling suspicions about the fate of internal organs.

In June 2001, Wang Guoqi, a Chinese doctor applying for political asylum, made contact with Harry Wu who, through his Laogai Research Foundation, assisted Wang in giving a written statement to the US Congress that he had removed skin and corneas from more than 100 executed prisoners for the transplant market at the Tianjin Paramilitary Police General Brigade Hospital, and that during at least one such operation the prisoner was still breathing. Wang, a "burn specialist", said that he had also seen other doctors remove vital organs from executed prisoners; and the hospital where he worked sold those organs to foreigners. Harry Wu said that he had gone to "great lengths" to verify Wang's identity and that both the foundation and congressional staff members found the doctor's statements "highly credible."

By 2005 the WMA had specifically demanded that China cease using prisoners as organ donors. In December of that year, China's Deputy Health Minister acknowledged that the practice of removing organs from executed prisoners for transplant was widespread, and he promised that steps would be taken to prevent abuse. According to Time, a transplant brokerage in Japan which organised 30–50 operations annually sourced its organs from executed prisoners in China.

On the eve of a state visit to the United States by President Hu Jintao, the 800-member British Transplantation Society also criticised China's use of death-row prisoners' organs in transplants, on the grounds that as it is impossible to verify that organs are indeed from prisoners who have given consent; the WMA once again condemned the practice on similar grounds.

Falun Gong allegations: 2006

Sujiatun case

In 2006, claims of harvesting of organs from live practitioners of the banned Falun Gong spiritual movement led to a disputed report being compiled by former Canadian member of parliament David Kilgour and human rights lawyer David Matas.

Throughout March 2006, Falun Gong-affiliated The Epoch Times (ET) published articles containing allegations by three anonymous individuals claiming to be eyewitnesses to organ harvesting at the Sujiatun Thrombosis Hospital and beyond, labelling it "Sujiatun Concentration Camp". One of the individuals was said to have worked in the Malaysian-owned hospital and was aware of 6,000 Falun Gong practitioners being kept alive in the basement. She alleged that the bodies of these people were thrown directly into the crematorium to be burnt after their organs had been extracted. Another individual who identified himself as a veteran military doctor in Shenyang was cited by ET to corroborate the claim. He said Sujiatun was just one of up to 36 such sites across China between which practitioners were rapidly transferred by closed freight train on special routes.

A Chinese foreign ministry spokesman vehemently rejected the ET claims about Sujiatun, and argued that the hospital was incapable of housing 6,000 persons, there is no basement for incarcerating practitioners as alleged, and that there was simply no way to cremate corpses in secret, continuously, and in large volumes. Investigators sent by dissident Harry Wu to Sujiatun three days after the story surfaced found no evidence of the existence of the alleged concentration camp. Wu dismissed the claims as merely hearsay from two witnesses, without the support of any paperwork or any detailed information.

In April 2006 U.S. representatives visited the site twice. They paid an unannounced visit one week after the report surfaced, and made a second visit with official cooperation three weeks later. Although the representatives found no evidence that the site was being used for any function other than as a normal public hospital, they expressed United States' concerns over China’s repression of Falun Gong practitioners and by reports of organ harvesting. Kilgour, and Ethan Gutmann, adjunct fellow at the Foundation for Defense of Democracies implied a cover up, stating that the three weeks between when the story broke to when the US State Department officials conducted their investigation was long enough by Chinese construction standards.

David Kilgour and David Matas conducted a two-month investigation at the request of the Coalition to Investigate the Persecution of Falun Gong, and reported on July 20, 2006 that large numbers of Falun Gong practitioners throughout China were victims of systematic organ harvesting whilst still alive. The findings were controversial as observers agreed the conclusions were based on circumstantial evidence. The authors admitted difficulty in verifying the Falun Gong allegations due to the lack of independent bodies which investigate conditions in China, and availability of eyewitness evidence and official information about organ transplantation. In addition, they claimed that their efforts were hampered by the denial of visas to China. The authors said the combination of the strands allowed them to deduce that the allegations of China's harvesting of organs from live Falun Gong practitioners were true. In 2007, the authors continued to allege that the harvesting of organs from unwilling Falun Gong practitioners was still taking place "on a large scale".

Response of Chinese authorities

China has repeatedly denied the organ harvesting allegations in the report. Upon release of the initial report on July 6, Chinese officials immediately declared that China abided by World Health Organization principles that prohibit the sale of human organs without written consent from donors, and accused the authors of wanting to smear China. They denounced the report as being "based on rumours and false allegations," and said the Chinese government had already investigated the claims and found them without any merit.

Other reports or reactions

In 2006, a Congressional Research Service report by Dr. Thomas Lum stated that the Kilgour-Matas report relied largely on logical inference, without bringing forth new or independently-obtained testimony; the conclusions also relied heavily upon transcripts of telephone calls with reported PRC respondents, the credibility of which is questionable due to the Chinese government's controls over sensitive information.

Associate Director of the Program in Human Rights and Medicine in the University of Minnesota, Kirk C. Allison, (2006) and Tom Treasure of Guy's Hospital, London (2007), considered the report plausible from a medical standpoint, based on the numerical gap in the number of transplants and the short waiting times in China compared with other countries. Allison asserted that the "short time frame of an on-demand system requires a large pool of donors pre-typed for blood group and HLA matching," and cited consistency with Kilgour and Matas' allegations about the systematic tissue typing of Falun Gong prisoners. Allison called for academia and medical circles to stop cooperating with China on organ transplantation.

