BY DAVID MATAS
(Remarks prepared for delivery to the University of Utah, 19 September, 2014)
I want today to address two topics, the evidence about the killing of Falun Gong for their organs and what Utah can do about it.
- Evidence
I am a lawyer in Winnipeg, Manitoba, Canada in private practice. My clients are primarily refugee claimants seeking protection in Canada. I have been engaged in this professional work for almost all of my professional career.
Because my clients flee human rights violations, I have become familiar through my work with the human rights situation in many countries, including China. I try, as best I can, not only to assist my clients in obtaining protection, but also to combat the human rights violations which caused them to flee. In addition to tribunal and court work for individual clients, I have become involved in research, writing, advocacy and activism in the broader human rights scene.
Because of my human rights work on human rights and refugees, I knew about the persecution of the practice of Falun Gong in China more or less from time it started. I knew that Falun Gong was a set of exercises with a spiritual foundation, started in 1992 with the teachings of Li Hong Zhi, initially encouraged by the Communist Party but then repressed in 1999 after it got too popular.
A woman with the pseudonym Annie made a public statement in Washington DC in March 2006 that her ex-husband had been harvesting corneas of Falun Gong practitioners in Sujiatun Hospital in Shenyang City in Liaoning province from 2003 to 2005. Other doctors had been harvesting other organs. The Falun Gong practitioners were killed through the organ extraction and their bodies were cremated. The organs were sold at high prices to transplant tourists. The Chinese government immediately denied what Annie said.
Annie’s statement and the Chinese government denial were two of the many human rights stories which pop up on my computer every day. Shortly after, a Washington based NGO, the Coalition to Investigate Persecution against the Falun Gong asked me and David Kilgour to investigate whether what Annie said was true.
It is common for me to be asked to assist in human rights work. This request though was unusual though because of the difficulties it posed.
Though I knew full well that in China practitioners of the exercises Falun Gong were being persecuted, that did not mean that they were being persecuted in this particular way, being killed for their organs. The Coalition who asked us to do the research did not give us any data, any money or any instructions. For my part, I had no idea whether what Annie said was true or not.
Her story presented a conundrum. How was it possible to know whether what Annie was saying was true or not? The question was not just, how do we prove what Annie said if it is true? The question was also, how do we disprove what Annie said if it is not true?
The situation the testimony of Annie presented was this. She was saying that there were no victims to interview because the victims were all killed. There were no bodies to autopsy because the bodies were cremated. There was no crime scene to visit, since the crime scene, an operating theatre, would have been cleaned up immediately afterwards. There were no accessible records, since what records there are belong to Chinese hospitals and prisons, labour camps and detention centres, none of which are publicly available. The sole witnesses available were perpetrators who were unlikely publicly to confess to crimes that they had committed.
The question whether what Annie said was true was difficult enough that it was unlikely to get much of a response either from human rights NGOs or inter-governmental organizations or the media. Human rights NGOs, though they have some research capacity, are for the most part campaign organizations. They look for the easily verifiable, not just because it makes research easier, but also because it makes campaigning easier. Inter-governmental organizations have little internal research capacity and tend to rely on the work of NGOs. As for the media, they cater to readers, listeners and viewers with short attention spans. If a story can not be told quickly and simply, it normally can not be told at all.
Addressing a claim of human rights violations with little or no evidence is a situation to which I am quite accustomed. That, in fact, is my daily work as a refugee lawyer.
Refugee claimants come to my office with stories of horror, the clothes on their backs and little else. They of course have this advantage that they are witnesses to what happened to them. Yet, they are often faced with sceptical refugee judges who suspect that they are economic migrants making up stories in order to move from a poor country to a rich country. Are the stories these clients tell true or not true? Answering that sort of question is not that different form assessing the truth of the story Annie told.
I am often faced with the task of assisting my clients in attempting to establish to the satisfaction of one these sceptical judges the truth of the story they tell.
