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

One can tell that an elephant is huge not just by looking at its body parts. There are many other indicators – from the size of its footprints, to the amount of food it eats, to the amount of underbrush it crushes.

Similarly with the Chinese transplant industry, its mammoth size, far larger than the official figure of 10,000 a year, can be detected not just by looking cumulatively at the many individual hospitals engaged in transplants, but also by looking at a wide variety of other indicators of volume. This chapter does that.

He Xiaoshun, a member of the Expert Committee of the Human Organ Donation Commission and vice president of the First Affiliated Hospital of Sun Yat-sen University, stated to the Southern Weekly in March 2010, “The year 2000 was a watershed for the organ transplant industry in China…the number of liver transplants in 2000 reached 10 times that of 1999; in 2005, the number tripled further [since 2000].”¹³⁸¹

China officially acknowledged 118 liver transplants in 1999. According to He Xiaoshun, the number in 2000 was 10 times higher; by 2005, the annual number had tripled to 5,192. However, this was just the beginning of the rapid growth, when liver and kidney transplants became a routine operation throughout the country.

On May 11, 2011, Wu Mengchao, president of the Affiliated Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University and “father of hepatobiliary surgery in China,”¹³⁸² claimed in an interview with Sina that, “in terms of liver transplants, our quantity has been the largest in the world. The quality and result are also good. We have caught up with international standards.” ¹³⁸³ About 6,000 liver transplants are performed in the U.S. each year.¹³⁸⁴ As set out elsewhere in this report, Tianjin’s Oriental Organ Transplant Center’s annual volume alone surpassed the annual number of liver transplants in the U.S.

In January 2015, Huang Jiefu told CCTV, “I would like to quote the words of the World Health Organization that China has undertaken such a path in six to seven years whereas other developed countries building up their organ donation and transplant framework took dozens of years.”¹³⁸⁵

In the previous chapters we cited a number of Chinese media reports as sources of evidence about transplant volumes in individual hospitals. These media reports are significant beyond the information contained in them.

Outside China, in countries with a free media, information in the media is not much different from information found elsewhere.  What is relevant is the information which is contained in the media.

In China, it is not like that, because everything in the media escapes either censorship or self censorship.  A media story in China is not just the information contained in it.  It is also a statement that the Party wants this published, or has allowed it to be published or that the author and medium both think that the Party would not mind its being published.

What is true of the media is also, in one sense, true of hospital websites and research publications.  Nothing gets posted or published without the approval or implied consent of the Party.  Nonetheless, the media are subject to especial Party scrutiny.

The Government of China General Administration of Press and Publication (GAPP) focusses specifically on the print news media and books. The State Administration of Radio, Film and Television (SARFT) focuses on radio, TV, film and internet broadcasts.  When something comes out in the media, the fact that it has survived this scrutiny means something.

The media stories about organ transplant volumes are a bit like the phone call admissions.  The medium which reports the story, like the person being called, is oblivious to what in fact is being admitted.

The media stories are snippets of information about high transplant volumes.  They are, in effect, mindless admissions or concessions by the Party/State that the volume of transplants is a lot higher than the official Party line of 10,000 a year.  We reproduce below some of these media stories.

In November 2011, Sina Global News reported that Wuhan, a major city in central China, is said to be China’s largest organ transplant centre. Among its hospitals, Tongji Hospital of Huazhong University of Science & Technology is the most well-known; it’s also one of China’s first and most authoritative hospitals for living kidney transplants. It conducts thousands of kidney transplants each year and has China’s largest pool of kidney recipients. ¹³⁸⁶

On April 4, 2006, Asia Times published a report entitled “Japanese flock to China for organ transplants.” The report states that Mr. Suzuki, chairman of the Japan Transplant Recipients Organization, discovered that a hospital in a major city in China conducted 2,000 organ transplants last year [2005] alone. Among the recipients, 30 to 40 were Japanese, and 200 were Korean. ¹³⁸⁷

In September 2013, Zhu Jiye, director of the Organ Transplant Institute of Peking University and the Department of Hepatobiliary Surgery of Peking University People’s Hospital told China Economic Weekly that “most of our nation’s organ transplants come from executed prisoners. Our hospital conducted 4,000 liver and kidney transplant operations within a particular year, and all of the organs are from prisoners sentenced to death.”¹³⁸⁸

On August 18, 2014, Radio Free Asia quoted Ms. Lin, a vice president of a large company who attended the 2014 World Transplant Congress, said, “I talked to a liver transplant expert from mainland China and was told that his hospital had conducted 100 liver transplants within 3 months. This hospital wasn’t even in a big city. Assuming there’re 50 such transplant centres, there’d be 18,000 liver transplants in a year.” ¹³⁸⁹

According to a report by China Times on May 1, 2006, two large Taiwan companies invested in the construction of Xiamen Changgeng Hospital, which was scheduled to become operational by the end of that year (2006). This hospital would focus on organ transplants. A Taiwanese businessman told the media that a Class 3 hospital in Zhangzhou, a city neighboring Xiamen, in Fujian Province, conducted at least 3,000 kidney transplants annually. ¹³⁹⁰ At least a quarter of the kidney recipients were from Taiwan. Calculating by the market price of $1 to 2 million NTD (New Taiwan Dollar) per kidney transplant, Changgeng Hospital would have a promising future by focusing on organ transplants.

On celebrating the 100 Anniversaries of the First Affiliated Hospital of Sun Yat-Sen University, a report was posted on the news website of Xinkuai Paper . ¹³⁹¹ It revealed that tens of thousands of patients had accepted liver or kidney transplants at its organ transplant center.

Over the past decade, the Chinese authorities have not released the annual volume of each hospital and only claimed that 10,000 to 20,000 organ transplants are performed each year. In addition, it has actively removed data previously published on individual hospital websites. However, even from the data scattered on the websites, it is obvious that this number would be easily surpassed by just a few hospitals and individuals.

One should keep in mind that many of these published figures are likely deflated, as hospitals attempt to cover up the true volume of transplants being performed (see section IV: Cover-Up).

Nanjing General Hospital of Nanjing Military Command has the earliest Military Nephrology Research Institute that is often seen as the “Mayo Clinic of China”. It was prioritized by the Central Military Commission¹³⁹² and was the first transplant center in China.¹³⁹³

Li Leishi, a member of the Chinese Academy of Engineering and an internist by training, became the director of the hospital’s transplant center. In 2008, when he was 82 years old and had cancer surgery, he said, “In the past, I myself used to do 120 kidney transplants per year. Now I only do 70 cases.”¹³⁹⁴

Li also said, “Because we are a research institute, we don’t do too many surgeries.”¹³⁹⁵ This statement appears to be accurate, at least in comparison to the other 40+ military transplant centers that concentrate more on operations. Yet, during an “Interview with Academician Li Leishi” on China Military Online,¹³⁹⁶ Li told a story of disciplining three doctors after a medical accident in 2001. One of them was a chief surgeon, and they had been performing “hundreds of kidney transplants a year.”¹³⁹⁷

The institution had close to 30 specialists before 2001. Eleven chief surgeons and six associate chief surgeons carried out kidney transplants.¹³⁹⁸ If the three doctors Li mentioned had been performing hundreds of kidney transplants a year, then the seventeen chief and associate chief surgeons would collectively have conducted well over thousands each year. In that case, how many transplants has the hospital performed in the past 15+ years?

Li Leishi was not the oldest of China’s active transplant doctors. Academician Wu Mengchao, China’s Father of Hepatobiliary Surgery and president of the Eastern Hepatobiliary Hospital affiliated with the Second Military Medical University, averaged 200 surgeries per year even at age 89. As of 2010, Wu had presided over 14,000 liver surgeries, including 9,300 hepatectomies,¹³⁹⁹ the remaining 4,000+ surgeries remain unidentified and are likely to be liver transplants.

The People’s Liberation Army Organ Transplant Center at No. 309 Hospital once completed 12 kidney transplants overnight.¹⁴⁰⁰ We list several well-known transplant doctors:

• Shi Bingyi had completed at least 2,130 kidney transplants, 380 liver transplants, and many heart, lung, pancreas, small intestine, and multi-organ transplants by 2011.¹⁴⁰¹
• Director Qian Yeyong of the transplant surgery department had also performed over 2,000 kidney transplants and many multi-organ transplants by 2013.¹⁴⁰²
• Cai Ming has completed about 1,000 kidney transplants, 100 liver transplants, and several hundred organ procurement surgeries.¹⁴⁰³

This transplant center has 231 medical and research personnel. It had 316 beds in 2010 and 393 beds in 2012, ¹⁴⁰⁴ though its website now says 330 beds. Its bed utilization reportedly leads that of similar military organizations. Even without taking into account deflation of published transplant volumes, its total number of transplants performed is staggering.

