Organ transplantation in China has taken place since the 1960s, and by the early 2000s had become one of the world’s largest transplant programmes, with official figures reporting over 13,000 liver and kidney transplants in 2004. However, independent academic analyses have raised questions about the accuracy of these official figures and highlighted gaps in the transparency of China’s transplant data. Official registries are not fully accessible to outside researchers, making independent verification of transplant numbers and the sources of organs difficult.
Involuntary organ harvesting was once legal on criminals, but outlawed in 2015. Growing concerns about possible ethical abuses arising from coerced consent and corruption led medical groups and human rights organizations, by the 1990s, to condemn the practice. These concerns resurfaced in 2001, when a Chinese asylum-seeking doctor testified that he had taken part in organ extraction operations."Doctor Says He Took Transplant Organs From Executed Chinese Prisoners" New York Times 29 June 2001
In 2006, allegations emerged that many Falun Gong practitioners had been killed to supply China's organ transplant industry.Gutmann, Ethan. "China’s Gruesome Organ Harvest" , The Weekly Standard, 24 November 2008 An initial investigation stated "the source of 41,500 transplants for the six year period 2000 to 2005 is unexplained" and concluded that "there has been and continues today to be large scale organ seizures from unwilling Falun Gong practitioners".
In December 2005, China's Deputy Health Minister acknowledged that the practice of removing organs from executed prisoners for transplants was widespread. In 2007, China issued regulations 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 the immediate family of the deceased.Press release, "Chinese Medical Association Reaches Agreement With World Medical Association Against Transplantation Of Organs" , Medical News Today, 7 October 2007. Retrieved 24 September 2010 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, China Daily 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 organ donation program starting after death, jointly run by the Red Cross Society and the Ministry of Health, in 10 pilot regions. In 2013, Huang Jiefu altered his position on utilizing prisoners' organs, stating that death row prisoners should be allowed to donate organs and should be integrated into the new computer-based organ allocation system.
In 2014, China announced that it would stop using organs from executed prisoners for transplants starting January 1, 2015. However, critics described this as an "administrative trick," noting that prisoners including those on death row are reclassified as citizens, allowing their organs to continue being used in transplants. In 2018 and 2019, media investigations and academic analysis into these allegations increased.How The West Enabled China Organ Harvesting Expansion, by Frances Martel, 22 June 2019, Breitbart News In August 2024, media outlets reported on the first known survivor of China’s forced organ harvesting.
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.HUMAN ORGAN TRANSPLANTATION – A Report on Developments Under the Auspices of WHO (1987–1991) , page 7, World Health Organization, Geneva, 1991
China itself began organ transplantation in the 1960s, which grew to an annual peak of over 13,000 transplants in 2004;"Health-System-Reform-in-China" The Lancet, 20 October 2008. Retrieved 24 September 2010 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. China explores innovative surgery, such as the world's first flesh and bone face transplant, performed by Professor Guo Shuzhong. Organ donation, however, has met resistance, and involuntary organ donation is illegal under Chinese law,"China fury at organ snatching 'lies'", BBC News, 28 June 2001. Retrieved 24 September 2010 as it is against Chinese tradition and culture, which attach symbolic life affirming importance to the kidney and heart.David N. Weisstub, Guillermo Díaz Pintos,
China is not alone in encountering donation difficulties; demand outstrips supply in most countries. The world-wide shortage has encouraged some countries—such as India—to trade in human organs.Reddy KC: In Land W, Dossetor JB (eds): Organ Replacement Therapy: Ethics, Justice, Commerce. New York: Springer-Verlag; 1990, p 173, 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.Jane Macartney, "China to 'tidy up' trade in executed prisoners' organs" , The Times, 3 December 2005 Development of an immunosuppressant drug, cyclosporine A, made transplants a more viable option for patients.
Milestones The first living related renal transplant was performed in China in 1972; the first allogeneic bone marrow transplantation was successfully executed in an acute leukaemia patient.Dr LU Daopei, "Blood and marrow transplantation in mainland China (Supplement 3)" . Hong Kong Medical Journal (3 June 2009) 15 (Suppl 3):9–12 The first recorded clinical liver transplant from a living donor in China took place in 1995, seven years after the world's first was performed in São Paulo, Brazil.Wang XH, Zhang F, Li XC, Qian JM, Kong LB, Huang J, et al. Clinical report on 12 cases of Living donor partial liver transplantation. Natl Med J Chin (Chin) 2002; 82: 435–439. Between January 2001 and October 2003, 45 patients received living donor liver transplantation (LDLT) at five different hospitals. In 2002, doctors at Xijing Hospital of the Fourth Military Medical University described three cases of living related liver transplantation. In 2003 a landmark brain-death case involving switched off ventilation came to the attention of the public and made a big impact on medical ethics and legislation. The first successful brain-death organ donation soon followed.Zhonghua Klaus Chen (6 December 2007). "Current Situation of Organ Donation and Transplantation in China" of the Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College and Huazhong University of Science and Technology, PRC, pub: City University of Hong Kong From October 2003 to July 2006, 52 LDLT operations were conducted at the West China Hospital, West China Medical Center of Sichuan University. In October 2004, Peking University People's Hospital Liver Transplantation Center executed two cases of living related liver transplantation involving complex blood vessel anatomy. In 2002, the Chinese media reported surgeon Dr Zheng Wei successfully transplanted a whole ovary at the Zhejiang Medical Science University to a 34-year-old patient, Tang Fangfang, from her sister.Woodford, Peter (15 March 2007) "Whole ovary transplant reverses early menopause" , National Review of Medicine vol 4 no. 5 In April 2006, the Xijing military hospital in Xian carried out a face transplant operation covering the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear while protecting his sheep.
The first successful penis transplant procedure was performed in September 2006, at a military hospital in Guangzhou. The patient, a 44-year-old male, had sustained the loss of most of his penis in an accident. The transplanted penis came from a brain-dead 22-year-old male. Although successful, the patient and his wife suffered psychological trauma as a result of the procedure, and had the surgery reversed fifteen days later. Following this, Jean-Michel Dubernard, famous for performing the world's first face transplant, wrote that the case "raises many questions and has some critics". He alluded to a double standard writing, "I cannot imagine what would have been the reactions of the medical profession, ethics specialists, and the media if a European surgical team had performed the same operation."
International concerns
Organs sourced from death row prisoners Transplantation first began in the early 1970s China, when organs were sourced from executed prisoners. Although other sources, such as brain-dead donors, had been tried, the lack of legal framework hampered efforts. Dr Klaus Chen said in 2007 that this was still the dominant pool. The Laogai Research Foundation website have a portal to display the relationship between execution and organ market in China. Concerns that some poorer countries were answering donor shortages by 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, in 1987 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 organisations 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, the BBC, and Chinese government documents produced by human rights activist Harry Wu."Senate Committee Hears How Executed Prisoners’ Organs are Sold for Profit" Laogai Report, November 1995. The Laogai Research Foundation. Retrieved 24 September 2010
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.Harold Hillman in a letter published in the November 2001 issue of British Medical Journal 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".Calum MacLeod, China makes ultimate punishment mobile , USA Today, 15 May 2006. Retrieved 24 September 2010 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.