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

Before the Ministry of Health implemented its new permit system in 2007, the total transplant volume of many medium and small transplant institutions comprised 80% of the total in China.  The large transplant centres made up the other 20%. Some of these smaller-scale institutions had significant transplant volumes.

Despite not having been granted approval by the Ministry of Health under the new system, many of these facilities have not halted their transplant activities. Compared to the large hospitals, these smaller institutions have more flexibility to obtain living organ sources through various channels. In addition, several dozen unapproved military and armed police hospitals face no restrictions and are performing organ transplants as usual, because they control abundant supplies of living organ sources.

The majority of 405 institutions in this category Class 3 Grade A hospitals. They have been involved in organ transplants but did not receive permits from the Ministry of Health in 2007. This category includes 56 military and armed police transplant hospitals and 349 civilian transplant hospitals. ¹³²⁴This category also includes some district, township, and even lower-level hospitals that have high transplant volumes.

On April 28, 2006, Hunan Provincial People’s Hospital made an announcement in several local newspapers, including the Xiaoxiang Morning News, that the hospital was offering 10 liver and 10 kidney transplants free-of-charge. ¹³²⁵ The story provoked questions about the source of these organs. The newspaper later modified its story to say that the “living kidney donors were from patients’ relatives.”

The hospital’s hepatobiliary surgery department claims to be one of China’s pioneers in hepatobiliary disease treatment.¹³²⁶ Established in 1983, it has grown to 268 beds and nearly 200 medical personnel. It integrates medical practice, teaching and research and serves as a national base for continuing medical education. This hospital was founded in 2000 and formally established a postdoctoral mobile station in 2008. In 2009, it established collaborative centres for hepatobiliary and pancreatic surgery with the U.S. and France. In 2010, the hospital released information indicating that it had over 10,000 outpatient visits and 6,000 inpatients annually.

Although not approved by the Ministry of Health for transplants, Hunan Provincial People’s Hospital’s organ transplant centre completed the first orthotopic liver transplant (the most common type of liver transplant) in Hunan Province.¹³²⁷ It also maintains a provincial record for the longest survival time after liver transplantation. The hospital currently performs a variety of routine liver and kidney transplant surgeries. In 2005, it introduced liver transplants for patients with advanced cirrhosis.

Both the former and current vice president of the hospital, Professor Li Zhuori and Jiangbo are experts in liver and kidney transplantation.

Yunnan Kunming Kidney Disease Hospital claims to be a first-class hospital specializing in kidney and liver transplantation in Yunnan province with approximately 100 beds, all in standard and deluxe rooms.¹³²⁹ The hospital has attracted “patients from over ten countries and regions, including Hong Kong, Macao, Taiwan, Australia, Thailand, Indonesia, Malaysia, Singapore, and Vietnam.”¹³³⁰

As one of the Top 100 Private Hospitals in China with over 110 staff members,¹³³¹ the hospital has both national-level technical experts and a professional nursing team. Xia Huisheng, an organ transplant pioneer, was an honorary president of this hospital. The well-known transplant expert Gao Wei formerly served as its president in charge of technology. Gao was a professor at Zhujiang Hospital affiliated with Southern Medical University, formerly the First Military Medical University.¹³³² Gao is listed as one of five doctors/authors of a research paper that includes 1,537 kidney transplants.¹³³³

The hospital later hired Guan Delin, former vice president of the First Affiliated Hospital of Tsinghua University, director of its Urology Centre and deputy director of the Beijing Organ Transplant Centre, as honorary president. His student, Li Guobin, acts as the vice president and director of kidney transplant department.¹³³⁴ Guan Delin’s personal webpage states that he had experience in over 2,700 kidney transplants and dozens of combined transplants.¹³³⁵

Although this township hospital¹³³⁶ was not included in the list of approved transplant centres issued by the Ministry of Health in 2007, it had performed over 3,000 kidney transplants as of 2007.¹³³⁷ In the first three months of 2006, this hospital performed over 300 kidney transplants.¹³³⁸