Tan Jianming, vice president of Fuzhou General Hospital of Nanjing Military Command, has led more than 4,200 kidney transplants as of 2014. Tan was previously also part-time director of the Urology and Transplantation Department at Shanghai Jiaotong University’s First People’s Hospital and its Shanghai Organ Transplant Center.¹⁴⁰⁵

Shanghai Changzheng Hospital, affiliated with the Second Military Medical University, hosts two prolific doctors: Zhu Youhua, who is considered a leader in the People’s Liberation Army on kidney transplantation, had completed 3,680 kidney transplants by 2010.¹⁴⁰⁶

Fu Yaowen, the founder of the First Hospital of Jilin University’s kidney transplantation program and blood purification center, had completed 3,000 kidney transplants as of April 2009. ¹⁴⁰⁷

The First Affiliated Hospital of Sun Yat-sen University has 8 chief and associate chief transplant surgeons (including two focusing on liver transplants), including Professor Zheng Keli, who has led more than 3,000 kidney transplants.¹⁴⁰⁸

In a paper published in 2004, Yu Lixin, the director of the transplant department at Nanfang Hospital of Southern Medical University, stated that the hospital had conducted 2,123 kidney transplants as of November 2001. The hospital consistently ranks second in the nation for the volume of kidney transplants performed.¹⁴⁰⁹

One particularly prolific institution is Xinqiao Hospital, affiliated with the Third Military Medical University. Its Renal Diseases Research Center claimed that it had “conducted 2,590 kidney transplants by 2002 … and once performed 24 kidney transplants in one day.”¹⁴¹⁰

According to an introduction published by sohu.com on Aug 3, 2005, Guan Delin at Beijing Huaxin Hospital (First Affiliated 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.”¹⁴¹¹

The Guangdong No.2 Provincial People’s Hospital’s organ transplant department was established in 1999. Its director Liu Dong had personally participated in more than 2,000 kidney and liver transplant surgeries as of 2015.¹⁴¹²

Deputy director Wu Jiaqing stated that, prior to August 3, 2006, the department had “more than 10 organ transplant surgeries every day,” and that “around August 2006, patients from 8-9 countries came to the hospital for organ transplants, including from Singapore, Cambodia, and France.”¹⁴¹³

The Navy General Hospital in Beijing “has helped thousands of end-stage liver cancer patients gain a second life through liver transplantation.”¹⁴¹⁴

Professor Wang Hongwei, director of the kidney transplant department at the Second Hospital of Shandong University, has participated in nearly 2,000 kidney transplants over the course of 20 years. He led his team once completed 10 kidney transplants in one day.¹⁴¹⁵ Deputy director Tian Chuan participated in nearly 1,000 kidney transplants.

At Ruikang Hospital in Guangxi, Gu Xinwei, director of the transplant department, participated in 2,000 kidney transplants, over 200 liver transplants, and over 20 liver-kidney and multi-visceral transplants. ¹⁴¹⁶ Lin Minzhuan, chief surgeon and guest professor at the hospital, has personally participated in close to 2,000 kidney transplants in 19 years. ¹⁴¹⁷

The web page of He Xiaozhou, the president of the First People’s Hospital of Changzhou, claims that he had personally led the department in conducting more than 1,700 kidney transplants.¹⁴¹⁸

Some hospitals evidently had access to abundant organ sources. For example, the People’s Liberation Army No. 458 Hospital (The Air Force Hospital of Guangzhou Military Command) had abundant cornea supplies that could not only provide for itself but also enable it to supply other hospitals. On May 15, 2011, the director of the ophthalmology department, Jing Lianxi, visited Purei Eye Hospital in Shanghai and promised to provide Purei with a stable supply of high-quality cornea transplant material.¹⁴¹⁹

We have seen many instances in which multiple donor organs were procured for the same patient, either due to organ rejection or as spares. These cases include even third and fourth transplants and eight spare organs procured for the same patient.

In 2006, a chief surgeon named Wang Guangce published a study analyzing 50 kidney re-transplant cases at the First Affiliated Hospital of Henan University of Traditional Chinese Medicine. ¹⁴²⁰ Among the 50 cases, 46 were second transplants, 3 were third transplants, and one was a fourth transplant for the same patient. Five of the cases were orthotopic re-transplants within 10 days of the original transplant, and the duration between transplants and re-transplants ranged between 2 hours and 8 years. This indicates that, in 5 such cases, a second kidney was found and transplanted within 10 days. In at least one case, another kidney was found within 2 hours. Some transplants took the lives of 3-4 people.

In mainland China, it is not unusual to perform several transplant attempts for the same patient if the initial attempt is not successful. Every year, there are numerous cases where two, three, or even four transplant operations are performed for the same patient.

For example, Shen Zhongyang at the Tianjin Orient Transplant Center performed two separate liver transplants for the ­­movie star Fu Biao. Surgeon Zhu Tongyu at Zhongshan Hospital Affiliated to Fudan University performed kidney transplantation for the fourth time for the same patient.

Shen Zhongyang stated that among its patients, the number of cases for his center to conduct secondary transplants for patients accounted for 10% to 20% of the total amount, due to improper handling or operation.¹⁴²¹

In April 2006, Huang Jiefu announced publicly at the National Liver Transplantation Symposium, “Due to donor quality issues, mishandling during surgery, or other reasons, the number of secondary liver transplants increased in China. Strengthening and standardizing management of organ transplantation has become a top priority.”¹⁴²²

Tan Jianming, vice president of the Fuzhou General Hospital of Nanjing Military Command, was reported to have completed more than 4,200 kidney transplants as of 2014.¹⁴²³ Among his patients was a 35-year old male at Shanghai General Hospital in September 2003. In two weeks, Tan was able to acquire 4 kidneys and blood samples, but none of them matched (the authors speculate that the donors’ locations made it impractical to perform cross-matching before excising the donor kidneys). Later, in March 2004, Tan managed to obtain 4 more kidneys in a row for the same patient, the last of which matched successfully. Thus, 8 “donor” kidneys were excised for just one patient. On one occasion, a doctor showed the patient a 20+ page list of available donors and reassured him that many on the list would be suitable for him, and that he would receive a kidney if he continued to wait.¹⁴²⁴

According to the Chinese Nurse magazine, on September 28, 2005, Huang Jiefu, then-Deputy Minister of Health, accompanied Luo Gan, Secretary of the central Political and Legal Affairs Committee (Political and Legal Affairs Committee) and member of the CCP Central Committee, to attend the 50th anniversary celebration for the establishment of the Xinjiang Autonomous Region.

There, Huang Jiefu performed a liver transplant for a local Communist Party official, at The First Affiliated Hospital of Xinjiang Medical University.¹⁴²⁵ He first planned to conduct an allogeneic transplant, for which a donor liver had been made available. Upon inspecting the patient’s body cavity, Huang found that an autologous transplant would be suitable. Nevertheless, he procured two spare livers for his demonstration–one from the First Affiliated Hospital of Sun Yat-sen University in Guangzhou, and another from the Liver Treatment Center of Chongqing Southwest Hospital, which is affiliated with the Third Military Medical University.

Within a few hours, each hospital had managed to find a donor with the “same blood type and genetic loci.” The next evening, those spare livers from both Chongqing and Guangzhou arrived in Xinjiang. Huang began the operation at 7 p.m. the next day and proceeded until the following morning at 10 a.m. After 24 hours of observation, Huang announced that the operation was successful and that the two spare livers were no longer needed. Because cold ischemia time for livers is limited to 15 hours,¹⁴²⁶ the ‘spare livers’ could only have been two living people waiting to be harvested; more than 60 hours had passed between procurement of the livers and the completion of the autologous transplant.

On March 14, 2006 Guangzhou Daily reported: Recently, in the operation room of the First Affiliated Hospital of Sun Yat-Sen University, the reporter witnessed 5 liver and 6 kidney transplants being conducted simultaneously… At its height, this centre performed 19 kidney transplants in one day. The record has been set for 6 liver transplants and one multi organ transplant in one day.¹⁴²⁷

Xinqiao Hospital, affiliated with the Third Military Medical University in Chongqing, once carried out 24 kidney transplants in one day, and conducted 2,590 kidney transplants by 2002.¹⁴²⁸

On December 1, 2008, Qilu Evening News reported that the General Hospital of Jinan Military Command was capable of performing 6 kidney transplants simultaneously. It set a national record of performing 16 kidney transplants within 24 hours. Its annual transplant volume has ranked among the nation’s top 10 for 10 consecutive years.¹⁴²⁹

The Liver Transplant Center at West China Hospital has five full sets of imported liver transplant equipment, allowing five liver transplant operations to be performed simultaneously.¹⁴³⁰ The Center once performed seven liver transplants in one day, setting a national record.¹⁴³¹

On February 18, 2014, sixteen doctors of the Hepatology Center at Fuzhou General Hospital of the Nanjing Military Command simultaneously carried out five liver transplants within seventeen hours.¹⁴³² This center claimed that it had performed “the first, most, and best liver transplants in Fujian Province.”

