The China Tribunal, an independent legal entity created to investigate decades of reports of China selling organs cut out of living political prisoners, concluded in its report published this week that live organ harvesting “continues to this day.”

The China Tribunal’s report follows months of investigations, including testimony from experts and first-hand accounts from former political prisoners, and compiles hundreds of pages of evidence that the Chinese Communist Party has a stable of people it can kill on demand to sell their organs to high bidders on the black market.

Those most vulnerable to having their kidneys, livers, hearts, and other organs cut out of them without anesthesia, as some testified occurred, are Falun Gong practitioners, though ample evidence also exists that Uyghurs and other ethnic minorities in China’s western concentration camps are also being routinely tested in a way consistent with medical testing for organ donation. Christians and other religious minorities in prison for their faith reported face similar testing.

The report also found ample evidence of torture and murder of political prisoners and ethnic minorities. Those in the concentration camps in Xinjiang, where most of the nation’s Uyghur population is located, testified to being electrocuted, beaten, forced into sleep deprivation, and witnessed rape and murder.

“Forced organ harvesting has happened in multiple places in the PRC [China] and on multiple occasions for a period of at least 20 years and continues to this day,” the tribunal concluded in its report. “Medical testing of groups, including Falun Gong and Uyghurs, was related in some way to the group concerned because other prisoners were not tested. The methods of testing are highly suggestive of methods used to assess organ function. The use of ultrasound examinations further suggests testing was focused on the condition of internal organs.”

The report goes on to note that China has not offered any rational explanation for this testing, leaving it to conclude that “[t]here has been a population of donors accessible to hospitals in the PRC whose organs could be extracted according to demand and this has coincided both with the longterm practice in the PRC of forced organ harvesting and with many Falun Gong practitioners, along with Uyghurs, being compelled to have medical tests, focused on their organs.”

The tribunal’s report finds the earliest evidence of the Chinese Communist Party seeking to cut open political prisoners while alive to extract their organs appears in 1978, in a paper in which a scholar says a police officer suggested cutting the kidneys out of a schoolteacher condemned to death for “counter-revolutionary” thoughts.

It would take nearly 20 years for another incident to be documented of live organ harvesting. The individual in question, Enver Tohi, narrated his experience to author Ethan Gutmann in the 2014 report The Slaughter, which has served as much of the basis for what is publicly known of China’s organ harvesting. Tohti said he was ambushed into cutting a living person open and taking out their organs, but was not certain the person was alive, without anesthesia, until he had already made incisions. Tohti testified before the China Tribunal last year:

I was seating next to him, 5 or 6 corpses were visible to me to the left, on the slop of the hill. Shaved heads with prison uniform, the foreheads were blown up, a police officer shouted at us: to the right, far right, the last one is yours. Confused, why is ours? Not time for that, moved to the location, our surgeons hold me and told me: hurry up, extract the liver and two kidneys. I turned into a robot trained to carry out its duty. Those police officers and my assistants put the body on the bed inside van already. The victim was a man in his 30s, unshaved with long hair and civilian clothes. The bullet gone through his right chest. The nurses have prepared the body, two chief surgeons standing on my left observing my movement, I asked to apply anaesthesia, they said no need, ‘We will apply if it is needed.’ It meant they will observe if the man is not moving and then they will do something. The man seems already dead anyway, so I started my insertion, the cut designed as upside-down ‘T’ shape, to expose internal organs as wide and possible. My scalpel finds its way cutting his skin, blood could be seen, it implies that his heart was still pumping blood, he was alive! My chief surgeon whispered to me: hurry up!

The China Tribunal also listened to the testimony of several individuals who were forced into Xinjiang concentration camps. These people said they endured torture, witnessed signs of rape and murder, and were routinely medically monitored in a manner consistent with seeking organ donors. While, unlike the case of Enver Tohti, no doctor has testified to executing live organ extraction in the Uyghur camps, the tribunal concluded ample evidence existed of the practice.

In Chinese prisons – the criminal entities, not the so-called “vocational training centers” that Uyghurs and other Muslim ethnic minorities are forced into, the tribunal found evidence of similar testing, but only for Falun Gong practitioners and some other religious minorities, like Christians and Tibetan Buddhists.

Apparently unrelated to organ harvesting, the report concluded “with certainty that the PRC has orchestrated within its penal system the endemic perpetration of rape and other acts of sexual violence and humiliation against male and female prisoners including Falun Gong practitioners. Specifically, the use of electric batons on the genitals of both men and women is prevalent.”

Chinese Communist Party officials were invited to attend and defend against the allegations but repeatedly refused the opportunity. The only indirect testimony from Chinese officials in the report comes from recent phone calls to hospitals that served as proof that hospitals had organs “on demand” for potential buyers. The only way to be able to ensure that organs will be available for a prospective client whenever they would want them is to keep a population of living donors reserved for when the call comes, the report affirmed.

The China Tribunal, citing the few who have survived Muslim concentration camps in Xinjiang, has been warning for months that signs indicate Beijing is seeking to sell Uyghur organs on the black market. Organ sales are a lucrative business, as the number of ill people in need of an organ transplant far exceeds the potential number of donors, including healthy organ donors dying in car accidents and other situations where their bodies can still be of medical use. The developments in Xinjiang are relatively new compared to the decades of mounting evidence that Falun Gong practitioners – who attempt to maintain high levels of health through exercise, diet, and meditation – have been killed in prisons to use their organs. The Tribunal noted in its report that, in 2006, China admitted to harvesting organs from political prisoners.

Free states have done little to curb China’s use of political prisoners for organ harvesting, particularly medical professional communities and organizations that have the opportunity to censure China or cease working with the regime.