The Taiping People’s Hospital hired Professor Gao Wei, originally from Zhujiang Hospital of Southern Medical University as its director. Gao was a State Council expert who earned a special allowance. He was on the editorial board of the journal Organ Transplantation in China and a member of the China Dialysis Transplantation Society. He also served part-time as the vice president of the Yunnan Kidney Disease Hospital. In exchange for helping several hospitals in Kunming to develop their kidney transplant centres and providing them with specialty support, the Taiping hospital obtained many living organ sources from Kunming.¹³³⁹

Most of the other doctors at the People’s Hospital were also professors retired from Zhujiang Hospital, affiliated hospital of the First Military Medical University. Among this group, Li Jie had participated in more than 4,000 kidney transplants and over 50 liver transplants, and presided over at least 500 kidney transplant as of 2010.¹³⁴⁰

The hospital actively recruited patients from Southeast Asia. On January 9, 2004, Min Sheng Daily News reported, “Transplant tourist groups from Taiwan ‘land’ [in Dongguan] every month. Taiping People’s Hospital in Dongguan City in Guangdong Province is one of the receiving hospitals, which is well-known for kidney transplants.” The report stated that the hospital had “performed kidney transplants for 425 patients from more than 10 countries and regions, such as Korea, Singapore, Malaysia, Vietnam, Hong Kong and Taiwan.” ¹³⁴¹

Below is the experience of a 52-year-old Singaporean businessman who received his kidney transplant there in February 2004: ¹³⁴²

“In late February 2004, by the arrangements of my friend and a local nephropathy authority, my blood tests report was sent to Taiping Hospital by fax on February 28. Four days later, I was notified that they had found a matching kidney source, which could be transplanted immediately.”

“On March 1, it took me two hours and a half to reach the Taiping Hospital. Its kidney transplant department was located on 2^nd, 3^rd and 4^th floors. The ward was a large suite, with a living room and kitchenette. On March 5, two days after I arrived, I received the transplant surgery performed by Professor Gaowei. I had stayed in Intensive Care Unit ward for five days, and I moved to the normal ward on the sixth day. Color TV, video player … the ward had everything that I expected, just like a four to five-star hotel. Four restaurants arranged by the hospital would deliver the meals I ordered to my ward. Since there was a business centre, it was easy for me to receive and send emails, faxes and phone calls. Everything was very convenient.”

Xi’an High-Tech District Hospital is a joint venture with a British hospital management company. Its organ transplant centre was established in 2003. Although this Class 3 Grade B hospital has not been approved by the Ministry of Health for transplants, its chief expert is Shi Bingyi, an expert from Beijing’s People’s Liberation Army No. 309 Hospital. This Xi’an hospital has also attracted a large number of patients from foreign countries.

In the first two years after its establishment, it had already performed more than 500 kidney transplants. The Centre’s deputy director, Fan Yuhui, said that the hospital had a large organ donor pool to enable quick matching. It ensured short times for transplants, the main reason it attracted many overseas transplant brokers.¹³⁴⁴

The hospital claimed that during its startup phase, “No matter how hot or cold the weather, 4 to 5 people squeezed into a run-down van to extract organs from donors,” and “7 to 8 transplants were performed over a period of one day and night.”¹³⁴⁵

This Guangzhou hospital is a Class 2 facility in the Guangzhou economic development zone. As of September, 2006, its former deputy director of organ transplant, Lin Minzhuan had personally performed over 2,000 kidney transplants. ¹³⁴⁷ Professor Lin holds a PhD in medicine and advises master’s students. He was formerly the director of Zhujiang Hospital Organ Transplantation and Blood Purification Centre of the First Military Medical University, the former of Southern Medical University. ¹³⁴⁸

Our analysis of hospitals indicates that, before the Ministry of Health released “Interim Regulations on the Management of Human Organ Transplant Clinical Applications,” the total volume of organ transplants conducted by a huge number of small and medium-sized transplant centres was not less than that of the large transplant centres. Once live organ harvesting became the norm, then, as long as an institution could procure organs, it would seize every opportunity to make money, regardless of approval by the authorities. In particular, the military and armed police hospitals felt unrestricted by the regulations and have continued to perform transplant operations even after 2007. Some small facilities were able to sustain their operations by building good relationships with military hospitals, large transplant centres, well-known experts, and the judicial system.