According to the website of Xiangya Hospital of Central South University, on May 26, 2005 it completed one liver, 6 kidney, and 8 cornea transplants.¹⁴³³ On September 3, 2005, it performed 7 heart, liver, and kidney transplants.¹⁴³⁴ On April 28, 2006, the organ transplant center conducted 17 transplants in one day, including 7 advanced-stage uremic patients simultaneously. On the same day, it also completed two liver transplants and 8 cornea transplants. ¹⁴³⁵

As early as in 2006, the president of Third Xiangya Hospital of Central South University, Huang Zufa, said in an interview, “Our hospital once performed 2 liver and 5 kidney transplants at the same time. We already have the ability to do 6 or 7 transplant surgeries at the same time.”¹⁴³⁶

The organ transplant center at the First Affiliated Hospital of Kunming Medical University once completed 7 transplants in one day, including 3 orthotopic liver and 4 kidney transplants.¹⁴³⁷

No. 474 Hospital of Lanzhou Military Command established its Organ Transplantation Blood Purification Center, which can carry out 12 kidney transplants at once.¹⁴³⁸

On January 17, 2006, Fuzhou General Hospital of Nanjing Military Command simultaneously carried out three liver transplants. ¹⁴³⁹ On February 18, 2014, sixteen doctors completed five liver transplants within seventeen hours. ¹⁴⁴⁰

No. 181 Hospital of Guangzhou Military Command performed 8 transplant surgeries on December 30, 2012 alone, including heart, lung, kidney, liver, cornea, and islet cell transplants.¹⁴⁴¹

Beijing Chaoyang Hospital reportedly conducted 21 transplant surgeries within one day around 2000-2001.¹⁴⁴²

The founder of the transplant center at the Second People’s Hospital of Shanxi, Wu Xiaotong, often spends 12 hours a day performing transplant surgeries, one after another. In August 2006, the center recorded over 100 patients waiting for transplants at any given time. On August 15 alone, the center conducted 11 kidney transplants.¹⁴⁴³

At Wuxi People’s Hospital, Chen Jingyu, “the No. 1 Lung Transplant Surgeon in China,” often completed four or five lung transplants a day.¹⁴⁴⁴

The Cardiovascular Surgery Department and Organ Transplant Center at Union Hospital of Huazhong University of Science and Technology set a national record of completing four heart transplants simultaneously on the same day.¹⁴⁴⁵

At Shenzhen Sun Yat-sen Cardiovascular Hospital on September 30, 2003, chief surgeon Ji Shangyi and Yang Jian’an completed two heart transplants in six hours, taking turns as lead surgeon.¹⁴⁴⁶

“Come as quickly as possible. There were 5 transplants last night and 6 more transplants scheduled for tonight. There are some scheduled for next week as well,” said the director of the urologic surgery department at the General Hospital of Guangzhou Military Command in the morning of April 21, 2006. This was in response to a WOIPFG investigator assuming the identity of a transplant patient inquiring about a kidney transplant over the phone.¹⁴⁴⁷

In countries with advanced healthcare capabilities and well-organized organ donation systems, patients usually wait many months or even years for a donor organ to become available.¹⁴⁴⁸ Yet, in China, where organ donation is culturally taboo and there is no effective organ donation system as of yet, patients can find matching organs whenever needed, suggesting that there is a large number of readily available organ sources waiting to be matched to patients.

In November 2013, an article published in the Chinese state-affiliated Phoenix Weekly highlighted the growth of organ tourism to China within the past decade, and how organs are supplied on-demand and matched quickly, with no waiting time. The article also stated that the number of transplants performed in China exceeded that in the U.S.

The article has since been deleted from its original website,¹⁴⁴⁹ but we have saved an archived version.

The abundance of organs available was also reflected on the website of Changhai Hospital affiliated with Second Military Medical University, which promoted its kidney transplantation as follows in 2008: ¹⁴⁵⁰

• Rapid recovery after surgery with high-quality kidneys
• Short waiting time for transplantation due to an abundant supply of kidney sources
• Low cost, with an average hospitalization fee of 50,000 RMB

This webpage is no longer accessible, though an archived version from 2008 exists. The hospital has deleted most pages under its organ transplant center and left only two expert profiles. Very little information remains.

In 2009, the median waiting time for kidney transplants was 3.6 years in the U.S.¹⁴⁵¹ In the U.K., the median wait for an adult kidney was 995 days during 2002-2006 and 1,191 days during 2005-2009.¹⁴⁵²

In China, it was common before March 2006 (when organ harvesting from Falun Gong practitioners was first reported internationally) that quite a few Chinese hospital websites offered to guarantee to find a living liver and kidney donor within two weeks. Some hospitals even claimed that they had ready donors available.

Shanghai Changzheng Hospital’s organ transplant department claimed on its application form for liver transplants in 2006 that the average waiting time for liver transplantation was one week,¹⁴⁵³ and that the shortest waiting time was 4 hours.¹⁴⁵⁴ Between 2003 and 2006, the hospital had performed 120 emergency liver transplants. Within the last 9 days of April 2005, this hospital completed 16 liver transplants and 15 kidney transplants.¹⁴⁵⁵

Emergency liver transplants are performed on patients who require a transplant operation within 72 hours. Outside of China, finding donor organs for such emergency transplants is nearly impossible. According to the China Liver Transplant Registry’s 2006 Annual Report,¹⁴⁵⁶ among the 8,486 liver transplants performed in 29 facilities in China, 4,331 were labeled as either emergency or elective. Emergency transplants comprised 1,150 (26.6%) of the labeled cases.

An academic paper published by Zheng Shusen, director of the First Affiliated Hospital of Zhejiang University, stated that the hospital had performed 46 emergency liver transplants between January 2000 and December 2004. All patients underwent transplants within 72 hours.¹⁴⁵⁷

In the afternoon of February 14, 2014, Jiangxi Provincial People’s Hospital consecutively performed one liver and two kidney transplants. The liver transplant patient was transferred from another hospital in a hepatic coma for an emergency transplant. The surgery began immediately after this patient was transferred to this hospital, indicating that the hospital has readily available liver sources.

On September 4, 2012, the Second Affiliated Hospital of Harbin Medical University performed a second heart transplant on the same patient, a rare surgery in the world and the second case in China. The donor heart matching and all other surgery preparation were completed in 4 days.¹⁴⁵⁸

Hebei Daily reported that, on April 7, 2011, vice president Liu Su of the Second Hospital of Hebei Medical University led his expert group to perform a heart transplant for 13-year-old Hua Jiale.¹⁴⁵⁹ The hospital found a matching child donor for the patient in a week. The report made no mention of the child “donor.” This case cannot be explained by the sourcing of organs from executed prisoners.

The Shenyang Evening News reported on October 19, 2003 that on October 17, a woman in Shenyang, who had acute severe hepatitis and liver failure after consuming alcohol, received an emergency liver transplant at the organ transplant department of the First Hospital of China Medical University. The entire liver transplant process took six hours. This case shows the existence of ready donors waiting.¹⁴⁶⁰

On January 28, 2002, People’s Liberation Army No. 281 Hospital of Beijing Military Command undertook seven cadaveric renal allografts. One patient experienced a renal arterial embolization seven days after surgery, on February 4, 2002. The next day, the patient was administered a “transplant nephrectomy and in situ re-transplantation.” In other words, the wait time for the second transplant, including organ sourcing and tissue matching, took only one day.¹⁴⁶¹

At one point, this hospital performed the most kidney transplants in the Beijing Military Command and in Hebei Province.¹⁴⁶² As of 2007, it has performed 6 to 9 simultaneous kidney transplants on 28 occasions.¹⁴⁶³

Some other hospitals also guaranteed to provide a second source within a week as a backup. For example, the First Affiliated Hospital of Chinese Medical University, Institute of Transplantation, China International Transplantation Network Assistance Center said that if a fatty liver or other anomalies are found during removal of the source organ, the recipient’s surgery would be canceled. The Center would offer the patient priority in finding another organ and schedule the surgery within a week.¹⁴⁶⁴

An article from the New Culture newspaper in Changchun City published on March 4, 2006 reported that The Second Hospital of Jilin University was able to find a heart donor for a patient named Xie Baoshi within one day and performed the transplant surgery for him the next day. It took the first team of doctors just 1.5 hours to get the heart from the donor 100 km away. Another team waiting at the Jilin hospital successfully transplanted that heart into the recipient 1.5 hours later.¹⁴⁶⁵

On May 30, 2014, Nanjing First Hospital performed two heart transplants simultaneously. According to a people.cn report on June 23, 2014, two patients surnamed Zhang and Li received notice at the same time on May 30 that donor hearts were available. The hospital’s vice president Chen Xin decided that the two heart transplant surgeries would proceed simultaneously. That afternoon, the two patients entered operating rooms at the same time. It took half an hour to transport the donor hearts to the First Hospital. After Chen Xin “installed” a new heart for the first patient, he immediately “installed” a different heart for the second patient. The whole process took over two hours.¹⁴⁶⁶

In early September 2014, the First Affiliated Hospital of Zhengzhou University carried out liver transplants for two male patients on the same day, one of whom needed only one day to achieve a successful match. The patients’ family paid 600,000 RMB in cash, and the surgery was done the next day.¹⁴⁶⁷

Our survey of 165 hospitals from Chapters Two to Six showed that the vast majority of hospitals have expanded into multiple types of transplants beyond the ones for they have received permits from the Ministry of Health. Currently, the Ministry issues permits for six types of solid organ transplants (kidney, liver, heart, lung, pancreas, and small intestine); cell and tissue transplants do not require permits.

