Medical specialists misdiagnosed patients as profoundly unresponsive and extracted their organs while still alive. This is the shocking conclusion researchers reached after completing a thorough investigation.
The Australian National University recently published what is claimed to be the world’s first study exposing the Chinese Communist Party’s (CCP’s) transition away from executing via firing squads towards killing in operating theaters.
Ph.D. researcher Matthew Robertson and Israeli cardiac transplant surgeon Jacob Lavee allegedly caught transplant physicians incorrectly certifying causes of death according to medical procedures listed in 56 hospitals across the communist-ruled nation.
Primary health care professionals also reportedly removed hearts, kidneys, livers, and other vital organs without consent. Unfortunately, practically all of these procedures resulted in the patient’s death.
Algorithmic and forensic search
After performing an algorithmic and forensic search across 2,838 research papers from 124,770 Chinese-language transplant publications, Robertson and Lavee made the bombshell findings. They also discovered “problematic declarations of brain death during organ procurement.”
“We have documented 71 descriptions of problematic brain death declaration prior to heart and lung procurement … [and,] given that the donors could not have been brain dead before organ procurement, the declaration of brain death could not have been medically sound,” they said in the study published by the American Journal of Transplantation. “In these cases death must have been caused by the surgeons procuring the organ.”
The pair revealed that Taiwan recorded 51 executions by firing squad back in 2011. Death-row prisoners were anesthetized, shot in the head to preserve heart function, and examined within 20 minutes of execution before being pronounced legally dead and rushed to a nearby hospital for organ procurement.
“The problem the authors identify is the unreliable nature of inflicting brain death by firing squad: the bullet penetrating the temporal bone of skull will not reach the brainstem, so a direct brainstem death could not occur,” they said in the document.
“However through causing intracranial hemorrhage, which will lead to increased intracranial pressure, herniation of the big brain [sic] and compression of the brainstem, this could possibly cause brainstem death to occur. However such a means is indirect, imprecise and unreliable,” they added.
Cranial damage can render typical means of establishing brain death almost impossible. This injury can cause a coma, pupil movement, facial and tracheal responses, lack of autonomous breathing, and other brainstem reflex absences.
“As a result, when being transferred from execution chamber to hospital for transplantation, the death-row inmates … execution is continued after the firing squad and finished by transplantation surgeons,” they said.
They are deeply concerned that organ harvesting has effectively become a new form of state execution.
“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,” they said. “Execution is continued after the firing squad and finished by transplantation surgeons.”
They also ruled out the possibility of death-row prisoners being brain dead before surgery. However, braindead patients must be unable to breathe without a ventilator, and physicians failed to account for this essential criterion.
“We identified over two dozen additional papers that described almost identical surgical procedures to the papers we classified as problematic brain death declarations (BDD). In these papers, reference is often made (n = 16) to ‘establishing ventilation’ or ‘maintaining ventilation’ immediately following the declaration of donor brain death and/or just prior to procurement,'” the pair said.
In some cases, health professionals even could have breached organ transplant regulations by using a face mask instead of the usual intubation process.
“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,” they said.
The only circumstances under which the dead donor rule (DDR) would not be violated is where surgeons adhered to rigorous BDD protocols.
“In that case, the phrase ‘establish ventilation’ could have referred to turning on the ventilator, not intubating the patient,” they said.
“This would only have been possible if the donor had already been intubated and the apnea test performed. However, none of this is described in the papers despite the otherwise detailed descriptions of routine surgical procedures,” they added.
The study also found physicians could have unnecessarily risked patients’ lives if they were intubated before the cause of brain death was confirmed.
“Brain death must have been achieved in a controlled manner to prevent cardiac arrest prior to transportation to hospital and procurement—and surgeons must have insisted on risking the donor’s cardiac death and ischemic damage while conducting the apnea test,” the document said.
“Given the number of papers we identified and the clear benefits to transplant success they imply, we think it is most probable that ‘establish ventilation’ simply refers to intubation. It also suggests that problematic BDD, and therefore likely DDR violations, may be more widespread than we can conclusively document,” it added.
‘Intimate’ and ‘active’ executions
Robertson and Lavee believe transplant physicians play an “intimate” and “active” role in carrying out the CCP’s controversial organ harvesting practices.
They cited a 1995 report from the Bellagio Taskforce, which revealed a Taiwanese-born physician sedated, intubated, and inserted an intravenous line before a death row prisoner was executed. Then, immediately after the patient was shot in the head, the health professional stemmed blood flow, put the subject on a respirator, and injected compounds to raise blood pressure and keep organs perfused.
“In this way, the physician became an intimate participant in the execution process, functioning not to preserve life but to manipulate death in the service of transplantation,” they said.
The pair also caught physicians wrongly injecting heparin intramuscularly and establishing venous lines for introducing heparin around intubation time.
“If the donor was a genuine brain-dead patient, venous lines would already have been established before BDD as part of antemortem treatment—they are never established just before organ procurement,” they said.