This category of 161 medium-scale transplant institutions includes 55 Class 3 Grade B hospitals and 106 Class 2 hospitals, as well as a few smaller ones that also conduct organ transplants. The medium-sized hospitals’ transplant centres usually perform more kidney transplants, which have lower technical requirements than liver transplants.

Many unqualified specialist hospitals, including those of Chinese medicine, maternity, forensics, occupational diseases, and other unrelated disciplines have tried to find ways to cash in on organ transplants despite not having the expertise or facilities to do so.

Kunming Forensic Hospital was the first designated forensic hospital in Yunnan Province.¹³⁴⁹ It was also one of the earliest research and development facilities to research “deaths induced by drug injection.” ¹³⁵⁰ This hospital also has a kidney transplant centre. In cooperation with Taiping People’s Hospital in Dongguan City, between 2001 and 2008, it completed thousands of solid organ tissue typing operations¹³⁵¹ and 1,537 kidney transplants.¹³⁵²

In December 2006, Gao Yuan Magazine reported that a college student who needed a kidney transplant had received an invitation on May 18, 2006 for a free kidney transplant from this hospital. On May 29, the Hospital president Wang Jun welcomed this student in person, and chief surgeon Gao Wei performed the transplant.¹³⁵³

The hospital’s website stated, “Nephrology is the first pillar of this forensic hospital. It mainly performs kidney transplants. Due to abundant kidney sources, it performs the majority of organ transplant surgeries in the province of Yunnan.”¹³⁵⁴

Gongyi City Chinese Medicine Hospital is located in Gongyi County of Zhengzhou City, Henan Province. Established in 1982, it was formerly a small hospital specializing in developing medical technology based on traditional Chinese herbal medicine.¹³⁵⁵ It is now a Class 2 hospital.

It established a kidney transplant centre in 2001 that could carry out 8 kidney transplants in one day.¹³⁵⁶ By 2006, Li Hongdao, director of the urology centre, had performed over 500 kidney transplants. On average, he conducted over 80 transplants per year from 2001 to 2006.

Weifang Ren De hospital is located in Weifang City’s High-Tech Industry Development Zone in Shandong Province. It is a private hospital originally staffed by just over 20 people in 1995. Its official website has been removed. However, an archived hospital webpage dated December 23, 2007 states that Weifang Ren De Hospital is a blood purification and kidney transplant-based urology hospital, ranking among the top in Shandong province in the field of kidney transplants.¹³⁵⁷ It has engaged in specialty collaboration with the Affiliated Hospital of Capital Medical University in Beijing and took the lead in HLA typing in Shandong province. In the five years between 1999 and 2004, the hospital completed thousands of tissue matches for organ transplants.¹³⁵⁸

The hospital’s president, Liu Zongjian, previously worked in the Weifang People’s Hospital’s urology department. Liu left to establish Ren De Hospital in 1995. The hospital brought in advanced management experience from the University of Pittsburgh Thomas E. Starzl Transplantation Institute in the U.S. As of 2007, it had performed kidney transplants for nearly 10 years.¹³⁵⁹

Li Dayue joined Ren De Hospital in 2001 as director of surgery. He performed over 300 kidney transplant surgeries in three years.¹³⁶⁰ He then moved to Qidu Hospital, a maternity and child care hospital located in Zibo City, ¹³⁶¹ where he was again in charge of an organ transplantation and blood purification centre.