The most varied example is Peking University Third Hospital, which carried out transplants of heart, lung, cornea, stem cell, bone marrow, vascular grafts, and hair, besides organ transplants approved for liver, kidney, pancreas, and small intestine transplants—eleven types in total, not including multi-organ transplants.

Sun Yat-sen Hospital of Xiamen University is approved for only heart transplants, but it also performs nine other types of transplants: kidney, liver, pancreas, spleen, lung, heart-lung, small intestine, islet cell, cornea, and bone marrow.

Wuxi People’s Hospital is approved for only lung transplants but also carries out eight other types–kidney, liver, heart, pancreas, cornea, stem cell, bone marrow, and vascular grafts.

Below, we list the types of transplants that these hospitals have claimed to perform on their websites, in media reports, etc. These types do not include combined organ transplants.

The short waiting times, quality of organs, and low fees in China attracted transplant patients from all over the world.

Below are individual accounts of foreign patients who traveled to China solely to receive organ transplants. These cases all featured fast availability of organs (most within a month) upon contacting a broker, as well as short hospitalization times (1-2 weeks for kidney transplants and 2-3 weeks for liver transplants). The hospitals either did not state the sources of donor organs or, when asked, said they came from executed prisoners.

When a native Japanese Hokamura Kenichiro’s kidneys failed, he waited over four years for a transplant before going online to check out rumors of organs for sale. ¹⁴⁶⁸

He was astonished by just how easy it was. Ten days after contacting a Japanese broker in China in February, he was lying on an operating table in a Shanghai hospital receiving a new kidney. A doctor had only examined him that morning. “It was so fast I was scared,” he says.

The price was 6.8 million yen (about US$80,000). “It was cheap”, says Hokamura.

Hokamura is one of hundreds of well-off Japanese who have recently made the trip to China for kidney, liver or heart transplants, drawn by the availability of cheap, healthy organs and rapidly improving medical facilities along the east coast of the mainland. The so-called ‘transplant tourism’ trade is also attracting a growing number of Koreans, Americans and other nationals.

His broker has helped more than 100 Japanese make the trip to China for transplants since 2004, and the trade is growing.

Hokamura negotiated the deal through a Japanese broker in Shenyang that operates under the name of the China International Organ Transplant Center which maintains a professional website with detailed information about their services for donors in English, Japanese, Korean and Russian. The website, http://en.zoukiishoku.com/list/link.htm (accessed April 2, 2006) provides the following information on the sources of organs:

If you send your personal data to this center by e-mail or fax and accept the necessary body examination in Shenyang, China in order to assure a suitable donor, it may take only one month to receive a liver transplantation, the maximum waiting time being two months. As for the kidney transplantation, it may take one week to find a suitable donor, the maximum time being one month.” The source of the organs, however, is not specified.

This is a cover story of ‘Japanese Flock to China for Organ Transplants’ posted on The Asia-Pacific Journal on April 2, 2006.

Below, we give several firsthand accounts of international patients who travelled to mainland China for organ transplants.¹⁴⁶⁹ (To protect the identities of organ recipients, their real names have been removed.)

In January 2001, Mr. L expressed a wish to go to China for an organ transplant and had his blood drawn. About four to five days later, Mr. L received a phone call from the clinic that a matching kidney had been located in China, and that he could start to prepare for his trip. Mr. L hesitated at first and wondered how a matching organ could be found so swiftly. After discussing with his family members, he decided to go anyway.

On February 1, 2001, Mr. L’s delegation of nine patients (5 male and 4 female) went together to Taiping Hospital of Dongyuan for organ transplants. After paying $130,000 HKD, Mr. L received a kidney transplant two days later, together with four other patients from southeast Asia. All 13 transplants (for the group of nine and the group of four) were finished within two days. Mr. L was hospitalized for seven days before returning home. Some patients were hospitalized for 14 days.

Mr. L did not know which doctor operated on him, and no one mentioned the source of the organ. Mr. L suggested that hospitals in mainland China were participating in organ trafficking.

Notes:

Mr. L: male, age 57, blood type O, chronic renal failure

Taiping People’s Hospital of Dongguan (in Humen District, Dongguan City, Guangdong Province) was not a military hospital. However, Wei Gao, the chief physician of the transplant department, was also a professor of and chief physician at the Zhujiang Research Institute of the First Military Medical University.¹⁴⁷⁰ Some other responsible people of this transplant department were also from military hospitals. Military hospitals or doctors could easily obtain organs.

Ms. Rou. Z.: blood type B, age in her forties, from Asia.

Ms. Rou. Z. was diagnosed as with chronic renal insufficiency in May 2000. After undergoing kidney dialysis, Ms. Rou Z. was recommended to go to mainland China for a kidney transplant.

On May 11, 2001, the broker obtained her health record and was told to stay at home to wait for further notice.

Approximately two weeks later, Ms. Rou.Z. was notified that a matched organ source had been located and she could go to China for the transplant. Not psychologically prepared for a matching organ to be found so quickly, she passed on this opportunity. After two weeks, the broker called again, saying that another matching organ had been found. This time, Ms. Rou.Z agreed to travel to mainland China for the transplant, and an operation was scheduled in late June.

A group of seven patients went to China together for organ transplant. Each was asked to bring $200,000 HKD.

The broker received the patients at the airport on June 25, 2001 and took them on a two-hour bus ride to Humen, Dongguan City. They were admitted on the same day to the Taiping People’s Hospital in Dongyuan and given various exams.

On the same day (June 25, 2001), a hospital staff member collected $140,000 to $150,000 HKD from each patient. Simplistic receipts were handed out. Patients with blood type O and those above 60 years old had to pay an extra $20,000 HKD. The entire transplant center was headed by Professor Wei Gao, but Ms. Rou.Z. did not know who her surgeon was.

All seven recipients had their kidney transplants done the next day (June 26, 2001). Three operating rooms were used simultaneously. Spinal anesthesia was applied. Ms. Rou.Z. was sent into the operating room at approximately 8:00 p.m., and the operation was completed at midnight. Ms.Rou. Z. was told that she received a HLA 4 matched organ.

Other patients who received a transplant on the same day included an Indonesian, a French Chinese, and a local Chinese. Surgeon Xu Jiahua had told them earlier that as long as a patient had received kidney dialysis within the hospital for five years, the patient could get a free kidney transplant.

The seven patients stayed in the hospital for seven days and return home on July 3.

Ms. Rou.Z. has not been told who her surgeon and organ donor were. The broker told her that the organs came from executed prisoners.

Ms. R.Z.: blood type AB, age about 50, from Asia.

Ms. R.Z. was diagnosed with chronic renal insufficiency in 1986. By December 2004, her situation had deteriorated, and she developed renal failure and required dialysis.

In early December of 2004, she was given a suggestion to go to mainland China for a transplant and was introduced to a broker, who took Ms. R.Z.’s blood sample to mainland China on December 17, 2004.

Two days later, on December 19, Ms. R.Z. was notified that a matching organ had been found that and she could travel immediately to Guangzhou for the transplant.

As Ms. R.Z. had a bad cold at the time, she was only able to travel to Guangzhou with her husband and younger sister on December 24.

The Economic and Technical Development Hospital of Guangzhou was situated far away from the city and was very desolate. The transplant department was on the tenth floor and had 13 rooms with three beds each. Each inpatient could have their family members live in the room with them. The chief physician of the transplant department was Lin Minzhuan. There were at least ten other patients waiting for transplants or recovering from one. Ms. R.Z. saw patients from Taiwan, Malaysia, Indonesia, and other countries.

The cost of the operation was $27,000 USD (including hospitalization, food and transportation). The money was paid in cash to Lin Minzhuan’s younger brother (the chief administrator) right before the operation. No receipt was issued at the time the money was paid, but under the request of Ms. R.Z.’s husband, a simple note indicating the paid amount was issued.

Ms. R.Z. entered the operating room at 5:00 p.m. on December 30, 2004. The hospital staff had gone to fetch the kidney for her that morning. The operation lasted approximately four hours under spinal anesthesia. There were four other patients receiving kidney transplants on the same day. Ms. R.Z. does not know who her organ donor was. She was told by a doctor that she received a HLA 5 matched kidney.

