AN UPDATE TO ‘BLOODY HARVEST’ & ‘THE SLAUGHTER’

For Communists, statistics are the pursuit of politics by other means. Statistics in China may be accurate, but only if the Party believes that their accuracy serves some political purpose. Determining the accuracy of Chinese statistics, when the source data on which the statistics are based are not available, requires evaluation.

For organ transplant statistics, the Communist system has had competing political considerations. One has been to show how advanced they were in transplant technology, a consideration which pushed them in the direction of large numbers. The other was not to create undue suspicion about sources, which pushed them in the direction of lower numbers.

The first tendency prevailed initially, leading to generation of inexplicably large number of transplants. The Party then realized that this manner of boasting was causing them a political problem, because it raised the question of the sources of all these organs, when they had no donation system and no national organ distribution system. They were stuck with the numbers they had produced. But, once they realized that those numbers were creating a problem for them, the numbers stopped increasing.

This is a simple enough analysis when we are looking only at national figures. Once we start to look at local figures, the analysis gets more complicated. Individual hospitals are less concerned about accounting for sourcing since, at least to date, there has been no international focus on their numbers. The tendency for individual hospitals to generate large numbers for boasting purposes is accordingly not as constrained as the national Party tendency is.

The numbers we get for transplants from individual hospitals, when added up, far exceed the totals coming from the national system. But, we had to ask ourselves, how much of this is just touting, the fiddling with statistics at a local level, generated by different political considerations than operated nationally?

As the reader can see, we have answered this question by looking, hospital by hospital, at a wide variety of other factors besides what hospitals claim there transplant numbers to be. We looked, for instance, at bed numbers. Bed numbers give us totals for physical entities and are likely to be accurate. Yet, they are not in isolation a perfect indicator of transplant numbers because beds are fungible and can be used for non-transplant purposes. This is less likely in a transplant hospital or a transplant wing of a hospital, but still possible. Even if beds are used only for transplants, we need to make allowances for use of beds for waiting and recovery times, which are not fixed.

We also looked at staff numbers. Again these are numbers of physical entities and themselves likely to be accurate. Presumably transplant staff are hired to work. Yet, numbers of staff do not tell us about the rate of work.

We looked at grants and awards. Grants and awards are indicators of activity. Award citations or acceptances may mention a figure. But is the recipient here too just boasting in order to justify the award? Grants may mention a projected figure. But is the projection realized?

We looked at publications, both newsletters and research studies. Again, we had to evaluate what those newsletters and research studies produced. Chinese organ transplant research is mostly not published in reputable journals, because those journals mostly reject research which relies on organs from sources not demonstrably proper. Chinese organ transplant research is often vanity published by journals attempting to give respectability to those researchers despite their inability to demonstrate proper sourcing of organs.

The result of these considerations means that no one piece of evidence for any hospital can tell us with certainty what its transplant volume is. Rather, as we did for our previous research, we suspended coming to any conclusion until we looked at all the data. What that data tells us consistently, hospital by hospital, looking at all factors in combination, is that transplant volumes in China are far larger than the official national figures.

The inclination of individual hospitals to engage in competitive boasting cannot alone account for the discrepancy between the total of local figures and national figures. The discrepancy is too consistent, over too many variables, for that. There may, on the contrary, be a greater likelihood of accuracy locally than nationally because the temptation to downplay figures in order not to raise questions about sources has been less likely to hold sway locally than nationally.

The claims of local hospitals that they are transplanting huge numbers do not have to be taken at face value. That is one reason why we have not come up with a specific figure about transplant volumes.  But they surely make ever more urgent the need to comply with the duties of transparency, openness to scrutiny and accountability. The large numbers the national system produces already impose the need to comply with those duties. The much larger numbers the totals which individual hospitals, in combination, claim impose this duty of compliance with even more force.

Over time, instead of increasing transparency, China has been going in the opposite direction, increasing opacity. There has been increasing cover up; the Party/State wants to hide something. What it wants to hide we can often see, because the Party/State has been systematically blocking our reports and taking down sources we cite from their websites.   The fact that our reports and their own data sources which we use to substantiate our work systematically disappear once we use them does not indicate that what is blocked and deleted is true. But it does show that what is blocked and deleted does not coincide with the current political stance of the Party.

Cover up tells a story, a story of what the Party does not want us to see. In this chapter we tell that story.

A number of hospital and transplant organization webpages and even websites were deleted after the Kilgour/Matas report was released in 2006. In addition, we observed that some hospitals have merged their dedicated transplant departments and centres back into their parent departments (hepatobiliary surgery, urology, etc.). The more generic departmental structure obfuscates any information remaining regarding transplant capacity and resources.

The Society of Transplantation website (http://www.cstx.org/) under the Chinese Medical Association (http://www.cma.org.cn/) became inaccessible shortly after the harvesting of organs from Falun Gong practitioners was publicized on March 9, 2006. Searching for the Society of Transplantation website stored on www.archive.org shows that the website was taken offline in April 2006.

Besides that, we found a listing of active transplant-related websites published in 2004, all of which are no longer accessible:¹⁵⁸⁹

China Organ Transplant Online (http://www.haoyisheng.com.cn/html/qywz/qgw/default.html) was established primarily by Beijing Chaoyang Hospital’s urology and kidney disease centre.

Transplant Space (http://www.transplantspace.com) was created by the First Hospital of China Medical University’s organ transplant research institute. It included sections on pancreas-kidney, liver, and kidney transplants, as well as a discussion forum.

The Chinese Renal Transplant Collaboration website (http://www.web-kidney.com/zxjj.htm) was operated by Zhengzhou Central Hospital’s kidney transplant department.

The Central China Military Renal Transplant Collaboration website (http://www.china-kidney.com) was operated by the People’s Liberation Army No. 460 Hospital’s urologic surgery department. It included online appointment registration and a transplant Q&A section. The website contained a video of a kidney transplant surgery and offered an organ transplant matching software for download.

The Huazhong University of Science and Technology Organ Transplant Research Institute’s website was http://www.tjtx.org/.

The Kidney Disease Treatment Centre website (http://www.cnur-dc.com) belonged to the Beijing Chaoyang Hospital’s urology department.