Around the 2006 Chinese New Year, Ren De Hospital charged 65,000 RMB for transplant surgery, including 30,000 RMB for the kidney source. The fee for the kidney source later rose to 50,000 RMB.¹³⁶² The physicians claimed that all of the donors they used were young and healthy.

Dr. Cui said, “Don’t underestimate this small hospital. We dedicate ourselves to specializing in this [organ transplantation]. I believe we have the largest source of kidneys in Shandong Province and perform the most [transplants]. We obtain our kidneys from sources throughout the country. The kidneys leave the [donor’s] body in less than 24 hours. The quality is absolutely assured. Our hospital president obtains the [kidneys] himself and performs the surgeries personally.”

We observed across the transplant hospitals surveyed that the hospitals performed a wide variety of transplants: kidney, liver, heart, lung, spleen, adrenal glands, pancreas, combined liver-kidney, combined pancreas-kidney, heart-lung, heart-kidney, small intestine, liver-pancreas-duodenum, pancreas-duodenum-kidney, liver-pancreas, liver-small intestine, pancreas-kidney, parathyroid, thyroid-parathyroid-thymus, abdominal organ cluster, all 7 abdominal organs, and eight large full abdominal organs. The list includes 23 kinds of single-organ and multi-organ transplants, including cornea, bone marrow, testicular, bone, skin (including facial), hair, larynx, and many other types of tissue transplants.

Compared to large organ transplants, cornea transplants have less technical requirements, much lower costs, and huge market demand. Many medical institutions are performing large volumes of cornea transplants. In addition to large hospitals’ ophthalmology departments and many eye hospitals, occupational diseases hospitals, traditional Chinese medicine hospitals, and others also took part in cornea transplants in large volumes. We list a few examples below.

Chen Jiaqi, director of the Zhongshan University Ophthalmic Centre, founder of the China Eye Bank, and director of the Eye Bank of Guangdong Province, said in an interview with People’s Daily on June 7, 2012¹³⁶³ that according to his estimation, China needs to perform at least 300,000 to 400,000 cornea transplants each year to meet the needs of patients. However, “of the 20 eye banks nationwide, almost all are empty,” because there are no national guidelines on centralized cornea donation, restrictions on their use, or reception of gifts from foreign eye banks.

The hospital’s website stated that the hospital had performed more than 40,000 cornea transplants and ocular surgeries. ¹³⁶⁴ Its total number of surgeries and volume per year ranked first in the country.

This hospital was one of the earliest in the field of cornea transplantation. It claims to be among the most advanced in the country and the leader in the province. It hosts the Heilongjiang Provincial Eye Bank. The hospital currently has more than 180 professional and technical personnel, including more than 90 doctors and 94 nurses and technicians, among whom 51 have senior titles, 56 have intermediate titles, 39 have doctoral degrees, and 42 have master’s degrees. The hospital has 229 beds, treats 190,000 patients, and conducts more than 10,000 surgeries each year.¹³⁶⁵

The dean of the Eye Hospital is Professor Liu Ping. He also serves as the director of the Eye Bank of Heilongjiang Province and director of the Key Laboratory of Eye Centre of the Harbin Medical University.  He led the formation of the eye bank and developed multiple technological innovations in cornea transplantation and preservation, which put the hospital in a leading position in this field domestically. ¹³⁶⁶

The Eye Bank was established in 1999 but received only one donation in the five years after it opened. Liu Ping said, “We have to find alternative sources of corneas to use for our transplants.”

In recent years, Liu has received funds for three projects under the National Natural Science Foundation—one under the national Eleventh Five-Year Plan (2006-2010), one under the Department of International Cooperation, and eight provincial research projects. He has also published six books and more than 200 papers in core journals at home and abroad, including 30 Science Citation Index papers.