In the next five days, she was hospitalized in an isolated care unit (the unit had six beds and monitored by staff 24 hours a day, with only one staff member at night). After that, she stayed in a regular room for seven days. She returned home after the stitches were removed on January 11, 2005.

Mr. J.C., in his fifties, was diagnosed with acute renal failure in January 2005. He received a hepatitis B vaccine in March and met the antibody requirements in September. He was told then that he could receive an organ transplant in mainland China.

The patient received notification of an organ match on October 19, 2005. The patient attended a pre-trip seminar on October 20, 2005, where he and other patients were informed of the cost involved and told that their organs had all been matched, so there was no need to worry.

The group of eight patients arrived at the Guangdong Province Border Patrol Armed Police Central Hospital in Shenzhen on October 26 at 4:10 p.m. Professor Wei Gao gave a pre-surgery seminar that evening. The surgery fee of $150,000 HKD in cash was collected from each patient. Some patients asked how the condemned criminals were executed. Dr. Gao said they were not shot; rather, they were given two injections (one for anesthetic and one painkiller) before the organs were taken.

The patient paid $2,700 HKD for accommodation, $12,800 HKD for medicine, and 700 HKD for haemodialysis. The entire operation cost in mainland China was $169,019 HKD. According to the interviewee, the transplant hospitals in Mainland China do not issue receipts of payment for medical treatment; the hospital gives proof of medical treatment only when deemed absolutely necessary. They would provide the proof of the last two dialyses done before surgery, so that patients could apply for the public health insurance reimbursement after returning to Taiwan. All expenditures were paid in cash with Hong Kong Dollars through the handyman.

The total cost for the patient was about $29,000 USD, including “red envelope” money, airline ticket, etc. Mr. J.C. stayed in China for only 3 days.

Mr. J.C. entered the operating room at about 4:00 p.m. on October 28. The kidneys for transplant arrived at the hospital at about 2:10 p.m. the same day. The location where the organs were obtained must not have been far from the hospital. The nurses, riding in an ambulance and carrying cooler boxes, came back with eight kidneys.

Mr. J.C. was out of the operating room at about 8:30 p.m. Afterwards, the eight transplant patients were hospitalized in the Supervision Unit, where family members were not allowed to enter. The patient was discharged on November 4.

The doctors in the hospital were all military doctors.

The medical certificate was given in the name of the Auxing Group Junhui Company (translated by sound of name), and the type of hospitalization was registered as self-paid locals.

The patient said that the group before them was from Indonesia. One day after they left, a group from Singapore would come to the hospital for organ transplants.

Note: This transplant was done at Guangdong Province Border Patrol Armed Police Central Hospital. It was said only military hospitals or doctors working at the army hospitals could easily obtain organs.

Ms. T, in her fifties, from Asia, was diagnosed with chronic renal insufficiency in 2000 and started dialysis in July 2003.

She got in touch with a local organ broker in November 2005. She had a pre-transplant evaluation and immunological evaluation at a local hospital and sent the results to the broker in early December.

The broker asked Ms. T to prepare $26,000 USD in cash and told her that it usually took one week to find a matching organ. The broker also said it was preferred that the patient go to mainland China to wait for a matched organ. However, Ms. T expressed that she would like to wait for a matched organ to be located before leaving for mainland China.

Ms. T was informed on January 4, 2006 that an organ source had been found and that her flight ticket was ready.

On January 6, 2006, the broker took Ms. T and another organ transplant patient and flew to Wuhan in Hubei Province. Ms. T was hospitalized at 2 p.m. on the same day at the Land Force General Hospital of Wuhan and received a blood test immediately. She was sent to an operating room at 5 p.m. and received spinal anesthesia. She was sent out of the operating room at about 8 p.m. The doctor in charge of her case was Tang Ligong.

There were three rooms for transplant patients, and each room had three patients; there were nine beds in total. She was told by a doctor that she received a HLA 3 matched organ.

She was discharged on January 19, 2006 and returned to Taiwan.

The Land Force General Hospital is a military hospital. The broker told Ms. T that the organ came from an executed prisoner (the same explanation generally given by hospitals in mainland China). It was said that military hospitals could easily obtain organs. No families were allowed to visit the transplant patients at this hospital.

Yunnan Kunming Kidney Disease Hospital is one of the Top 100 Private Hospitals in southwestern China and specializes in kidney and liver transplantation. It has approximately 100 beds¹⁴⁷¹ and has attracted patients from over ten countries and regions.¹⁴⁷²

When answering a patient’s question online, this hospital referred to itself as “an organ transplant hospital which has donors seeking matched recipients.” It “guarantees to find a healthy kidney in the shortest possible time,” “provides the shortest possible cold and warm ischemia times,” and “in case of failure, will continue to perform transplants until one is successful.”¹⁴⁷³

On December 15, 2002, Xinhua News Agency reported that on December 14, Lhasa City People’s Hospital in Tibet performed the first successful orthotopic liver transplant in the Tibet Autonomous Region. This was the first such operation in the world to take place at an altitude of 3,700 metres. The surgery took place at 15:00 on the 13^th. The four surgeons included Tang Jinhai, dean of Lhasa People’s Hospital, and Professor Yan Lvnan of West China Medical Center of Sichuan Medical University. The surgery lasted 14 hours. ¹⁴⁷⁴

Dean Tang Jinhai said that the success of the operation sets an example for future medical research and practice in the plateau region, and puts an end to the part of Tibetan history that does not include major organ transplantation, and that it owes to the support of the Party. ¹⁴⁷⁵

Tang Jinhai set out a significant detail of this operation. [Regarding] Lhasa being at an altitude of 3,600 meters: “In order to ensure the activity of the liver’s hepatocytes, the extraction of the liver from the donor must take place simultaneously with the removal of the bad liver from the receiver. If the aircraft carrying the donor could not fly from outside the region to Tibet on time due to bad weather (such situations in Tibet are quite common during the winter), the consequences would be disastrous.”

This report illustrates that a living “donor” was killed when his/her liver was excised at the same time as the recipient’s bad liver was removed. It also indicates that transplants are performed in every corner of China, no matter how remote.

On January 12, 2015, Huang Jiefu appeared on Phoenix Television and addressed the limiting factors of organ transplantation in China: “The first is an economic reason. A transplant surgery is very expensive, and not many citizens can afford the medical costs. The second is that, even though we have such well-qualified hospitals, there aren’t that many experienced and skilled doctors. Only the third is that there are not that many donor bodies; even though donor bodies are abundant right now, there aren’t that many hospitals and that many doctors that can [perform transplants].”¹⁴⁷⁶

In October 2015, Huang Jiefu told Beijing Youth Daily that China had only 169 hospitals with permits to perform one or more types of transplants. He expressed a desire to increase the number of qualified transplant hospitals from 169 to 300 and train 400 to 500 young doctors.¹⁴⁷⁷ A more recent Xinhua report published in China Daily on May 15, 2016 stated that, according to Huang Jiefu, “China will increase the number of hospitals conducting organ transplants to 300 in the next five years.”¹⁴⁷⁸ This suggests that the current system-wide capacity far from meets demand.

Evidently, the availability of organs is not the main limitation. The continued expansion of existing transplant centers and plans to qualify so many new ones suggest that the number of transplant operations is constrained by medical facilities and personnel.

We found a number of hospitals with bed utilization rates between 100% and 200%.

For example, the kidney transplant department at Zhengzhou No. 7 People’s Hospital posted an update on March 31, 2015 indicating that it has 46 approved beds, 70 or more patients at any given time, and a bed utilization rate that “exceeds 130%.”¹⁴⁷⁹ The department has also reported, “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.”¹⁴⁸⁰

At No. 474 Hospital of Lanzhou Military Command, the Organ Transplantation Blood Purification Center has 62 open beds and 12 intensive care beds dedicated to transplantation. The utilization rate of these beds exceeds 110%.¹⁴⁸¹

The First Affiliated Hospital of Soochow University has a kidney transplant center with 55 beds, 130 monthly admissions/discharges, and a 101% turnover rate.¹⁴⁸² In 2012, it performed over 1,170 renal transplants.¹⁴⁸³

Despite having approval for only kidney transplants, the Affiliated Hospital of Zunyi Medical College has also performed liver, bone marrow, cornea, stem cell, and other types of transplants. In 2012, its urologic surgery department reportedly had 51 beds and maintained a level of 100 patients, resulting in a utilization rate of around 200%.¹⁴⁸⁴ The department has since been expanded to 100 beds.¹⁴⁸⁵

The Tianjin Medical University General Hospital’s website showed in 2016 that its general surgery department had a subordinate organ transplant research institute, which conducts liver, small intestine, and other abdominal organ transplants. The department has 208 beds and averages a 115% utilization rate.¹⁴⁸⁶ Its lung cancer surgery department contains the Tianjin Lung Transplant Center, which has 110 beds for its professional clinical team and admits an average of over 160 inpatients per month.¹⁴⁸⁷ Its urologic surgery department began conducting kidney transplants, has 96 beds, and admits up to 150 inpatients per month.¹⁴⁸⁸ Its ophthalmology center carries out cornea transplants, has 42 beds, and admits more than 100 inpatients each month on average.¹⁴⁸⁹

On May 29, 2005, the hospital opened its new 16-story surgery building with 724 beds.¹⁴⁹⁰ Its thoracic surgery department expanded from 24 beds to 54 beds and was the region’s first clinical department to perform heart transplants.¹⁴⁹¹

The Hepatobiliary Surgery Department at Guizhou Provincial People’s Hospital focuses development on liver transplantation as its key discipline. It can routinely carry out liver, pancreas, and other types of large-organ transplants.