The Organ Transplantation website (http://www.gaowei.com/) belonged to Dongguan Humen Taiping People’s Hospital’s Blood Purification and Organ Transplant Centre.

Xiangya Hospital Deletes Report of Record-Breaking 17 Transplant Surgeries in One Day

On May 14, 2006, Xiangya Hospital of Central South University published a report titled “Our Hospital Again Sets a New Record in Organ Transplant Surgeries.”

(http://www.xiangya.com.cn/medpro/xyyx/zhyx/2006-05-14/medpro_20060514165311.html).

The report stated that the hospital set a new record by performing 2 liver, 7 kidney, and 8 corneal transplants in one day.

The report was deleted shortly after it was mentioned on an overseas website. Records on archive.org indicate that the article had been deleted by June 22. However, the title of the report was still listed on the “Comprehensive Medical News” page. (https://web.archive.org/web/20060622184627/http://www.xiangya.com.cn/medpro/xyyx/index.html)

Clicking the link to the report titled “Our Hospital Again Sets a New Record in Organ Transplant Surgeries” results in a message saying “The content you are looking for has been deleted, renamed, or is temporarily unavailable.” Other articles in the same list were still accessible.

Nevertheless, the original article is still available on the news website of Central South University, under the title “Xiangya Hospital Organ Transplantation Sets New Record: 17 Transplant Surgeries Completed in One Day:” http://news.csu.edu.cn/info/1142/97907.htm

The website of the China International Transplantation Network Assistance Centre (CITNAC) was shut down after live organ harvesting was publicized in 2006. The website http://zoukiishoku.com was previously available in Japanese, Russian, English, and Chinese.

The Affiliated Hospital of the Medical College of Chinese People’s Armed Police Forces has deleted almost all relevant information on its website. The hospital also later removed content regarding its kidney transplant and nephrology departments, leaving the columns blank on the official website.¹⁵⁹⁰

The Second People’s Hospital of Shanxi has removed almost all transplant-related information on its website and now claims 100 transplants each year.

The Third People’s Hospital of Datong City deleted almost all information about its transplantation activities online after the publication of the Matas/Kilgour Report in 2006.

The original web pages of the Shanghai Xinhua Hospital Liver Transplant Centre and its experts have been removed. The current pages no longer contain the information regarding its number of beds and personnel.¹⁵⁹¹

At the First People’s Hospital of Changde the profile of expert Zhu Huachen, director of organ transplantation, had all of its content removed, with only a photo remaining. In a national ranking of recommended public hospital doctors (http://m.120bst.com/), Zhu was ranked fourth among kidney transplant surgeons in Hunan Province.¹⁵⁹²

For the book Bloody Harvest, David Kilgour and David Matas were able to garner information about transplant volumes from the China Liver Transplant Registry in Hong Kong.¹⁵⁹³ After publication of the book, The China Liver Transplant Registry shut down public access to statistical aggregate data on its site. Access is available only to those who have a Registry issued login name and password.

For a while after, the names and locations of transplant hospitals reporting to the registry were still public. That listing indicated that military as well as civilian hospitals are reporting. The registry listed 35 national hospitals (including 9 military) and 45 provincial hospitals (including 11 military). After David Matas referred publicly to that data, it too was removed from public view.

At The Transplantation Congress in Vancouver in August 2010, Haibo Wang, assistant director of the China Liver Transplant Registry, presented at the same session as David Matas did. David Matas asked him why public access to the data on the Registry website was shut down and if it could be restored. His answer was that public access was shut down because people were misinterpreting the data. If anyone was to get access from then on, the Registry had to know first the purpose for which the data was to be used and have some confidence that the data would not be misinterpreted.

The Chinese health system runs four transplant registries, one each for liver, kidney, heart and lung. The other three are located in mainland China – kidney¹⁵⁹⁴ and heart¹⁵⁹⁵ in Beijing, and lung¹⁵⁹⁶ in Wuxi. The data on the other three sites are also accessible only to those who have registry-issued login names and passwords.

The Ministry of Health issued two regulations showing widespread, extensive underreporting by transplant centres in mainland China:

The Ministry of Health Medical Regulation Notice (2009) #55 included a zero-tolerance policy of suspending the transplant approval of any hospital found not to be complying with human organ transplant reporting requirements.

The Ministry of Health Medical Regulation Notice (2010) #105 requires reporting within 72 hours after performing a transplant surgery. Hospitals found to be in violation would have their transplant qualifications suspended.

After these notices were issued, has the situation changed?

In April 2011, The Economic Observer’s report titled “Who can solve the difficulties in organ donation in China?” showed wide gaps between the reporting and registration system used by transplant centres and transplant numbers in reality.¹⁵⁹⁷

The article cited an example in which Tianjin First Central Hospital (Oriental Organ Transplant Centre) registered only 7 liver transplants (including from living and cadaveric donors) in 2010, yet its public liver transplant figure was 330. Hospital president Shen Zhongyang and Wang Haibo, who manages the national liver transplant registry at Hong Kong University’s Queen Mary Hospital, both declined to explain this discrepancy.

Per our earlier analysis, this hospital’s transplant volume is at least 6,000 to 8,000 per year and may reach as high as 7,800 to 10,400 per year. Its registered volume is not even a tiny fraction of its actual transplants performed. Yet, its transplant centre claims to have performed the most transplants in the country and ranked first in the registration system consistently for more than a decade. This suggests that other transplant centres might have registered even fewer than 7 transplants per year.

From this example, we can see that underreporting among China’s transplant centres can be described as “severe.” The transplant statistics reported by the authorities are far from reality. One reason for Shen Zhongyang and Wang Haibo’s silence is that these huge volumes of transplants simply cannot be accounted for by organ donations (more details are available in the “Donation after cardiac death” section).

Even so, the liver transplant registry’s situation may not be the worst; the kidney transplant data centre, managed by the People’s Liberation Army No. 309 Hospital (People’s Liberation Army General Staff Department Hospital) does not provide public data at all.¹⁵⁹⁸ Shi Bingyi, director of the hospital’s People’s Liberation Army Organ Transplant Centre, stated that its data systematically covers all hospitals in the country qualified to conduct kidney transplants, including sources of organs. However, it denied an Observer reporter’s data request, stating that “none of the data is public; to see [the data], one must obtain approval from OTC [Ministry of Health Human Organ Transplant Technology Clinical Application Committee].”