According to the Centre’s website,¹³⁶⁷ the hospital established China’s first formal eye bank in 1979 and had carried out nearly 10,000 cornea transplant surgeries by April 2014. The hospital thanked the relevant government departments in actively supporting, cooperating, and broadening the sources of cornea donors. According to the doctors’ paper, between July 1984 and December 1990, the hospital had only 898 cases (1,139 eyes) of outpatient registration appointments for cornea transplantation.¹³⁶⁸ Thus, the other 9,000 or so transplants were carried out in or after 1991.

This hospital’s website claimed to have a formal eye bank approved by the Health Department of Shandong Province in 2007.¹³⁶⁹ Since it performed its first cornea transplant in 1999, it has carried out thousands of cornea transplants. The Centre has a number of experts, including Zhang Shaobin, who has independently completed a few thousand cornea transplants of various types.¹³⁷⁰ The hospital’s website also states that its eye bank provides patients with ample cornea sources.

This facility carries out a large number of cornea transplants. Multiple media reported that the director of the institute, Zhang Lixin, had performed over 10,000 cornea transplants by April 2008.¹³⁷¹

In June 2006, a patient`s family member wrote to the Minghui.org website,¹³⁷² “I have a relative who was referred to the Shandong Eye Institute by the Third People’s Hospital of Dalian. The cornea transplant surgery was performed on the third day of admission. There are many young doctors working in that hospital for patients from all over the country. Beds are rarely vacant, and doctors are very busy. They need to do more than a dozen transplants every day.”

The General Hospital of Shenyang Military Command is one of the largest military hospitals in China. Not only are its kidney and liver transplant centres well-known in China, but the hospital is also well-known for its ophthalmology department, which has the largest eye bank in the People’s Liberation Army and in northeastern China.¹³⁷³ This hospital leads the northeastern region in cornea transplant volume. It is known as the only hospital in the region with readily available corneas for transplant patients at any given time.

No. 463 Hospital is the location of the Liaoning Province Red Cross Eye Bank. It claims to be the biggest cornea transplant centre in the northeastern region and have the richest source of highest-quality corneas. At least six of its doctors are involved in cornea transplants.¹³⁷⁴

The First Hospital of China Medical University, located in Shenyang, Liaoning Province, also performs cornea transplants on a large scale.

Its ophthalmology centre spreads over 4,000 square meters. It has six standardized operating rooms and 62 beds. Its outpatient capacity reaches over 60,000 per year. The hospital performs over 2,500 surgeries annually. It has 59 professional and technical personnel, including 15 with senior titles, 10 with intermediate titles, and 17 residents.¹³⁷⁵

Its former director of the cornea centre, Hong Jing, was also the director of the Eye Bank of China Medical University from 2002 to March 2006. She joined the centre as a master’s student in 1990¹³⁷⁶ and started to perform cornea transplants in 1996. In 10 years, she conducted over 1,140 cornea transplant of various types.¹³⁷⁷ The centre’s website claimed that it performed 2,000 cornea transplants between 1996 and 2012, a number incommensurate with the hospital’s other figures.

A woman using the pseudonym Annie in 2006 stated that her ex-husband worked at this hospital as a surgeon and, between October 2001 and October 2003, removed 2,000 corneas from living Falun Gong practitioners.¹³⁷⁸ This hospital is 30 kilometers away from the General Hospital of Shenyang Military Command.

Even hospitals of non-transplant-related specialties, such as occupational diseases hospitals and traditional Chinese medicine hospitals, are performing cornea transplants. For example, a doctoral thesis from the Henan Provincial Occupational Diseases Hospital claimed that, between 2003 and 2007, the cornea donors they used were young adults who had suffered sudden deaths.¹³⁷⁹ Between 2000 and 2001, the cornea donors used by the Jiangsu Province Jintan City Chinese Medicine Hospital were also young adults who had suffered sudden deaths; cornea procurement was completed within two hours.¹³⁸⁰

In general, the scale of cornea transplantation in mainland China is at least that of liver and kidney transplants.