In 2005, I was astounded to hear from a patient who was a candidate for a heart transplant, and who had been hospitalized for a year in my department at the Sheba Medical Center, Tel Hashomer, that he had received an offer from his insurance company to fly to China and undergo the surgical procedure there, on a specified date within two weeks. A necessary precondition for a heart transplant is the donor’s demise on the day of the surgery, which obviously is not an event whose date is known weeks in advance. My astonishment only increased when the patient did in fact make the trip to China and had the transplant on the promised day. He was the first Israeli to have a heart transplant in this way.

Intrigued by the case, I started investigating the subject of organ transplants in China. I discovered that as early as 1984 a secret law had been promulgated there allowing the organs of persons condemned to death to be harvested for transplants. The law, whose existence gradually leaked out, is contrary to all international law and ethical procedures, which absolutely prohibit the use of organs of individuals who have been executed. Indeed, even asking a condemned person to agree to become an organ donor after his or her death is forbidden. Nevertheless, the law spawned a flourishing industry in China worth billions of dollars to the state and other players, involving tens of thousands of procedures a year, based on the sale to transplant tourists of organs of people sentenced to death.

In 2008, Israel passed the Organ Transplant Law, making it the first country in the world to bar its citizens from traveling to China (or elsewhere) for such procedures. The law prohibits the country’s health maintenance organizations and insurance companies from underwriting organ transplants in any country where the procedure is carried out in a manner that the Israeli legislation defines as commerce in body organs. Israel drew wide international praise for the law, which was also copied by a number of other states.

For many years, the Chinese authorities denied outright both the existence of the secret law and the source of the organs they were selling, before finally admitting to the facts in 2005. A year later, two Canadian researchers published a comprehensive report, titled “Bloody Harvest,” which revealed that the organs used in transplants in China come not only from individuals officially condemned to death by the judiciary system. Much of the supply originated with a vast population of prisoners of conscience, particularly from Falun Gong practitioners, a group whose members in 1999 were declared opponents of the communist regime, and had their legal rights annulled. They were incarcerated en masse in so-called “reeducation camps,” tortured and, in what are estimated to be tens of thousands of cases, were executed on demand so their organs could be sold for transplantation. Many testimonies and studies over the years have confirmed that Chinese prisoners of conscience were being subjected to such treatment, but the authorities in Beijing continue to deny it to this day.

The exposure of the immoral and unethical behavior of those physicians and surgeons in China who are involved in organ transplants spurred an academic boycott of them by the international medical community. For many years they were barred from publishing their studies in medical journals or presenting them at international conferences. Under the impact of the boycott, which accompanied international pressure to stop the use of organs of condemned prisoners for transplants, the regime’s leaders declared that as of January 1, 2015, organ procurement from condemned individuals – officially condemned, that is – would cease completely. Concurrently, the authorities announced a reform in the field of organ donations and the adoption of a national system to encourage dying hospital patients to become organ donors, with the surgery performed in the hospital, subject to the agreement of their families. In the wake of the announcement, the international academic boycott was lifted and Chinese transplant physicians were once more welcomed with open arms by their colleagues around the world.

Unfeasible and illogical

Two important documents published recently shed new light on the behavior of the Chinese authorities and reveal the web of lies under whose cover China continues to carry out the organ-transplant project, which has been categorized as a crime against humanity.

The first document was the final judgment of the independent China Tribunal, which investigated forced organ harvesting from prisoners of conscience in China, and published its report last June. The tribunal’s panel was chaired by British jurist Sir Geoffrey Nice, who led the prosecution of Slobodan Miloševi, former president of Serbia, at the United Nations’ International Criminal Tribunal for the former Yugoslavia in the early 2000s. For a year, the China Tribunal – whose other members included physicians, legal scholars, historians and international relations experts – heard testimony from 50 witnesses and received a host of written evidence and photographs, which together indicated that little had changed in China since 2015, despite the promises of reform.

The unanimous judgment stated that “forced organ harvesting has been committed for years throughout China on a significant scale and that Falun Gong practitioners have been one – and probably the main – source of organ supply. The Tribunal has had no evidence that the significant infrastructure associated with China’s transplantation industry has been dismantled, and absent a satisfactory explanation as to the source of readily available organs concludes that forced organ harvesting continues till today.”

Furthermore, the “commission of Crimes Against Humanity against the Falun Gong and Uyghurs has been proved beyond reasonable doubt by proof of one or more of the following, legally required component acts: murder, extermination, imprisonment… torture, rape… persecution on racial, national, ethnic, cultural or religious grounds… and enforced disappearance... in the course of a widespread and systematic attack or attacks against the Falun Gong and Uyghurs.” The report also noted the possibility that, since “concerted persecution and medical testing of the Uyghurs is more recent,” it could be that “evidence of forced organ harvesting of [the Uyghurs] group may emerge in due course.”