Wu Mengchao stated in an interview with iNewsweek.cn on February 23, 2006, “There are problems with the organ sources, so it’s hard to organize cases after performing [transplants], and we can’t publish papers.”¹⁵⁹⁹

Tax evasion has become a common practice for enterprises and institutions in mainland China. In addition to the financial aspect, transplant centres also maintain two sets of books when it comes to transplant volume.

In the industry’s early period of growth after 2000, because transplant volume was limited by technology and price of immunosuppressants, hospitals and doctors engaged in high-profile publicity to attract patients. Along with the quick reduction of such bottlenecks, transplant volume increased. For self-financed hospitals, how to protect this surge in profit from taxes became a practical problem. Underreporting transplant volume became a solution. To what extent was it implemented?

As mentioned earlier, the Oriental Organ Transplant Centre performs thousands of transplants per year but reported only 7 liver transplants to the registry in 2010.

We also examined such a scenario at Peking University People’s Hospital. As of July 16, 2014, its website stated that since 2000, the hospital has carried out 600 liver and 510 kidney transplants in total. Since it became an approved transplant centre in 2007, it has performed “80 to 90 transplants per year.”¹⁶⁰⁰

In other words, as of 2014, Peking University People’s Hospital performed fewer than 1,200 liver and kidney transplants in over a decade. This can be considered its public record.

However, in an interview with China Economic Weekly, Zhu provided an entirely different picture: “Before the 2010 pilot [donation] program started in 2010, all of our organ sources came from executed prisoners. Our hospital once did more than 4,000 liver and kidney transplants in one year. These organs all came from executed prisoners.”¹⁶⁰¹

Zhu was describing events before 2010. The hospital’s transplant centre moved into its new 470-bed surgery building in December 2005; its website now claims 120 to 130 liver and kidney transplants per year,¹⁶⁰² which is only 1/33 the number stated by Zhu Jiye. It is unlikely that a transplant centre with 470 beds would perform only 120 to 130 surgeries per year.

In another example, a senior military doctor who belonged to the General Logistics Department of the Shenyang Military Command wrote to the Epoch Times on March 31, 2006, “The number of underground transplants performed in China exceed the public figures by several times. For example, if the official number is 30,000 cases, then the actual number would be 110,000. This is also the root cause of plummeting prices of organ transplants in China…Because there is a huge source of living organs, many military hospitals report their transplants to their supervising authorities. At the same time, they also carry out organ transplants on a large scale in private. This leads to the fact that the actual numbers are much higher than the official statistics.”¹⁶⁰³

Having analyzed this pattern among the 165 hospitals in Chapters Two to Six, we present a series of representative case studies in the “Falsifying Transplant Data” section.

Many hospitals now list living-donor and donation after cardiac death transplants as their signature services or even main organ sources. However, we found that the actual number of donations is extremely low.

In 2003, Jiangsu Province Hospital designated its liver transplant centre as the “priority of priorities” for development into a nationally known discipline. Within three years, the hospital, the provincial government, and the provincial health department provided tens of millions of RMB in development funds. In the span of three to four years, its Liver Surgery Department grew from nonexistence into one of the five largest liver transplant research centres in the country.¹⁶⁰⁴

In 2005, the centre became the Chinese Living-Donor Liver Transplant Research Institute, with two wards, 100 beds, and a laboratory centre. In the same timeframe, its urologic surgery department had 94 beds, and its cardiothoracic surgery department had 120 beds.¹⁶⁰⁵ With surgery costs of one-eighth to one-tenth that of similar procedures outside of China, it has attracted many patients from overseas.

Its liver transplant centre had 100 beds by 2005, yet claimed that it can perform 80 to 100 liver transplants each year. However, this annual volume would require no more than 8 beds.

The centre has always featured living relative-donor transplants as its signature service. However, in July 2003 it claimed that, among the 100 liver transplants it had completed, 26 involved living donors, that these 26 represented 60% of all living-donor transplants, and that it performed the most living-donor liver transplants in the country.¹⁶⁰⁶ This leaves the sources of the other 74 transplants unaccounted for; it also implies that there had been fewer than 50 living relative-donor transplants in all of China.

According to the Foshan First People’s Hospital, China had more than 200 living-donor kidney transplants in 2001, and the living-donor ratio increased to 4% of 7,000 kidney transplants in 2004. As of 2005, the Wuhan Tongji Hospital Organ Transplantation Research Institute had completed 85 living relative-donor kidney transplants, the most in China. Jiangsu Provincial Hospital had also performed more than 50 such transplants. The ratio of living relative-donor transplants was still far lower than that of Western countries, Japan, Korea (averaging 90%), and Hong Kong and Taiwan (averaging about 20%).¹⁶⁰⁷

According to Zheng Shusen, a member of the Chinese Academy of Engineering, China performed its first living-donor liver transplant in 1995, but the number was far behind that of liver transplants with deceased donors; between 1995 and 2005, there were only 73 living-donor liver transplants in total [note: this number differs from the 2001 figure mentioned earlier].¹⁶⁰⁸

On March 26, 2012, JCRB.com (managed by the Supreme People’s Procuratorate) published a report titled “Defendant of Beijing’s Largest Organ Trade Case: Donors Are Almost All Fake Relatives.” The report covered a case involving an underground kidney broker, Cai Shaohua (defendant), who said that doctors told them that the matching rate between relatives was very low; even if there is a marginal match, it could result in complications after surgery, which would only cause bigger losses for the patient’s finances and health. “Now [among relative-donor] organ transplant surgeries, nine out of ten are fake relatives. Those in the hospitals are well aware of the things that we [brokers] do,” said Cai.¹⁶⁰⁹

Zhongnan Hospital affiliated with Wuhan University became the first unit approved by the Ministry of Health to perform transplants using donations after cardiac death (DCD). Vice President Ye Qifa, the Executive Chairman of the China Organ Transplant Alliance, was one of the most important proponents of Chinese donation after cardiac death operations, of which his team has performed the most. Huang Jiefu called this team the domestic icon of the donation after cardiac death field.¹⁶¹⁰