The hospital completed its new surgical building in 2007 with 22 floors and modern 100 and 1000-level laminar flow operating rooms and ICU.¹⁴⁹² Since its Hepatobiliary Surgery Department moved into the new building, it has opened two hepatobiliary wards planned for 92 beds but in reality with 150 beds.¹⁴⁹³

Despite the increased capacity of transplant centers, there is still a growing stream of patients waiting for transplants in the transplant hospitals, as one can see from the following examples. The high demand drives high bed utilization rates and number of transplants performed.

According to a report by the Sanxiang City News on November 10, 2012, there were over 1,000 people waiting for an organ transplant at the Third Xiangya Hospital of Central South University.¹⁴⁹⁴

The director of the organ transplant center at the First Affiliated Hospital of Xi’an Jiaotong University, Xue Wujun, stated that over 1,000 patients were waiting for organ transplants. This China News report was published on April 17, 2015. ¹⁴⁹⁵

A people.cn report on January 20, 2011 stated, “In a ward in the First Affiliated Hospital of Zhejiang University, where Zheng Shusen is located, currently lies more than 50 patients who urgently need liver transplants … At the Tianjin First Center Hospital Orient Transplant Center, there are no fewer than a thousand late-stage liver disease patients registered on the waiting list for liver transplants…”¹⁴⁹⁶

In an interview with Oriental Outlook in September 2013, Shi Bingyi, director of the No. 309 Hospital’s People’s Liberation Army Organ Transplant Research Institute, indicated that the institute had five to six thousand patients waiting for transplants each year. ¹⁴⁹⁷

A report from October 2014 indicated that there were more than 400 patients waiting for kidney transplants at the Second Yinzhou Hospital.¹⁴⁹⁸

To meet the ever-increasing demand for transplants, most hospitals we analyzed have expanded their transplant wards and even constructed new buildings, often including VIP-style amenities to cater to transplant recipients from other countries. Reading through the individual hospitals for the first time, we felt as if we were observing a monstrous flywheel.

The Urology Department of Shanghai Renji Hospital established a new wing and renal transplant ward in Pudong in November 1999. It has expanded from its original 29 beds to 70 beds. Its new medical team and distribution system allowed its number of surgeries to increase by 300%.¹⁴⁹⁹ Under the leadership of Professor Huang Yiran, the medium-sized department, with fewer than 70 beds, performs over 5,000 surgeries per year, with over 60% being large and extra-large operations. The average hospitalization time is five days.¹⁵⁰⁰

“There are too many, too many patients! We have surgeries here overnight, nonstop for 24 hours a day,” Dr. Cheng Zheying told a Wenhui Daily reporter in March 2016.¹⁵⁰¹ Chen also said that the surgery building is the main battlefield for Renji Hospital’s surgeries. As many as 120 surgeries are performed here in a day. The most difficult and advanced surgeries, including robotic surgeries, are all performed here. Each operation lasts over four hours, so even with the over ten operating rooms all open, doctors have to operate until late at night. This does not include liver transplants, as liver sources coming from other areas are often brought back to the hospital late at night, so it is quite common to conduct surgeries until early morning.

“The operating room is like a secret garden in the hospital. We have no time to be in contact with the outside world. The lights are on 24 hours a day here. Seven or eight o’clock at night is the same as in the morning. One can’t tell day from night,” Chen Zheying said. Because of the long-term continuous operations, many of the medical personnel have developed lumbar diseases, cervical spondylosis, and varicose veins.

The outside world knows little about the fully loaded and even overloaded operations here. Director Huang Yiran of the Urology Department sighed while holding the monthly statistical data of various surgeries, “one-third of the operations should not have been done here.”

In 2005, Renji Hospital’s east surgical building was put into use. It has 1,000 beds.¹⁵⁰² The number of operating rooms has increased from 24 to 38.¹⁵⁰³ Its Liver Transplant Center is located on the 14^th and 15^th floors of this new building. The 15^th floor has a 10,000-class laminar flow isolation ward and liver transplant ICU.¹⁵⁰⁴

The Liver Transplant Center has experienced phenomenal growth. It increased its bed count from the original 13 at the end of September 2004 to 23 beds less than 10 days later. It later increased to 90 beds in June 2007¹⁵⁰⁵ and 110 beds in 2014.¹⁵⁰⁶ Its utilization rate and transplant volume also continued to hit new highs.

Director Xia Qiang of the Liver Transplant Center stated that the center has ranked first in Shanghai in annual liver transplant surgeries performed for eight consecutive years since 2007. It has also and has ranked first in the country for four consecutive years since 2011. Its pediatric liver transplant volume has ranked first in the world for three consecutive years since 2012.¹⁵⁰⁷

The 307th Hospital of Chinese People’s Liberation Army claims to be one of Beijing’s largest renal transplant centers. With a high surgical success rate, its survival time after kidney transplant surgery has always been at a leading level domestically and attracts many specialists and transplant recipients from throughout the country.¹⁵⁰⁸

In September 2005, the hospital moved to its new site in Fengtai District of Beijing, where its building area tripled and number of beds doubled. In May 2009, its new medical building officially opened and increased its bed count to 1,100. In September 2013, its emergency medical building was put into service, which increased its bed count by another 500.¹⁵⁰⁹

In 2004, Dong Jiahong, the director of People’s Liberation Army Hepatobiliary Surgery Institute of Southwest Hospital affiliated with the Third Military Medical University, stated in 2006 that the department planned to expand to three wards, with 150 beds to accommodate “the needs of large-scale transplantation”, so that each year, the facility could admit 3,000 hepatobiliary and pancreatic patients domestically and abroad, and perform 2,400 liver transplants.¹⁵¹⁰ The number of beds at the center later increased to 200.¹⁵¹¹

Navy General Hospital’s archived web page shows that its hepatobiliary surgery department was the first in China to carry out liver transplants. The special edition of its introduction to liver transplantation states, “As liver transplantation has become the only effective treatment of end-stage liver cancer, the Navy General Hospital has helped thousands of end-stage liver cancer patients gain a second life through liver transplantation.”¹⁵¹²

The hospital’s new medical building entered use on December 16, 2009. The 70,000+ square meter building represented 400 million RMB of investment. It has 724 open beds, 18 operating rooms, and a special ward for international patients and VIPs. ¹⁵¹³

The People’s Liberation Army No. 458 Hospital (Air Force Hospital of Guangzhou Military Command)’s liver transplant center has 108 beds and can simultaneously carry out two liver transplants and one regular surgery. Patient rooms are well-equipped with amenities, including air conditioning, televisions, telephones, central gas, intercoms, refrigerators, and microwaves. The center also has five “presidential suites” with high-speed internet access.¹⁵¹⁴

Led by the development of kidney transplantation, the People’s Liberation Army 452 (Chengdu Air Force) hospital leaped from a “township-level scale” of 210 beds in 2002 to over 1,000 beds in 2009. It performed the most kidney transplants in Sichuan Province.¹⁵¹⁵

A Health News report in April 2005 stated that the Third Affiliated Hospital of Sun Yat-sen University had completed 800 liver transplants. Its transplant center has nearly 40 beds that are always full. The center performed 259 liver transplants in 2004; there was at least one transplant almost every weekday.¹⁵¹⁶ The center has five wards and focuses on liver, pancreas, small intestine, combined, and complicated transplants. It currently has 113 open beds.¹⁵¹⁷

The new surgery building at Wuhan Union Hospital was under construction between August 8, 2002 and September 2006. It has 32 stories above ground and 2 underground. The integrated surgery ward building has 1,050 beds and 42 operating rooms. ¹⁵¹⁸ It can accommodate 200 surgeries per day, a volume equivalent to those of five medium and large-scale hospitals. ¹⁵¹⁹ It is the largest-scale surgery building in Asia, and its advanced facilities are second-to-none in Asia.