In its interim report last January, the tribunal had stated, “We can properly remind ourselves of past atrocities where states sought destruction of some part of their communities and recall the parts played in horrifying events that unfolded by others who remained silent.”

The final judgment concluded with the assertion that “governments and any who interact in any substantial way with the PRC … should now recognize that they are, to the extent revealed above, interacting with a criminal state.”

The second document is a broad research study that I published last month in the journal BMC Medical Ethics, about the way China has manipulated the number of organ donations it has reported from deceased persons in the years since the 2015 declaration. The study, which was carried out and written in conjunction with two Australian colleagues, examined the official reports issued by those in charge of the organ transplants system in China. Our conclusion was that the dramatic annual increase of transplants originating with hospital-based donors that was reported following the supposed cessation of organ sourcing from condemned prisoners, was fabricated.

An analysis of the annual reports showed that the statistics all conform precisely to a simple mathematical formula – an impossible, illogical situation, given the large number of variables that generally affect organ donation and transplantation. A comparison of the Chinese reports with the parallel annual reports from some 50 other countries showed that the Chinese data deviate from those of every other country by 100 percent to 200 percent. Suspiciously, and in contrast to every other country in the world, it was possible to predict the Chinese data precisely with a mathematical formula whose level of sophistication recalls middle-school algebra.

Everyone who is knowledgeable about organ transplants understands that there is no logical way to explain such an increase unless the numbers have been pre-determined and falsified.

Additionally, the analysis of the Chinese data revealed a whole series of illogical or medically unfeasible deviations: a report on the use of an average of 21 organs per donor over a particular two-week period (the maximum number of organs that can be taken from a human body ranges from four to eight); deviant daily leaps of hundreds of percentage points in the number of persons registered as potential organ donors – apparently to ensure that they would always be consistent with a fixed and uniform value of 2.75 organs per donor; and an extreme mismatch between the data concerning organ transplants as reported by the hospitals involved and the official national figures.

Our study found that only in a few of the approximately 700 organ transplant centers in China is the procurement of organs from deceased donors truly voluntary. The cumulative findings of the research, which come on top of numerous Chinese reports that classified condemned prisoners as voluntary donors, cast serious doubt on the credibility of the declarations about a cessation of forced organ harvesting, and affirm the tribunal’s conclusions about the continuing perpetration of such crimes against humanity in this connection.

Violating their oath

The gloomy picture of the Chinese transplant situation obligates us all to recognize the seriousness of the facts and to abandon the ostrich-like approach that is being taken by the nations of the world and international bodies toward the authorities in the country. If similar grave suspicions were raised about any Western country, could we even imagine not demanding answers and explanations?

Chinese authorities did not bother to accede to the independent tribunal’s invitation to appear before it and argue its case; they also continue to deny persistently all the allegations against them and to claim that they amount to anti-Communist propaganda. Unfortunately, the tribunal’s report has not elicited international action. The world’s prolonged thunderous silence on this subject is tantamount to collaboration and acquiescence in crimes that continue to be committed and exact their price in the lives of innocent people.

The silence of the community of physicians, particularly transplant surgeons, worldwide, in the face of the atrocities being perpetrated in this field in China, is a gross violation of the Hippocratic Oath, which calls on every physician, even before starting the process of curing a patient, to avoid causing harm to any person. By our silence, we are allowing not only “harm to be caused,” but for innocent people to be killed. The rapid lifting of the academic boycott against the Chinese transplant surgeons, on the basis of declarations of reform whose credibility was not examined independently, was equivalent to affirming the veracity of a system lacking credibility, in which physicians are responsible for the execution of innocent individuals during organ harvesting.

The Jewish people, who experienced on their own flesh systematic mass murder while the world looked on in silence, must not remain silent at this time. Even if we in Israel succeeded by means of our singular legislation in preventing our nationals from undergoing transplants in China, it remains our obligation to be at the forefront of those sounding the alarm and calling in every international forum for the immediate cessation of this ongoing crime against humanity. We must on no account turn a blind eye to the distress of others who are being executed in their masses because of their collective identity alone, and in spite of their having done no wrong.

Prof. Jacob Lavee is director of the heart transplantation unit at the Sheba Medical Center, Tel Hashomer, and a member of the international advisory board of Doctors Against Forced Organ Harvesting.