Ye’s team has successfully launched 23 new technologies and businesses. It has received more than 10 national and provincial science and technology awards and more than 10 million RMB in research funding.¹⁶¹¹

The transplant surgery department performs conventional liver, kidney, pancreas, small intestine, combined kidney and liver, allogeneic liver cell, spleen cell, and islet cell transplants. It claims that its total donation after cardiac death transplant volume ranks sixth in the country. Its clinical department (including liver and gallbladder transplants) has more than 150 specialist beds and 10 ICU beds. ¹⁶¹²

Yet, because tradition requires bodies to be preserved intact after death, China has neither related legislation nor significant voluntary organ donation. According to Chen Zhonghua, the first Executive Chairman of the Organ Donation Management Commission of China,¹⁶¹³ between 2003 and August 2009, only 130 citizens successfully donated their organs after death in mainland China.¹⁶¹⁴

In April 2011, the Ministry of Health began pilot programs for donation after cardiac death at some 3A hospitals.¹⁶¹⁵ In this context, donation after cardiac death refers to organs donated systematically through the Red Cross Society of China (though whether the participating hospitals followed these regulations is another discussion). In 2010, the Ministry of Health asked the Red Cross to establish pilot organ donation programs in 11 provinces and cities, including Shanghai, Zhejiang, Shandong, Guangdong, Nanjing, and Wuhan.¹⁶¹⁶

The Ministry of Health stipulated that hospitals that complete more than 10 such donations and their respective transplant surgeries within the pilot period could report to the Ministry of Health through provincial health administrative departments, to gain Ministry approval for donation after cardiac death transplants.^{1617 1618} Those that already had the provincial level permit for transplant and complete 5 transplants from donations after cardiac death within the same period could report to the Ministry of Health through provincial health administrative departments and obtain approval from OTC [Ministry of Health Human Organ Transplant Technology Clinical Application Committee]. ¹⁶¹⁹

A year after the pilot programs were started, 46 people nationwide successfully donated their organs, far from meeting clinical needs. In 2011, the Ministry of Health expanded pilot programs from 11 provinces and cities to 21.

The one-year pilot period was later extended to at least two years. In 2013, the Ministry of Health claimed that hospitals from 19 provinces and cities were participating, ¹⁶²⁰ but it did not release a list of such hospitals.

On March 22, 2012, the “National Human Organ Donation Pilot Program Wrap-Up Meeting” was held in Hangzhou. The Red Cross announced that, in the two years after the pilot programs began, China completed 207 donations [after cardiac death].¹⁶²¹ Divided among the more than 147 hospitals that did not receive approval in 2007 but had donation after cardiac death pilot programs, this amounts to an average of less than one donation after cardiac death case per year per hospital.

In August 2013, the National Health and Family Planning Commission released the list of 165 hospitals nationwide that had been approved for transplants. Zhongnan Hospital of Wuhan University had been added to the list because it exceeded the requirements for donation after cardiac death transplants.

According to Huang Jiefu, Zhongnan Hospital completed more than 20 donation after cardiac death donations and transplant surgeries during the pilot period (2011 to August 2013) and became the first among donation after cardiac death pilot hospitals to gain Ministry approval. He added that future transplants at this hospital would all come from voluntary and post-death donations.

Later, four more transplant centres received approvals for transplants in 2013 and the original list has been finally expanded to 169 transplant-approved hospitals.

As of February 2016, we searched online and found 75 hospitals that have received permits for donation after cardiac death pilot programs. These hospitals are located in 19 provinces and directly-controlled municipalities. It is apparent that most of these hospitals could not achieve the minimum requirement of 5 or 10 donations after cardiac death to get approved during the pilot period.

If Zhongnan Hospital’s transplants really come from voluntary and post-death donors as Huang Jiefu had claimed, these 20+ transplants would have been accommodated by a single bed. Were almost all of the 150 specialist beds and 10 ICU beds sitting empty these few years?

Ye Qifa reported that 4,626 citizens in China donated their organs after death between 2010 and August 2015. Even if this number is true, it cannot cover the needs of even this one hospital with its transplant bed count.

Government of China Health officials sometimes use the potential to procure multiple organs from the same donor to explain the gap between the number of organ sources (including voluntary donors and executed prisoners) and its official number of transplants. However, this efficiency cannot be applied in most cases. According to a Guangxi News report on December 14, 2012, more than 60 doctors carried out 6 transplant surgeries simultaneously at No. 303 Hospital of Guangzhou Military Command on that day. These included liver, lung, pancreas-kidney, and kidney transplants, as well as two cornea transplants.¹⁶²² Dr. Sun Xuyong, president of the hospital’s Transplantation Research Institute, stated that the six organs were procured from the same donor, but did not explain the source of the donor. Lan Liugen, deputy director of the surgery division, indicated in March 2013 that only two hospitals in China had this capability at that time; the other was the Tongji Organ Transplant Research Institute of the Huazhong University of Science and Technology.

Some large hospitals publish extremely low bed counts in their surgical departments compared to their scale.

Tongji Hospital of Huazhong University of Science and Technology is the nation’s largest and earliest comprehensive medical facility and research institute specializing in clinical application and experimental research of organ transplantation. It is capable of carrying out heart, lung, liver, kidney, spleen, pancreas transplants, combined pancreas-kidney, liver-intestine, and multiple abdominal organ transplants, among other difficult and complicated clinical transplants.¹⁶²³

The current website of its Organ Transplant Institute claims that its transplantation program, total number of cases, and long-term survival rate have continuously led the nation over the past 50 years. It reportedly performed more than 500 liver transplants and nearly 3,000 kidney transplants during these five decades. It lists 65 beds and 65 research personnel under its organ transplant research institute.¹⁶²⁴ Yet another introductory webpage for its key specialty department, The Organ Transplant Basic Research Center, says that the clinical department currently has a 2,400-square-meter dedicated transplant ward designed for 86 beds.¹⁶²⁵

In November 2011, Sina Global News reported that the best-known facility is Tongji Hospital of Huazhong University of Science and Technology carries out thousands of kidney transplant surgeries annually and has the most donor transplant recipients waiting for kidney transplants in the country.¹⁶²⁶

Averaging the 3,500 total transplants over 16 years (conservatively assuming a negligible volume before 1999) would yield just over 200 transplants per year, which would require no more than one-third of its claimed bed count. Furthermore, 65 beds would allow the institute to conduct more than 1,000 kidney transplants per year, assuming a three-week hospitalization period and full utilization. Thus, if the institute carries out “thousands” of kidney transplants per year, its true bed count is likely several times higher.

