American Journal of Transplantation: Forced Organ Harvesting in China

(Minghui.org) American Journal of Transplantation, the journal of the American Society of Transplant Surgeons (ASTS) and the American Society of Transplantation (AST), published an article on April 2 on organ harvesting in China with the title of “Execution by organ procurement: Breaching the dead donor rule in China.”

“In these cases, the removal of the heart during organ procurement must have been the proximate cause of the donor's death. Because these organ donors could only have been prisoners, our findings strongly suggest that physicians in the People's Republic of China have participated in executions by organ removal,” wrote the authors, Matthew P. Robertson from Australian National University and Jacob Lavee from Sheba Medical Center in Tel Aviv University.

Organ Extraction Prior to Death

The dead donor rule (DDR) is a fundamental requirement for transplant ethics. “The rule states that organ procurement must not commence until the donor is both dead and formally pronounced so, and by the same token, that procurement of organs must not cause the death of the donor,” wrote the article, “In a separate area of medical practice, there has been intense controversy around the participation of physicians in the execution of capital prisoners.”

Based on 2,838 papers from a database of 124,770 Chinese-language transplant publications, the authors conducted a computational text analysis for a forensic review. “Our algorithm searched for evidence of problematic declarations of brain death during organ procurement,” wrote the article, “We find evidence in 71 of these reports, spread nationwide, that brain death could not have properly been declared.”

“From these reports, we infer that violations of the DDR took place: given that the donors could not have been brain dead before organ procurement, the declaration of brain death could not have been medically sound. It follows that in these cases death must have been caused by the surgeons procuring the organ,” the article concluded.

Much Evidence

Medical literature between 1980 and 2015 shows China is the second-largest transplant country in the world based on absolute transplant volume, while human rights researchers found the actual organ transplant numbers in China are much higher. “PRC hospitals continue to advertise transplant waiting times of weeks, whereas wait times in the United States are measured in months and years,” wrote the authors. These organ tourism advertisements appeared on websites in English, Russian, Arabic, and other languages.

Adding to this perplexing situation was the lack of voluntary donation system and very few voluntary donors in China. The article states that according to three official sources, including the current leader of the transplant sector, the number of voluntary (i.e., non-prisoner) organ donors in China cumulatively as of 2009 was only about 0.3% of the 120,000 organs officially reported to be transplanted during the same period.

In addition, the leader of China's transplant sector wrote in 2007 that 95% of all organ transplants were from prisoners. Adding these together, “it logically follows that almost all the organ transplants in the papers we consider must have been from prisoners. Presumably this includes both death row prisoners and prisoners of conscience,” wrote the article.

To solve this puzzle, the authors chose hearts and lungs for the analysis because their procurement typically involves donors whose hearts are still beating. “The 71 papers we identify almost certainly involved breaches of the DDR because in each case the surgery, as described, precluded a legitimate determination of brain death, an essential part of which is the performance of the apnea test, which in turn necessitates an intubated and ventilated patient,” wrote the article, “In the cases where a face mask was used instead of intubation—or a rapid tracheotomy was followed immediately by intubation, or where intubation took place after sternal incision as surgeons examined the beating heart—the lack of prior determination of brain death is even more apparent.”

Media Reports

“China has been reliably and repeatedly accused of killing Falun Gong and other political prisoners for their organs. Now, a paper just published in the American Journal of Transplantation — one of the world’s most respected medical journals — lays out a convincing case that Chinese doctors are not only harvesting from executed prisoners, but that organ removal was often the means of execution,” wrote a National Review article on April 4 titled “Study: Chinese Doctors Executed Prisoners by Organ Removal.”

“We found that the physicians became the executioners on behalf of the state, and that the method of execution was heart removal,” remarked one of the authors, Robertson, according to an Australian Financial Review article titled “Surgeons executed Chinese prisoners for organs, says ANU study.”

“These surgeries are highly profitable for the doctors and hospitals that engage in them,” he explained, “There are probably a lot more hidden. This is taken from a small sample.”

“Chinese surgeons removed the hearts of death-row prisoners before they were confirmed to be dead, according to an Australian study of organ transplants,” reported Times in an April 5 article with the title of “Chinese surgeons removed hearts of death-row inmates who were still alive, study suggests.”

“Researchers at the Australian National University (ANU) examined thousands of Chinese medical papers and concluded that surgeons killed some prisoners during surgery, including some ‘prisoners of conscience’ who had not been certified to be brain-dead,” wrote the article, “The study’s authors say their computer modeling disproves Chinese claims that all prisoners were brain-dead before their organs were ‘harvested’.”