“The donor had no peripheral venous lines before surgery and may even have been ambulant. This is consistent with [an] eyewitness testimony about organ procurement from prisoners but it is not consistent with standard procurement procedures in brain dead donors,” they added.
Robertson and Lavee found research papers that claim even “voluntary” organ donors were declared brain dead and had intubation. They cited a case where three donors were in a deep coma without breathing spontaneously despite being “normally healthy.”
“Mechanical ventilation was maintained through tracheal intubation; the brainstem reflex had disappeared, electroencephalogram was flat, and the transcranial Doppler ultrasound showed brain death patterns,” they said.
“Such reports, particularly in recent years, are consistent with change of practice in line with official PRC claims of procurement from voluntary donors (they are also consistent with increased reporting of ethical procurement surgery).”
The pair is still trying to determine how so-called organ donors were prepared for organ procurement if multiple DDR breaches were recorded in those papers.
“Textual data in the cases we examine is silent on the matter. However, Taiwan is the only country we know where death penalty prisoners’ vital organs have been used following execution—this reportedly took place during the 1990s and then once more in March 2011,” they said.
Second-largest transplant market
Medical literature ranks mainland China as the world’s second-largest transplant country based on absolute transplant volume and second only to the United States. Human rights researchers estimate the East Asian nation performs more transplants than the United States’s 39,000 total sum for 2020.
However, the CCP has been asked for information about how Chinese hospitals can advertise transplant waiting times of weeks compared to months, and even years, required for a matching organ in North America.
“Hospitals continue to advertise organs to transplant tourists with websites in English, Russian, and Arabic [and] Chinese authorities now say they will be performing 50,000 transplants by 2023–allegedly all from voluntary donors,” the study said.
“If this transpires, China will be operating the most successful and rapidly growing voluntary transplant program in the world but Chinese governmental accounts of its organ transplantation sector are often contradictory, and the state has published confusing and demonstrably manipulated datasets to the international community,” it added.
From the 1980s to the present, the CCP developed one of the globe’s largest transplantation systems based primarily on organs from prisoners, supplied by the state’s security and judicial system. International medical organizations have condemned this controversial practice.
The CCP regards both the number of judicial executions and the true number of transplants as state secrets. Moreover, the identity of all prisoner donors is also unknown, and speculation continues to grow about whether non-condemned prisoners of conscience like Falun Gong practitioners and Uighur Muslims are unethically targeted for their organs.
The United Nations (UN) previously condemned the CCP’s alleged organ harvesting as “extremely” alarming. The intergovernmental organization cited “credible information” that clearly shows that peaceful Falun Gong, Uighur, Tibetan, Muslim and Christian people are forcibly subjected to blood tests, ultrasounds, x-rays, and other forms of medical examination without consent. This is despite the absence of any requirement for prisoners of conscience to undergo such medical tests.
“Forced organ harvesting in China appears to target specific ethnic, linguistic or religious minorities held in detention—often without explaining the reasons for their arrest; or they are given arrest warrants—at different locations,” the UN said. “We are deeply concerned by reports of discriminatory treatment of the prisoners or detainees based on their ethnicity and religion or belief.”
The organization also criticized the CCP for registering test results in a living source database for “organ allocation.” State-run healthcare providers allegedly use the information to find potential buyers who can pay anywhere up to $1 million per organ.
The organization’s human rights experts previously contacted the CCP about these disturbing allegations in 2006 and 2007. However, the CCP failed to provide detailed information on “waiting times for organ allocation, or information on the sources of organs.”
This lack of transparency became a significant obstacle to successfully identifying and protecting “victims of trafficking” and investigating and prosecuting any suspected traffickers.
“Despite the gradual development of a voluntary organ donation system, information continues to emerge regarding serious human rights violations in the procurement of organs for transplants in China,” UN experts said.
The CCP further inflicted suffering on grieving family members by preventing them from collecting the deceased’s body by quickly cremating their remains.
“We believe this is genocide, and it is now the time for UN and the international community to take action and immediately stop the forced organ harvesting in China,” Toronto expatriate and Falun Dafa Association of Australia President Dr. Lucy Zhao previously said.
Macquarie University clinical ethics professor Wendy Rogers added that forced organ harvesting is “continuing, with Uighurs and Falun Gong practitioners [being] the main victims.”
Ethan Gutmann, an Asia expert who grew up in Southern Vermont, previously estimated the CCP’s organ black market could be worth between $8 billion and $9 billion each year, according to the Minghui website.
From 1992 to 1999, Falun Gong enjoyed immense popularity, with an estimated 70 million to 100 million people practicing in mainland China alone. The practice has also spread to the United States and more than 70 countries globally, while Falun Gong’s books have been translated into over 40 different languages.
However, the CCP grew increasingly unsettled by its rapid growth and the high number of influential party members who had joined. Late in 1999, Chinese dictator Jiang Zemin decided to arbitrarily arrest and torture adherents to death, confiscated and destroyed more than 2 million Falun Gong books, and ordered state-run media to publish hundreds of articles that defamed the practice.