The General Hospital of Shenyang Military Command stated that it has “one of the best-known transplant centres in the country,” and that “since it successfully carried out the first kidney allograft in August 1978, the hospital has completed more than 1,700 kidney transplants.” The centre claims to have 36 inpatient beds.¹⁶²⁷ This volume of less than 100 per year does not match its high status in the country.

The First Affiliated Hospital of Xi’an Jiaotong University‘s website claims that since 1999, the hospital has witnessed a period of “glorious development” in kidney transplantation. As early as June 2000, it said it had completed over 1,140 kidney transplants.¹⁶²⁸ However, this hospital was tracked by overseas media since the release of the Matas/Kilgour report in 2006. It has since tried to hide the number of transplants performed, and lists on its website only that it has 48 beds. However, when our investigator called the transplant department under the guise of introducing a patient on behalf of another hospital and inquired whether the department had enough beds, its medical personnel indicated that there was no need to worry, and that they could add beds if needed and even appropriate beds from other wards.

The No. 81 Hospital of Nanjing Military Region in a patient counseling article on website published in August 2010, Wang replied to a patient, “To date, our centre has done more than 300 clinical liver transplants of various types, one liver-kidney transplant, 10 emergency liver transplants, and 10 relative-donor liver transplants. ¹⁶²⁹

On May 24, 2014, an introduction on the hospital’s website showed that it was able to perform two liver transplants simultaneously. It became one of the main bases for liver transplantation in eastern China. The hospital has completed more than 300 combined liver-kidney transplants, including 15 emergency liver transplants. ¹⁶³⁰ A June 2014 report by the Nanjing Morning News, Wang said the hospital has performed more than 200 transplants since its first liver transplant in 2003.¹⁶³¹

The cumulative figure on its website for 2014 was the same as for 2010, and the number Wang provided in 2014 was 100 fewer than that in 2010. The figure of 300 total cases is equivalent to fewer than 30 cases each year, in which case only two beds and one surgeon would be needed.

Tianjin First Central Hospital’s Oriental Organ Transplant Centre is the largest in Asia and has ranked first in China in cumulative volume of transplants performed since it was established in 1998.¹⁶³² Liver and kidney transplants became the centre’s routine surgeries in 1999.¹⁶³³

The centre’s archived web pages show that it broke ground on its new building in 2002. The construction was funded by the Tianjin municipal government. The new building had 500 transplant beds, and the Centre aimed for 500 liver transplants and 300 kidney transplants per year.¹⁶³⁴ This implies that each transplant bed would accommodate fewer than two patients per year. We can thus see that the centre began to deflate its transplant volume from an early stage.

According to a special interview with Shen Zhongyang in February 2006 by the Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care, the newly completed Oriental Transplant Centre building had actually opened with 700 beds.¹⁶³⁵ This was 200 more than the announced bed count in the report in September, 2006. ¹⁶³⁶ And the centre could simultaneously carry out nine liver transplants and eight kidney transplants.¹⁶³⁷ By October 2009, its bed utilization rate reached 90% ¹⁶³⁸ and 131% in 2013 before it added more beds. ¹⁶³⁹

Even if we count it as 500 beds, when it achieved a 100% bed utilization rate (around 2010 by its growth trend), with an average liver transplant hospitalization time of 3 to 4 weeks,¹⁶⁴⁰ the transplant volume may have reached 6,000 to 8,000 per year. With its 131% bed utilization rate in 2013, the corresponding annual volume may have been as high as 7,800 to 10,400.

Yet the current official website shows only 120 transplant surgery beds and seven liver and kidney transplant teams. This bed count is even fewer than that before the new building was put into use in 2006.¹⁶⁴¹ In 2010, the hospital publicly claimed 330 liver transplants but reported only 7 to the official liver transplant registry.¹⁶⁴²

The centre claims that it has completed 10,000 organ transplants in total.¹⁶⁴³ However, this number would have been easily surpassed by just a few of its doctors:

• The centre’s director Shen Zhongyang had reportedly completed close to 10,000 liver transplants himself by 2014.¹⁶⁴⁴ His colleagues and the majority of the doctors he had trained had each independently completed over 1,000 transplants.¹⁶⁴⁵
• By 2011, Vice President Zhu Zhijun had completed 1,400 liver transplants and 100 liver transplants from relative donors.¹⁶⁴⁶
• Deputy director Cai Jinzhen has completed 1,500 liver transplants.¹⁶⁴⁷
• By July 2006, associate chief surgeon Pan Cheng had independently completed over 1,000 liver transplants and participated in over 1,600 liver graft procurements.¹⁶⁴⁸
• Chief surgeon Song Wenli from the renal transplant department had completed over 2,000 kidney transplants and over 100 combined transplants.¹⁶⁴⁹
• Associate chief surgeon Mo Chunbo has completed over 1,500 kidney transplants.¹⁶⁵⁰
• Chief surgeon Gao Wei had completed over 800 liver transplants and 100 from relative donors after he graduated from the university. He joined the Oriental Organ Transplant Centre in 1999.¹⁶⁵¹

In 2006, the centre had 310 medical professionals.¹⁶⁵² The total number of transplants performed by this centre is huge.

The First People’s Hospital of Yunnan Province hospital successfully completed the world’s first pediatric heterotopic liver transplant (the donor liver was partially cut to reduBce the liver volume and was implanted in the spleen nest). It boasts to have reached an advanced level both nationwide and in Yunnan Province in the field of organ transplantation.¹⁶⁵³

It website has deleted the introduction to its organ transplantation department. Based on a version saved on transplantation.org.cn on January 9, 2014, the hospital claimed to have conducted 18 liver transplants between April 2005 and February 2014, and 21 liver transplants to date.¹⁶⁵⁴

However, we found a liver transplant study published by one of its doctors, for which the patient sample size was six times the number of transplants that the hospital had claimed. These samples were only a small portion of a large number of transplants that met the study criteria. Therefore, the hospital’s actual number of liver transplants is most likely well above six times the official number.