Its Urologic Surgery Department enjoys a high academic status in the country and has now become one of the largest kidney transplant centers in the region.¹⁵²⁰ The Liver Transplant Center is a main component of its General Surgery Department, which has been designated a national key discipline, and liver transplantation has become a routine practice. Its heart transplantation and combined heart-lung transplantation are state of the art. The Cardiovascular Surgery Department once completed 4 heart transplants simultaneously and within 22 minutes,¹⁵²¹ and claimed to have completed the largest number of heart transplants in the country in 2014.¹⁵²²

Peking University Third Hospital began to conduct clinical liver transplants in May 2000. In October 2001, its organ transplant center was formally established.¹⁵²³ It worked with other hospitals affiliated with Peking University to establish the largest organ transplant center in China.¹⁵²⁴  In December 2005, it moved into a new 470-bed surgery building, ¹⁵²⁵ where its facilities have been improved fundamentally, which has brought greater development opportunities to the center.¹⁵²⁶ Its quality and quantity of liver transplants ranks near the top in China. The transplant center’s director Zhu Jiye stated in an interview in 2013 that his hospital performed more than 4,000 kidney and liver transplants in one year.¹⁵²⁷

In 2010, the People’s Liberation Army No. 309 Hospital’s transplant center had 316 beds, and claimed to lead in annual capacity and bed utilization rate among similar departments in the military.¹⁵²⁸ As of 2012, this transplant center had its own building and had expanded to 393 beds. ¹⁵²⁹

A report in 2004 showed that the transplant volume at Zhongshan Hospital of Shanghai Fudan University had been increasing at a rate of 50% per year.¹⁵³⁰ The quantity and success rate of liver transplantation of its liver surgery department lead the country.¹⁵³¹ In February 2015, it moved into the new Shanghai Liver Cancer Medical Center building. It now has 230 beds, with its scale and medical capabilities among the world’s best.¹⁵³²

Fujian Medical University Union Hospital leads the nation in the number of allogeneic heart transplants performed. Its pediatric heart transplantation and heart re-transplantation fill a gap in this field in China. Its technology in liver transplants, heart re-transplants, and bilateral lung transplants lead the nation.

Since its cardiac surgery department conducted the first orthotopic heart transplant in Fujian Province in 1995, it has successfully performed heart transplants for patients with advanced heart disease from more than 30 cities and regions of China. The department ranks among the best in allogeneic heart transplant, holds 16 “first in the country” titles, and serves as the base for heart transplantation in China.

The hospital’s dedicated heart surgery building entered operation in 2007. After moving to the new building, its cardiac surgery department expanded from 67 beds to 102 beds. It has 21 ICU beds, dedicated patient rooms for transplants with laminar-flow air purification systems, and an independent pediatric ward.¹⁵³³ The hospital began construction on a new, integrated surgery building on January 1, 2005. The building was completed in September 2008¹⁵³⁴ and officially entered use in July 2009. The building has 13 stories above ground, 3 stories below ground, and 806 beds.¹⁵³⁵

The Affiliated Hospital of the Medical College of Chinese People’s Armed Police Forces claims that it conducts the second highest number of kidney transplants annually in Tianjin,¹⁵³⁶ and its transplant volume is at the forefront in the Beijing and Tianjin areas and among China’s top 20 major hospitals.¹⁵³⁷ The hospital’s data showed that its bed utilization rate had reached 107.6%, with an average bed turnover rate of 35.8 times per year.¹⁵³⁸

Yet, in 2003, the hospital ranked last among the 37 hospitals at the division level and above in the military and armed police forces. Because 149 patients and medical staff at the hospital were infected with SARS, its 34 departments were merged into two, and its bed count was reduced to 50. The hospital experienced a sharp financial downturn. With support from Zhang Gaoli, a Politburo Standing Committee member and former Tianjin Party Secretary, this military hospital was unexpectedly included in Tianjin’s Twelfth Five-Year Plan. It was gradually constructed into a modern medical complex with over 30,000 square meters of building area.¹⁵³⁹

In 2011, the hospital launched another expansion project. The first phase was to build a 17-story inpatient building and corresponding medical technology building, which increased the hospital’s bed count by nearly 700. The second phase was to building an emergency building and a 19-story surgery building. After its completion, the hospital would have 2,700 beds in total. The third phase was to build another medical building, which would further increase the hospital’s bed count to 3,000.¹⁵⁴⁰

Lanzhou General Hospital of Lanzhou Military Region successfully conducted China’s first kidney transplant in 1965.¹⁵⁴¹ The levels of medical treatment, scientific research and teaching in its urologic surgery department are at the forefront in both the province and in the country. Its People’s Liberation Army Blood Disease Center is the largest in northwestern China. It carried out the first bone marrow transplant in the country. Its scale, technology, and quality of transplantation are at the forefront in northwestern China.¹⁵⁴² The center has 150 beds, 15 ultra-clean wards for hematopoietic stem cell and bone marrow transplants, and 18 surgeons, 9 of whom are in senior positions and more than half hold master’s or PhD degrees.¹⁵⁴³

In 2004, the hospital invested 120 million RMB to build a 20-story surgical care building with 900 beds–the largest in the city of Lanzhou. In 2008, the hospital invested 20 million RMB to renovate the ward for cadres according to modern medical standards. The hospital has 1,300 beds. Each year, it receives 37,000 inpatients, performs 126,000 surgeries, and earns 444 million RMB in revenue.¹⁵⁴⁴

The First Affiliated Hospital of Jinan University (Guangzhou Overseas Chinese Hospital) established its kidney transplant department in 1997 and changed its name to the ‘Organ Transplant Center’ in 2003. It specializes in kidney, liver, pancreas, and other types of transplants. Its kidney transplantation leads the province. ^{1545 1546}

On December 9, 2012, the hospital’s new 19-story, 1,300-bed ward building became operational, which contains its organ transplant center, urologic and cardiothoracic surgery departments, and the VIP ward. It has 20 laminar-flow operating rooms meeting international standards.^{1547 1548} Its VIP patient rooms mirror hotel standards and have various high-end medical facilities to satisfy the expectations of high-end patients from within China and other countries.¹⁵⁴⁹

Yiyang Central Hospital became the first in the province to start performing kidney transplants in 2000.¹⁵⁵⁰ In 2004, it established a kidney transplant center with independent wards. The center’s success rate of 99.6% is at an advanced level domestically. In 2009, it scored among the top ten in the CSRKT ranking.¹⁵⁵¹ Facing demand growing by the day, the hospital increased its investment in equipment and facilities and is currently constructing a new 25-story surgery building.¹⁵⁵²

No. 303 Hospital of Guangzhou Military Command established its transplant center in 2004. ¹⁵⁵³ Its 10-story organ transplantation building entered operation in 2006. ¹⁵⁵⁴ In 2010, the hospital established a Transplantation Research Institute and Key Laboratory Training Base that integrates clinical care, education, and research.¹⁵⁵⁵

In March 2006, the First Hospital of Shanxi Medical University formed a new division specializing in organ transplantation. It moved into the new No. 1 Inpatient Building with 90 beds. In 2010, the transplant division expanded to 140 beds.¹⁵⁵⁶

The First Affiliated Hospital of Inner Mongolia Medical University is this region’s only heart and lung transplant center.¹⁵⁵⁷ In recent years, the hospital has carried out the first heart, liver, small intestine, kidney, cornea, stem cell, and other types of transplants in the region. Some of these types of transplants have become routine operations for the hospital.¹⁵⁵⁸ The hospital’s new inpatient building entered use in 2005. It has 448 modern standard patient rooms, 1,332 beds, and laminar flow operating rooms and isolation wards.¹⁵⁵⁹

In 2009, the Shanghai Municipal Government collaborated with the People’s Liberation Army General Logistics Department to develop the Second Military Medical University. Its development strategy was to move its affiliated Changzheng Hospital eastward to the Pudong District, and to move its affiliated Eastern Hepatobiliary Hospital westward to Jiading.

On October 18, 2015, the Eastern Hepatobiliary Hospital, located in Anting in Jiading District, Shanghai, started operations.¹⁵⁶⁰ The hospital covers a construction area of 200,000 square meters and contains 1,500 beds.

In 2015, Changzheng Hospital invested 2.9 billion RMB in a new development project in Caolu, Pudong District, with a plan to build a new branch in Pudong with 2,000 beds. The project is expected to be completed within 3 years.¹⁵⁶¹

Fuzhou General Hospital of Nanjing Military Command began construction on its new ward complex in 2011. The new complex began operations in 2015. Its north building has 19 stories and contains the surgery department and transplant center. With a total area of 154,900 square meters and 1,680 beds, the new complex is the largest in Fujian Province.^{1564 1565}

We observed that a number of medical teams and individual doctors struggled to carry out the volume of transplants demanded of them. The scale can be seen in surgeons working overtime to procure organs and conduct transplants, as well as departments carrying out multiple transplants simultaneously. One hospital even resorted to training almost all of its general surgeons to conduct organ transplants.