The two-decade human rights crisis has caused at least 4,641 known Falun Gong adherents to be persecuted to death, with “tens of thousands more [cases] to be confirmed,” according to the latest data collected by the Minghui website. The CCP’s policy to cremate the dead bodies of victims without asking permission from family members has only added to the difficulty in ascertaining exactly how many Falun Gong adherents have been persecuted to death since 1999.
Actual number questioned
Robertson and Lavee suspect the actual number of patients who died from organ harvesting is much higher than reported.
“Problematic BDD, and therefore likely DDR violations, may be more widespread than we can conclusively document,” they said.
The authors believe these violations conflict with the Hippocratic Oath health professionals take to “do no harm” to their patients. They also challenge an existing injunction against physicians participating in executions and the dead donor rule that forbids procuring vital organs from living donors for transplant.
“These two prohibitions are adhered to throughout most of the world: transplant doctors typically procure organs from free and voluntary donors who have died of natural causes; most countries do not carry out capital punishment,” they said. “Very few countries, even those retaining capital punishment, allow organ donation from condemned individuals.”
Data was gathered between late-2018 and October 2020 using dozens of keyword searches for transplant-related terms in several CCP databases, including one that claims 90% coverage of all academic publications in China.
The study examined transplant surgery data between the years 1980 and 2015. During this period, no voluntary donation system existed, and there were very few voluntary donors.
The number of voluntary, non-prisoner organ donors in China cumulatively as of 2009 was either 120 or 130, representing only about 0.3% of the 120,000 organs officially reported to be transplanted during the same period if each voluntary donor gave three organs.
The leader of China’s transplant sector wrote in 2007 that effectively 95% of all organ transplants were from prisoners. However, according to further official statements, citizens only began using a national organ allocation system in 2014.
“Papers we examine typically do not say anything about the donors’s identity and do not identify the donors as prisoners. However, based on the above official statements, it logically follows that almost all the organ transplants in the papers we consider must have been from prisoners,” the study said.
“Presumably this includes both death row prisoners and prisoners of conscience. The question remains as to how they were executed, and the role of transplant surgeons and other medical workers in that process,” it added.
The full dataset covered publications between July 1951 and October 2020. These were filtered for publications from 1980 onwards involving heart and lung transplants from human subjects, leading to a total of 2,884 papers. This number was reduced to 2,838 after subtracting 46 files for which researchers could not obtain the entire file in portable document format (pdf). These 2,838 pdf files were converted to plain text files using UNIX command-line utilities and optical-character recognition software.
Researchers then developed a “fuzzy string” matching algorithm in R statistical programming language. They used it to search across the corpus for language similar to the text strings identified in the pilot phase.
“To avoid extensive manual review, we used a stringent cut-off for string similarity. This meant that only papers that included strings with a Jaro Winkler distance of less than 0.28—that is, very similar—to the curated target strings were included, and which included the Chinese term ‘donor’ in the surrounding text,” they said. “This reduced the number of papers for clerical review from 2,838 to 310.”
Each of these 310 papers was manually reviewed and qualitatively evaluated against the criteria for problematic BDD and likely DDR violations. Duplicates were removed, and relevant text extracted author names and institutions from the reference metadata excerpted and classified according to institution type and location using geo computation libraries in R.
“Machine translation was initially used for the problematic BDD excerpts found by our fuzzy matching algorithm. Each translated excerpt was then examined and corrected by the lead author (MPR) and reviewed by two native Chinese speakers familiar with clinical procedures,” the study said. “Both authors then examined, discussed, and coded the papers.”
Hearts and lungs were selected for analysis because their procurement typically involves donors whose hearts are still beating. DDR requires patients to be brain dead before ethically procuring vital organs from so-called heart-beating donors.
In countries with hospital-based donation systems, brain death is commonly caused by a stroke or head trauma and is certified before procurement. The CCP does not have a brain death law. Still, Chinese transplant clinicians have published extensively on the topic since the 1980s, translating and discussing definitions and operationalizations of brain death in Japan, England, and the United States.
“It is unclear how the DDR might apply in cases where vital organs are procured from prisoners. China provides no information about whether, or how, the prisoner-cum-donor is rendered brain dead in preparation for procurement,” Robertson and Lavee said.
Procuring vital organs from prisoners requires close cooperation between executioners and transplant teams. The state’s role is to administer death, while the physician’s role is to procure a viable organ.
“If the execution is carried out without heed to the clinical demands of the transplant, the organs may be spoiled. Yet if the transplant team becomes too involved, they risk becoming the executioners,” the authors said.
The researchers also tried to establish whether the transplant surgeons check if prisoners are dead before procuring their hearts and lungs.
“Is the donor intubated only after they are pronounced brain dead, and is the donor intubated by the procurement team as part of the procurement operation? If either were affirmative the declaration of brain death could not have met internationally accepted standards because brain death can only be determined on a fully ventilated patient,” they said. “Rather, the cause of death would have been organ procurement.”