For example, Mo Yiwo, current director of hepatobiliary surgery, published a study that he conducted on eight piggyback orthotopic liver transplants between August 2000 and July 2002 (23 months).¹⁶⁵⁵ Another doctor from the hospital published a paper about lung infections in 55 orthotopic liver transplant patients between April 2005 and May 2007.¹⁶⁵⁶ Zeng Zhong, deputy director of the transplantation centre, published a paper about biliary reconstruction of ⁵⁵ orthotopic liver transplant patients between April 2005 and March 2007.¹⁶⁵⁷ Another paper randomly selected 12 orthotopic liver transplant patients who underwent the surgery at the hospital between 2007 and 2009.¹⁶⁵⁸

The online profile of the hospital’s transplantation department states that it has conducted 41 kidney transplants since 1983, including 17 with living relative donors.¹⁶⁵⁹

However, doctors at the hospital published a study in 2008 based on 50 “living relative-donor kidney transplants” between February 2002 and May 2008.¹⁶⁶⁰ Based on this number, in the six-year period between 2002 and 2008, the number of “living relative-donor kidney transplants” is three times the hospital’s total claim for the 33-year period. Another study was based on a sample of 18 out of 84 kidney transplants.¹⁶⁶¹ From these fragments, one can see that the public transplant volume has been severely deflated.

The kidney transplant department of Zhengzhou No. 7 People’s Hospital was established in 1987 and performed kidney allografts relatively early in China. It claims that its quantity and quality of kidney transplants in the past 20 years ranks first in Henan Province.¹⁶⁶²

According to the kidney transplant department’s website, “Since the establishment of our specialist department, we have conducted more than 2,000 kidney transplants. We have conducted 130 kidney transplants from living relatives.”¹⁶⁶³

According to an update published by the kidney transplant department on March 31, 2015:¹⁶⁶⁴

“In 2014, our department completed over 50 kidney transplants, leading the entire province. Size of the department: there are 46 approved beds, but the number of patients is now usually maintained at 70 or more. The bed utilization rate exceeds 130%.”

The claimed transplant volume in this update does not make sense for the department’s bed count: with such a high bed utilization rate, 50 kidney transplants per year would require only 3 beds; with 46 beds with occupancy as high as 130%, a conservative estimate using a 20-day hospitalization period would show that 46 beds can accommodate over 1,000 cases. (annual capacity of beds = 46 * 1.3 * 365/20 = 1091)

The website of General Hospital of Jinan Military Command states that its urologic surgery department has completed 1,500 kidney transplants since 1978 and ranks among the top ten in China and the top five in the military.¹⁶⁶⁵ These two figures imply that the hospital has performed fewer than 200 kidney transplants per year since 2003.

However, according to the Qilu Evening News in 2008, the department once performed 16 kidney transplants in 24 hours. In addition, transplantation.org.cn reported in 2012 that the department’s director, Zhang Aimin, claimed that the hospital had performed more than 2,500 kidney transplants between 1978 and 2012.¹⁶⁶⁶ The total on the hospital’s website in 2016 is 1,000 fewer than Zhang Aimin’s figure from 2012.

The News Centre of the website of the transplant centre at Third Affiliated Hospital of Sun Yat-sen University stated in 2006 that “Director Chen Guihua has served as lead surgeon for more than 1,000 liver transplants in recent years.” ¹⁶⁶⁷After the release of the Matas/Kilgour report in 2006, Chen’s personal webpage showed that he undertook only over 100 liver transplants. ¹⁶⁶⁸

On the night of February 10, 2004, Chen oversaw 4 liver transplant operations simultaneously. He conducted 246 liver transplants in 2005, according to the hospital’s News Centre. ¹⁶⁶⁹

Photo: It’s Again the Dead of Night – A scene of the People’s Liberation Army 458 Hospital’s first liver transplant, Author: Dr. Sun Ningdong

In 2006, a Lifeweek report titled “Medical Stories behind the Lens” featured a segment regarding liver transplants at the People’s Liberation Army No. 458 Hospital: ¹⁶⁷⁰On September 28, 2006, Dr. Sun Ningdong of the People’s Liberation Army 458 Hospital’s hepatobiliary surgery department hosted his first photography exhibition. Sun was most proud of one photo that had won many photography awards, “It’s Again the Dead of Night.” That was a scene of the hospital’s first liver transplant: “At that time, this surgery had already lasted 6 hours at night. Some people were dozing off, and some were moving. If you magnify it, you can see the eyes of the lead surgeon–they are really bright.” The 458 Hospital has now performed over 140 liver transplants…

This report shows that in the two years after its first liver transplant in 2004, this hospital carried out more than 140 liver transplants. Twelve years later, however, its total number of liver transplants has not grown on paper.

If this were really the case, the hospital could not have maintained its certification by the Ministry of Health. The hospital also self-reported doing 20 liver transplants each year (the minimum requirement to maintain its Ministry approval). Based on this number, by 2016 it should have performed nearly 400 liver transplants. Using a conservative figure of 70 cases per year from the media report, it would have accumulated nearly 1,000 liver transplants to date.

Its liver disease centre has 108 beds and can simultaneously carry out two liver transplants and one regular surgery. Patient rooms are well-equipped with amenities, including five “presidential suites” with high-speed internet access.¹⁶⁷¹ If we assume that each operating room is used only once per day (otherwise, only one operating room for liver transplants would suffice), it would have performed 800 per year, or 10,000 to date. We estimate that the hospital’s public numbers represent about 1/70 of its actual liver transplant volume.