Our survey of hospitals left us with the impression that the majority of hospitals and doctors have routinely been overloaded with transplant surgeries since 2000. Below are several examples:

At the Second Xiangya Hospital of Central South University, the director of the urological transplant department, Peng Longkai, has completed more than 2,000 kidney transplants.¹⁵⁶⁶

One could observe the volume of transplants at this hospital from how busy its doctors were: “Transplant surgeons often have to work for over 20 consecutive hours performing surgeries. They will start another round of operations after they rest for three or four hours. The surgeons are still at the operating table, while the scrub nurses have changed several shifts. They often conduct a dozen operations over a period of 2 to 3 days. They once performed 9 kidney transplants in one day.” ¹⁵⁶⁷

On April 10, 2008, head nurse Zhang Chunyan shared on Liaocheng People’s Hospital’s website, “Our cardiac surgery department’s nurses, while performing our duties during routine heart surgeries, are also responsible for postoperative for heart, liver, kidney, and lung transplants.”

“During transplants, because of special aspects of the donor organs, we often need to do heart, liver, and kidney transplants simultaneously. This increased our workload more than ten-fold. Every person is overloaded with work every day and put in multiple times the effort.” She included one example: “In October 2005, we performed heart, liver, and kidney transplants in one day. This was a major test for us.” The team first carried out the heart transplant, followed by kidney and then liver.

“If I’m not at the hospital, I’m at the kidney procurement place. If I’m not at the kidney procurement place, I’m on the way between the hospital and the kidney procurement place.” This was the portrayal of the busy lifestyle of the transplant team at Qilu Hospital of Shandong University. Members of the team were often unable to go home for one or two weeks at a time. On December 26, a report on its official website stated:¹⁵⁶⁸

“Due to the current international criticism of organ sourcing in China, the number of usable cadaveric donor kidneys has decreased significantly, causing an increase in uncertain factors and intense competition. However, due to the tireless efforts of Director Dong Laidong of the Organ Transplant Supply Department and Director Tian Jun of the Blood Purification Department, the number of cadaveric kidney transplants well surpassed that of last year, and the wait time for kidney transplants have not increased noticeably.”

By the end of 2014, Shen Zhongyang, Director of Tianjin First Central Hospital’s Oriental Organ Transplant Center, had performed close to 10,000 liver transplants.¹⁵⁶⁹ This hospital is the largest organ transplant center in Asia.

A media report stated, “As a leader, Shen Zhongyang pays a price that ordinary people cannot imagine. He has virtually no time for himself. In the past ten-plus years, he has basically gone from one thing to the next, day and night, he hasn’t had a single meal at regular times, and he’s often at the operating table until midnight or the following morning.”¹⁵⁷⁰

Other transplant doctors also have not rested: “The hospital’s transplant surgery division’s doctors hurriedly shuttle between wards and operating rooms, with no time to greet one another. They kept saying, ‘These few days are crazy busy, with more than a dozen surgeries a day.’ Some doctors were even “rushing surgeries all night long [and] did not sleep at all.” Doctors complain that the off-season is only a month after the New Year; they are busy until the end of the year and normally don’t go home.”¹⁵⁷¹

“Under Shen Zhongyang’s guidance, each of his former young doctors has independently completed nearly 1,000 liver transplant surgeries.”¹⁵⁷²

This fervor in pushing transplant volume is not limited to national-level hospitals. We have found that transplantation has become a major business activity for municipal hospitals and subsidiary hospitals of state-owned enterprises, as exemplified by the case below:

The Dongfeng Company Hospital is operated by an automaker in Shiyan, a small industrial city in central China. In less than ten years, the explosive growth in this hospital’s transplantation activities “caused the local economy to prosper,” “elevated the city’s reputation,” and gradually replaced the Dongfeng vehicle as the new “business card of Shiyan.”¹⁵⁷³

As early as in August 2000, it conducted 10 kidney transplants, one thyroid transplant, and 3 cornea transplants in the same day. The hospital also performs liver, cornea, in situ parathyroid, bone marrow, and other types of organ and tissue transplants. ¹⁵⁷⁴

The hospital’s vice president Yuan Fangjun stated in 2009, “Kidney transplantation is now a routine surgery. Almost all surgeons at our hospital can independently complete kidney transplants.” ¹⁵⁷⁵

According to the hospital’s website, it has 10 surgical departments and more than 100 surgeons. How many transplants is the hospital performing to necessitate training almost all of its surgeons in the procedure?

In addition, the hospital has a breast transplant department with more than 40 beds, 3 chief physicians, 2 associate chief physicians, 4 attending physicians, and 3 residents.¹⁵⁷⁶ These doctors’ web pages are no longer accessible.

After the 2006 publicity surrounding live organ harvesting, the Party/Government indicated that transplant numbers had gradually decreased. Yet, that was not the case. There has been continued expansion of transplant hospitals after 2006.

The Government blamed the chaotic market for live organ harvesting. To “recertify and regulate” the market, the Ministry of Health started to issue permits to transplant centers, and hospitals without permits would no longer be allowed to continue conducting organ transplants after July 1, 2007.

In July 2007, more than 1,000 transplant hospitals in China applied for permits under this new system, including nominally unrelated hospitals of traditional Chinese medicine or occupational diseases.¹⁵⁷⁷ Only 164 received permits.

This meant that the Government could monopolize and redistribute the organ market. As a result, large transplant centers faced less competition and achieved even greater development than before.

We observed that some institutions that did not receive permits either reduced their transplant volumes, stopped performing transplants, or operated under increased secrecy. Nevertheless, many that did not have permits but were able to obtain organs continued to operate.

In fact, the Ministry of Health had not really closed the door to hospitals that had not obtained approval for transplants in 2007; the Ministry later introduced pilot programs for donation after cardiac death, and these hospitals were encouraged to apply for approval after procuring five or ten transplants from donation after cardiac death. ¹⁵⁷⁸

By January 2014, the approval list had been expanded to 169 hospitals.¹⁵⁷⁹ Among the five newly added centers is the First Hospital of Foshan, which was limited to liver and kidney transplants from donors with no cardiac activity. Based on its website archived on November 1, 2012, before being approved,¹⁵⁸⁰ it had launched not only kidney, liver, heart, lung, kidney-liver, and pancreas-kidney transplants but also living-donor liver transplants.

The website stated that within 24 hours on December 28, 2004, this hospital performed 5 kidney and 2 liver transplants.¹⁵⁸¹ On March 1, 2005, its entire transplant team cooperated to perform 2 liver and 6 kidney transplants within 8 hours, from eleven o’clock in the morning to seven in the evening.¹⁵⁸² On December 29, 2005, its transplant center completed 7 kidney transplants.¹⁵⁸³

The hospital’s website has not published its transplant numbers after the publication of the Matas/Kilgour Report in 2006. However, its addition to the list of approved hospitals in 2013 indicates that it continued its transplant operations after 2011.

Similar situations occurred with the other four newly added transplant centers. We further found that at least 75 non-approved hospitals were issued permits for pilot runs of transplants from DCD starting in 2011 and continued to perform transplants.

Party-controlled media claimed that organ transplants had been drawn down or stopped, that there were not as many organs available, and that transplant hospitals could hardly sustain themselves. The transplant hospitals also removed or tampered with related websites and information regarding the number of transplants performed, and either falsified or stopped updating their reported data.

Contrary to the message from the Government, we observed that the scale of organ transplantation in mainland China in general has not been declining; rather, it has entered a period of stable development.

The Chinese Government issued statements that the scale of organ transplantation has decreased since 2006. For example, on December 18, 2007, Southern Weekend published an article entitled “China calls for a halt to ‘organ transplant tourism.’”¹⁵⁸⁴ The article stated that the largest organ transplant center in Asia, Tianjin Oriental Organ Transplant Center, saw a sudden drop in the number of transplants performed since 2007 due to a lack of donor availability. The article also stated that in the first half of the year, the center had only 15 liver transplants, all of which were from patients’ relatives.

Yet, it bears repeating that the Tianjin Oriental Organ Transplant Center opened a new transplant building in September 2006 with a capacity of 500 beds. Its number of transplant teams also increased from 7 to about 17.¹⁵⁸⁵ Seven months earlier, a report in the February 2006 issue of the Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care had set out, “The newly completed Oriental Transplant Center building has 700 beds…[and] currently has 310 medical professionals. The center plans to focus on liver and kidney transplants continuously and form an integrated transplant center which is the “best in Asia” and “world-famous.”¹⁵⁸⁶

By 2013, the hospital’s overall bed utilization rate had increased to 131%.¹⁵⁸⁷  Based on developmental needs, the hospital added 300 beds and adjusted the number allocated for several departments, including the organ transplant center.

The First Affiliated Hospital’s Liver Transplant Center of School of Medicine at Zhejiang University stated on their official website on February 28, 2011, “Our country`s liver transplantation business has entered a period of stable development. Under the leadership of academician Zheng Shusen, the liver transplant business at First Affiliated Hospital of Zhejiang University is flourishing. It moved into a new building in 2007. Liver transplantation has become more systematic, professional, and large-scale.”¹⁵⁸⁸