Hong Kong-based Phoenix TV aired a programme in June 2007 which refuted the Sujiatun allegations, and attacked the Kilgour-Matas report. It said the hospital was not equipped for organ transplantation; the premises and staffing were inadequate for housing thousands of prisoners; that the incinerator was actually only a water-boiler. The hospital denied the claimed witnesses were employees; doctors interviewed also denied involvement. The programme showed that the area around the hospital was in a dense conurbation where large movements of people would be noticed.

In May 2008 two United Nations Special Rapporteurs reiterated their previous request for the Chinese authorities to adequately respond to the allegations, and to offer an explanation for the source of organs which would account for the sudden increase in organ transplants in China since 2000. In November 2008, the United Nations Committee Against Torture noted its concern at the allegations and called for China to "immediately conduct or commission an independent investigation of the claims", and take measures "to ensure that those responsible for such abuses are prosecuted and punished".

David Ownby, a noted expert on Falun Gong, said "Organ harvesting is happening in China, but I see no evidence proving it is aimed particularly at Falun Gong practitioners." Glen McGregor of the Ottawa Citizen, who had been the target of personal attacks by Kilgour and Matas, said "Depending on who you believe, the Kilgour-Matas report is either compelling evidence that proves the claims about Falun Gong... or a collection of conjecture and inductive reasoning that fails to support its own conclusions". He said his 'crime' of failing to report the allegations as fact had led to him be compared to Holocaust deniers.

International concerns: 2006–2007

According to a 2006 Congressional Executive Commission report, Huang Jiefu, China's Vice Minister of Health, indicated in July 2005 that as many as 95% of all organ transplants in China derived from executions.

In June 2006, Edward McMillan-Scott, vice president of the European Parliament, said he believed that nearly 400 hospitals in China shared the lucrative trade in transplant organs, with websites advertising new kidneys for $60,000.

The US National Kidney Foundation (NKF) stated in August 2006 that they were deeply concerned with the allegations in the Kilgour Matas report, and that "any act which calls the ethical practice of donation and transplantation into question should be condemned by the worldwide transplantation community." The NKF also condemned organ transplant tourism in general.

In December 2006, the Australian Health Ministry abolished training programs for Chinese doctors in organ transplant procedures in the Prince Charles and the Princess Alexandra Hospitals and the banning of joint research programs with China on organ transplantation.

In early 2007, Israeli health insurance carriers stopped sending patients to China for transplants. This was in part related to an investigation in which Israeli authorities arrested several men for tax evasion in connection with a company that mediated transplants of Chinese prisoners’ organs for Israelis. One of the men had stated in an undercover interview that the organs came from "people who oppose the regime, those sentenced to death and from prisoners of the Falun Gong sect." In May 2007 Rabbi Yosef Shalom Eliashiv prohibited Jews from deriving any benefit from Chinese organ harvesting, "even in life-threatening situations"; other rabbis also oppose the use of Chinese organs for transplants.

Regulatory environment since 2006

In March, 2006, the Ministry of Health issued the Interim Provisions on Clinical Application and Management of Human Organ Transplantation, which stipulated that medical centres must meet new requirements for transplant services; the provinces were made responsible for plans for clinical applications. Establishments performing transplantation were thereby obliged to incorporate considerations for ethics, medical and surgical expertise, and intensive care. In April 2006, the Committee of Clinical Application of Human Organ Transplantation Technologies was created to standardise clinical practice; a national summit on clinical management took place in November 2006 which issued a declaration outlining regulatory steps.

In May 2007 the Regulation on Human Organ Transplantation came into force, banning organ trading and the removal of a person's organs without their prior written consent, and this has been favourably received by the World Health Organisation and The Transplantation Society. Doctors involved in commercial trade of organs will face fines and suspensions, and only a few certified hospitals will be allowed to perform organ transplants in order to curb illegal transplants. As a result of a systematic overhaul, the number of institutions approved for transplants has been reduced from more than 600 in 2007 to 87 as at October 2008; another 77 have received provisional approval from the Ministry of Health.

To further combat transplant tourism, the Health Ministry issued a notice in July 2007 in line with the Istanbul Declaration, giving Chinese citizens priority as organ recipients. In October 2007, after several years of discussions with the WHO, the Chinese Medical Association agreed to cease commercial organ harvesting from condemned prisoners, who would only be able to donate to their immediate relatives. Other safeguards implemented under the legislation include documentation of consent for organ removal from the donor; review of all death sentences by the Supreme People’s Court. Transplant professionals are not involved until death is declared. A symposium among legal and medical professionals was held in April 2008 to discuss the diagnostic criteria for brain death for donors of transplant organs.

Organ donation programme

The Health Ministry began establishing an organ-donation policy that will allow people to express their wishes on their driver’s licences; and participation by the Red Cross to publicise the need for organ donation. In 2008, a liver-transplant registry system was established in Shanghai, which allows the monitoring of the after-care of liver recipients; at the same time a nationwide proposal was announced that would allow people to note on their driving licence that they wish to donate their organs. Despite these initiatives the China Daily newspaper reported in August 2009 that approximately 65% of transplanted organs still came from death row prisoners. Condemned prisoners have been described as "not a proper source for organ transplants" by Vice-Health Minister Huang Jiefu, and China's first posthumous organ donation system was jointly launched in March 2010 by the Red Cross Society and the Ministry of Health. Huang Jiefu announced the scheme would be trialled in 10 pilot regions including the cities of Tianjin, Wuhan and Shenzhen. Funds will be made available for the families of people who voluntarily donate their organs. If successful Chinese authorities say they hope this will reduce the need for organs taken from death row prisoners and will stem the tide of black market organs.

See also

• Organ transplantation in different countries

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• Use mdy dates from August 2010
• Health in the People's Republic of China
• Organ transplantation by country