The website of the First Affiliated Hospital of Anhui Medical University indicates that its liver transplant centre has 28 formal beds and features highly mature surgical skill and perioperative treatment. Let alone, it’s suspicious that such a large scale transplant centre has only 28 beds, it states that the centre had performed 23 total liver transplants of various types, as of May 2010.¹⁶⁷²

According to the hospital’s website, to manage the follow-up work of the centre’s large volume of liver transplant patients, the centre’s director Geng Xiaoping instructed associate chief physician Zhao Yijun to design and work with Hefei Hengtong Software Development Company to develop the “Kangheng Medical Follow-Up Management System,” which entered clinical use in April 2012 and was granted a national patent that November.¹⁶⁷³

Rendering: The Organ Transplant Centre

The official transplant figure implies that, in the 13 years after 1998, the centre performed an average of fewer than two liver transplants a year, a figure that far from justifies its bed count and custom-developed follow-up management software.

Furthermore, a liver transplant conference the centre hosted in September 2011 was attended by more than 30 patients who had received liver transplants at this hospital.¹⁶⁷⁴

The introduction to the liver transplant centre of the West China Hospital of Sichuan University published on September 2, 2004 mentioned that its five full sets of imported liver transplant equipment allowed five liver transplant operations to be performed simultaneously, and that the centre had 72 beds.¹⁶⁷⁵ CCTV’s People column broadcast a special interview with Yan Lvnan, whose team set a record of performing seven liver transplants on the same day.

The webpage claimed that the centre had conducted nearly 800 liver transplants, including more than 260 from relative donors. Based on its bed count and a 30-day average hospitalization duration, the centre would be able to perform more than 800 transplants in a single year.

The liver transplant centre no longer appears on the hospital’s website. The most recent search result states that the centre “now routinely performs donation after cardiac death (liver donation after cardiac death) liver transplantation, adult and pediatric living donor liver transplantation, split form liver transplantation, approximately 100 cases per year”.

The hospital has Asia’s largest ultra-clean surgery department. According to a purification engineering plan for the department, the hospital has 67 operating rooms, including at least 9 for the urologic surgery department (3 originals and 6 newly constructed), at least 8 for the general surgery department, and 6 for the cardiothoracic surgery department.¹⁶⁷⁶

The hospital’s web page with a posting date of February 22, 2005 shows, “Since its first kidney transplant carried out in September 1978, the centre has performed more than 4,000 kidney transplants.” ¹⁶⁷⁷

By September 2014, the listed number of transplants had shrunk: “the centre has performed more than 2,500 kidney transplants. ¹⁶⁷⁸ From 2011 onwards, more than 200 kidney transplants have been completed annually.” ¹⁶⁷⁹ This volume would require no more than one operating room.

Xinqiao Hospital of the Third Military Medical University claims to be the largest organ transplant centre in southwestern China. It was one of the first hospitals to carry out kidney, cornea, pancreas-kidney, and other types of transplants. Its qualification documents, “Urology Surgery History of People’s Liberation Army Nephrology Centre,” states, “As of 2002, 2,590 renal transplants [have been] performed…The centre once performed 24 kidney transplants in one day.”¹⁶⁸⁰

However, its current webpage states, “Since our first kidney transplant performed in January 1978, our department has performed more than 2,100 surgeries to date, becoming the third site to exceed 2,000 surgeries in the country.”¹⁶⁸¹ Compared to its number from 2002 (2590 cases), the current figure after 13 years is 490 cases short, which suggests that the current figure has been deflated.

A few years ago, the official web page of the Navy General Hospital titled “Introduction to hepatobiliary surgery” claimed that “Several thousand patients with end-stage liver cancer have gained a second life through liver transplantation at the hepatobiliary surgery department of Navy General Hospital.” ¹⁶⁸²

Yet, the same webpage in 2015 stated, “Since 1999, 300 liver transplants have been successfully carried out.”

The Peking Union Medical College Hospital’s website has removed all its liver transplant quantity figures and claims that it has only 28 beds. However, when interviewed by a Guangzhou Daily reporter in 2013, Huang Jiefu stated that he performed more than 500 liver transplants in 2012, one of which was “the first voluntary citizen donation meeting Chinese standards.” ¹⁶⁸³

It is unclear whether all of Huang’s 500 transplants took place at PUMC, but it is highly likely that some of them would have. This hospital has a strong team of liver transplant doctors trained overseas, with 2 doctoral advisors, 3 Master’s advisors, 5 professors, and 5 attending surgeons and physicians, all of whom hold doctoral degrees. They include Mao Yilei, Sang Xinting, Zhong Shouxian, and other high-profile transplant experts. Due to Huang’s administrative and political duties, his own transplant volume would not be the most prominent.

Its urologic surgery department currently has 67 personnel and 80 beds. Its website shows that since the first kidney transplants were carried out in the 1970s, it has completed nearly 1,000 kidney transplants. However, this number has not been updated since 2004.¹⁶⁸⁴

Fuzhou General Hospital of Nanjing Military Command claims to perform the greatest variety of transplants, including kidney, liver, pancreas, and 8 other major organ transplants, as well as islet cell, stem cell, and cornea transplants. The hospital also claimed to have performed the most kidney transplants in the country.¹⁶⁸⁵ Tan Jianming, director of urology, had performed more than 4,200 kidney transplants as of 2014.¹⁶⁸⁶ The hospital’s hepatology centre had 150 beds in 2011.¹⁶⁸⁷ On February 18, 2014, 16 doctors completed 5 liver transplants within 17 hours.¹⁶⁸⁸

In April 2012, the website of the People’s Liberation Army Organ Transplantation Centre showed that the hospital’s cumulative number of kidney transplants ranked first in the country; its annual transplantation volume ranked among the top three for six consecutive years. Since its first kidney transplant in 1977, the hospital has performed a total of 3,358 renal transplants.¹⁶⁸⁹ Since starting liver transplantation in 1982, it has conducted a total of 558 liver transplants.¹⁶⁹⁰

These numbers were subsequently removed from the website for a few years but have now reappeared. Its current webpage for the hepatobiliary surgery department shows that it has 115 beds and has conducted 400 liver transplants.¹⁶⁹¹ Meanwhile, its Research Institute of the Hepatobiliary Division shows that it has 150 beds and has performed over 150 liver transplants.¹⁶⁹² (The time of update is unknown.)

