Chinese authorities insist the practice of organ harvesting hasn't gone on for years, but the statistics suggest otherwise. junrong/Shutterstoc

Inside China’s hospitals and prison system, you can find one of the darkest stories of the 21st century.

If you received an organ transplant in China in the past few decades, there’s a strong chance it was harvested from an executed prisoner against their will. A shortage of organ supply opened up the doors for illegal organ trafficking and forced organ harvesting. Many of these prisoners are not murderers or rapists, but “prisoners of conscience” who were arrested for their political or religious beliefs, such as the peaceful practitioners of Falun Gong.

The Testimonies

In October 1995, Wang Guoqi was working as a medical doctor for the Chinese Army at a prison in Hebei Province when he witnessed prisoner executions that changed his life. While still holding onto their last breaths, doctors were brought in to harvest the prisoners' organs for the purposes of a transplant.

"My work required me to remove the skin and corneas from the corpses of over one hundred executed prisoners, and on a couple of occasions, victims of intentionally botched executions," he told the US Congress in June 2001.

Over the past two decades, a stream of whistleblowers have left China and testified about the similar horrors they endured. As part of the Kilgour–Matas report, a private investigative report into allegations of forced organ harvesting in China, David Kilgour spoke to the ex-wife of a Chinese surgeon who removed as many as 2,000 corneas from executed Falun Gong prisoners.

“Usually these Falun Gong practitioners were injected with a shot to cause heart failure. During the process these people would be pushed into operating rooms to have their organs removed,” she recalled. “On the surface, the heart stopped beating, but the brain was still functioning, because of that shot. These people were [then] pushed to other operation rooms for removals of heart, liver, kidneys... After their kidneys, liver, and skin were removed, there were only bones and flesh left. The bodies were thrown into the boiler room at the hospital.”

The System

The system is still shrouded in mystery and, as such, there is no smoking gun that conclusively proves the scale of the problem. It is also unclear how pervasive the problem is today. Although the Chinese government has admitted it harvested organs from prisoners in the 1990s and 2000s, it has insisted the practice ended in 2015. Chinese authorities now say they have switched to a fully legitimate organ transplant program that only uses voluntary donors.

However, many argue the statistics suggest otherwise, and the practice is ongoing.

China is notoriously shady about releasing official statistics about the number of executions and the number of organ transplantations they carry out. However, numerous investigations by journalists and NGOs have shown that their statistics don’t add up. One major report, The Bloody Harvest/The Slaughter, has stated the rate of executions and the number of organs taken from executed prisoners remains “a state secret,” adding “we are convinced that transplant volume is substantially higher than the official figure.” Another study, published in January 2019, carried out a forensic analysis of data about organ donation between 2010 and 2018. They found a "systematic falsification and manipulation of official organ transplant dataset" and concluded China's claims of reform are highly questionable.

A protest against forced organ harvesting in Causeway Bay, Hong Kong, 2011. lasse-san/Flickr CC BY-NC 2.0

China is fast becoming the world leader of organ transplants in terms of the number of operations – over 1 million transplants since 2000 – but there are still relatively few voluntary organ donations in the country. For cultural reasons, Chinese people are typically reluctant to donate their organs after death. So, where are the organs coming from?

“The Chinese governments claim they do around 10,000 each year, let’s say, but that seems very unrealistic when you look at factors like bed capacities of hospitals and the amount of resources they put into transplants. That ‘official’ quota can essentially be met by a couple of hospitals, and there are over 200 hospitals doing transplants,” Sarah Cook, Senior Research Analyst for East Asia at Freedom House, told IFLScience.

“When you look at a self-reporting on a local level and individual hospitals saying how many transplants they did, you get an estimate in the 60,000 to 100,000 range.”

The Falun Gong

The Falun Gong has consistently taken the brunt of organ exploitation, although other marginalized minority groups, such as Muslim Uyghurs and Tibetan Buddhists, have also fallen victim.

There are over 70 million followers of Falun Gong, representing the second-largest faith community in China after Chinese Buddhism. It essentially teaches its practitioners meditation, mindfulness, and exercise for the purposes of “self-cultivation”. While their actions are totally peaceful – in fact, non-violence is a major totem in the practice – the Chinese Communist Party has dispelled it as a dangerous cult. As such, they are subject to widespread surveillance, imprisonment, torture, and execution without trial.

Also, rather helpfully for the Chinese government, they are an extremely healthy group of people.

“They are a vilified group and they are known for having a very good health profile. Even the Chinese government admits that,” said Cook.

“They don’t smoke, they don’t drink, they exercise a lot. It’s a readily available prisoner population that’s been vilified and they have a relatively healthy profile, so it’s opportunistic.”

Taipei, Taiwan, November 8, 2014: Falun Gong practitioners meditate at Taipei's Freedom Square. Liudmila Kotvitckaia/Shutterstock

As a particularly sinister clue, dozens of Falun Gong practitioners have reported the systematic use of health check-ups, especially blood tests, while serving time in prison, suggesting this is a way for the authorities to know their health and blood types ready for transplantation.

“I was illegally detained three times and was forced to submit to a physical exam each time. I didn't understand why we had to have physicals done. The guard's answer was, ’It's a routine process,’" Chen Ying, a practitioner, explains in a Falun Gong blog about his experience in numerous Chinese labor camps. "The way they conducted the exam made me feel that they were not doing it out of consideration for my health but instead, they wanted to get something specific from the results.”

On-Demand Organs

The speed at which patients can receive an organ also hints there is some kind of “on-demand transplant system”. Outside of China, it can take months or even years for a donor organ to become available. Since organs can only remain viable outside the body for a few hours, would-be organ recipients have to “wait for the phone call” telling them a potential donor has passed away and then rush to the hospital.

However, in China, it’s sometimes possible to get an organ in a matter of weeks, if not days. It’s even possible to book a transplant for a few weeks' time. This strongly suggests there is a system where on-demand executions can be used to quickly get a patient a “fresh” organ.

A 2017 documentary by the Korean Chosun Broadcasting Company investigated rumors that a handful of hospitals in China have secret detention centers in their basements for the purposes of holding prisoners before organ extractions. While they failed to definitely prove the presence of these secret basements, the film found many Chinese hospitals were licensed to use a patented "brain death machine," a grim contraption that can render people brain dead while still maintaining their organs viable for transplant.

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Transplant Tourism

There is big money at stake. According to the Kilgour–Matas report, the prices for organs in 2006 were $62,000 for a kidney, $98,000-$130,000 for a liver, $170,000 for a lung, $160,000 for a heart, and $30,000 for a cornea.

The appeal of easy organ transplantation with short waiting time, combined with profit-seeking hospitals, also draws international business. The scale of health tourism for harvested organs is not known because it’s a shady “grey market,” however, the World Health Organization has noted that China’s organ transplantation system is being used by internationals. It’s thought to be especially common in nearby countries, such as Japan, South Korea, and Taiwan, as well as further afield in the Middle East, Europe, and North America.

What’s Happening About It?

There has been growing criticism and awareness of the practice since China revealed its secret in the 2000s. In reaction, China claims it has reformed and not used the organs of executed prisoners since 2015. Many international critics remain dubious.

An independent tribunal has recently been established in London to inquire into forced organ harvesting from prisoners of conscience in China. Among the many questions they hope to be answered, is whether China's promise of reform is true.