Traces can be found on its page on technical expertise:¹⁶⁹³ “This centre is among the earliest institutes that conducted kidney transplant. We perform over 100 kidney transplants annually, giving a total of 1,600 to date. Our centre has guided surgeries in more than 20 hospitals around Guangdong, Shanghai, Zhejiang, and other areas.” The page also says, “Our centre is one of the earliest hospitals in the military and in the country and volume is relatively high, with a total of 13 clinical liver transplants [to date].”

The website of the Third Hospital of Hebei Medical University stated that it has performed “nearly 200 liver transplants to date, entering an advanced level in the country.”¹⁶⁹⁴ The hepatobiliary surgery department web page does not list the number of beds or personnel, and states it has only “conducted more than 60 transplants to date.”¹⁶⁹⁵

This figure would be insufficient to maintain its Ministry of Health approval. Furthermore, a study published by doctors at the hospital in 2013 involved a sample of 291 liver transplant patients.¹⁶⁹⁶ Finally, director Dou Jian stated to a reporter in 2013 that he had individually completed more than 160 liver transplants.¹⁶⁹⁷

The liver transplant centre at People’s Liberation Army No. 302 Hospital has 100 registered beds. However, its official introduction states that it has carried out only 400 liver transplants. ¹⁶⁹⁸ This figure is most likely falsified, as its official figure of 30 transplants per year would require no more than 3 beds. Furthermore, Liu Zhenwen at the centre individually has performed over 1,000 liver transplants.¹⁶⁹⁹

Shanxi Provincial People’s Hospital performed the first heart, liver, and combined pancreas-kidney transplants in the province.¹⁷⁰⁰ It claims to lead the province in liver transplant capabilities. The hospital’s website shows that it has completed 23 liver transplants to date¹⁷⁰¹–a number equivalent to fewer than two cases per year, fewer than the minimum requirement of twenty to qualify as a transplant centre approved by the Ministry of Health.

Fu Yaowen, the founder of the kidney transplantation and blood purification centre at the First Hospital of Jilin University, had completed 3,000 kidney transplants as of April 2009. With 22 other surgeons, this centre carries out a huge number of kidney transplants. However, its website currently shows that the centre has conducted only 3,000 kidney transplants to date.

The First Affiliated Hospital of Henan University of Traditional Chinese Medicine’s website states that the urologic surgery department has completed more than 700 kidney transplants to date. However, Wang Guangce’s expert profile on the website indicates that he has experience in leading more than 1,000 kidney transplants, and he has been working at this hospital for most of his transplant career. In a conference notice for December 2014, the website stated that Wang has experience in managing more than 1,400 kidney transplants–400 more than his 2016 total.

The website for the First Affiliated Hospital of Chongqing Medical University’s Department of General Surgery claims that it has performed 132 liver transplants since 2001. However, Du Chengyou wrote in his thesis that the research was targeting 10 patients who suffered biliary complications among the 140 liver transplant patients at the organ transplant centre between January and March of 2005. This means that from January to March of 2005, this centre performed 140 liver transplants in two months, greater than the 15-year total on official website.

The First People’s Hospital of Yunnan Province has deleted the introduction of its organ transplantation department. Based on an archived version saved on January 9, 2014, it conducted 18 liver transplants between April 2005 and February 2014, and 21 liver transplants so far. However, one of its doctors published a paper about a liver transplant study, for which the patient sample size was six times of the number of transplants the hospital claimed to have performed.

The People’s Liberation Army No. 181 Hospital hepatobiliary surgery department’s archived website shows that it has had 50 beds since 2011 and performed over 30 liver transplants in total. However, these numbers were deleted in 2013.¹⁷⁰² The equivalent annual volume of transplants would not meet even the Ministry of Health’s minimum requirement for transplant certification.

A People’s Liberation Army Kidney Transplant and Dialysis Centre was established in its nephrology department. It has 100 medical professionals. It has 150 beds in total and claimed 100 kidney transplants annually.¹⁷⁰³ (This webpage is no longer accessible. However, we have on record its archive page.)

The Hepatobiliary Surgery Department at Beijing Chaoyang Hospital claims that its liver transplantation is leading in the country. It can carry out almost all types of liver transplant procedures. However, its website states, “To date, this department has completed more than 500 liver transplants.” This volume, less than 30 cases per year on average, amounts to less than a fraction of that of Tianjin Orient Transplant Centre. The hospital’s website states that it has performed more than 3,000 kidney transplants in total, purportedly one of the highest among transplant institutions in China. ¹⁷⁰⁴ This figure translates to less than 200 per year and does not at all match the claim that it is among the highest in the country.

President Li Ning of Beijing YouAn Hospital is a leader of the liver transplant discipline in the Beijing area. China News reported in 2010 that he has led over 500 liver transplants over the past 10 years. ^{1705 1706} However, at the time this report was written, the hospital’s website claimed that he has led 200 liver transplants, 300 fewer than the 2010 figure.¹⁷⁰⁷

According to an introduction published by sohu.com on Aug 3, 2005, Guan Delin at Hua Xin Hospital (the First Hospital of Tsinghua University), had experience in “over 2,700 kidney transplants, over 40 kidney transplants from relative donors, and close to 20 combined kidney-pancreas transplants.”¹⁷⁰⁸ Yet, in May 2006, an introduction was posted on Chaoyang Hospital’s website stating that Guan joined this hospital after having personally completed over 1,000 kidney transplants.¹⁷⁰⁹ The 2006 figure was 1,700 lower than the figure published in the previous year.

Zhejiang Provincial People’s Hospital‘s cardiothoracic surgery department pioneered heart transplantation in Zhejiang Province. Its kidney and combined heart-kidney transplantation performance is in a leading position in China.¹⁷¹⁰

It has deleted almost all information about its transplant-related activities online. Its website states that it has carried out a total of 19 heart transplants.¹⁷¹¹ In the 14 years in which its heart transplant laboratory has continuously expanded, it is unlikely that the hospital has performed less than 2 transplants per year.

The hospital’s website states that the organ transplant department has 25 beds and performs nearly 100 surgeries per year. Based on a conservative hospitalization duration of 30 days, 25 beds would enable at least 300 operations per year. Furthermore, if the department performs only 100 transplants per year, one transplant surgeon and 8 beds would be more than enough.