Often when victims or their representatives come to me for general assistance to combat a human rights situation abroad, I can send them off to the media or the local Member of Parliament or a human rights NGO or a UN human rights mechanism. I realized though that, for what Annie said, that would not do. If something was going to be done, David Kilgour and I were going to have to do it ourselves.
But the question was what was that something to be? I began constructing imaginary evidentiary trails, trails that would either prove or disprove all the allegations. In doing so, I followed four principles.
One was never to rely on rumour or hearsay. If someone told me what someone else told him or her, I put the information to one side.
Second, I refused to rely on information from perpetrators. In the course of our work, some perpetrators did come forward to offer testimony, subject to various conditions. I turned all such offers aside, partly because I wanted to have nothing to do with perpetrators and partly because I have in the past found in other contexts perpetrator information to be self exonerating and unreliable.
Third, I insisted that all information I saw anyone else could see. No one, after our work was done, had to rely on our conclusions. Anyone who wanted to do so could look at the information we considered and come to his or her own conclusions.
Fourth, I determined not to draw conclusions either one way or the other based on one bit of evidence only. Rather I intended to have regard to all the evidence before coming to any conclusion.
The conclusion was that Falun Gong practitioners have been and are being killed for their organs. While it would take far too long for me to go through all the evidence which led to that conclusion, I will mention here a few bits.
- Investigators made calls to hospitals throughout China, claiming to be relatives of patients needing transplants, asking if the hospitals had organs of Falun Gong practitioners for sale on the basis that, since Falun Gong through their exercises are healthy, the organs would be healthy. We obtained on tape, transcribed and translated admissions throughout China.
- Falun Gong practitioners and non-Falun Gong practitioners alike who were detained and who then got out of detention and out of China told that
1) Falun Gong practitioners were systematically blood tested and organ examined while in detention. Other detainees were not. The blood testing and organ examination could not have been for the health of the Falun Gong practitioners since they had been tortured; but it would have been necessary for organ transplants.
2) Falun Gong practitioners who came from all over the country to Tiananmen Square in Beijing to appeal or protest were systematically arrested. Those who revealed their identities to their captors would be shipped back to their home localities. Their immediate environment would be implicated in their Falun Gong activities and penalized.
To avoid harm to people in their locality, many detained Falun Gong practitioners declined to identify themselves. The result was a large Falun Gong practitioner population in detention whose identities the authorities did not know. As well, no one who knew them knew where they were. This population is a remarkably undefended group of people, even by Chinese standards. This population provided a ready source for harvested organs.
3) The Party has engaged in a prolonged, persistent, vitriolic national and international campaign of incitement to hatred against Falun Gong. The campaign has prompted their marginalization, depersonalization and dehumanization in the eyes of many Chinese nationals. To their jailors, Falun Gong are not human beings entitled to respect for their human rights and dignity.
- Patients we interviewed who went to China for transplants told that
1) Waiting times for transplants of organs in China are days and weeks. Everywhere else in the world waiting times are months and years. A short waiting time for a deceased donor transplant means that someone is being killed for that transplant.
2) There is a heavy militarization of transplantation in China. Hospitals with a ready supply of available organs are often military hospitals. Even in civilian hospitals, the doctors performing operations are often military personnel. The military have a common culture with prison guards and readier access to prisoners as organ sources than civilian hospitals and civilian personnel do.
In China, the military is a conglomerate business and the sale of organs is a prime source of funds. Military hospital web sites used to boast this fact before we started quoting them. Though they have since taken down the boasts, we archived this information so that independent researchers can still see them.
3) There is an inordinate secrecy surrounding transplantation in China. The names of doctors are not identified. Patients are not allowed to bring their own doctors with them. Before our 2006 report came out, Chinese doctors used to provide letters to patients indicating the treatment given and counselled. The letters ceased after the publication of our report.
- The standards and mechanisms which should be in place to prevent the abuse are not in place, neither in China nor abroad. International organ transplant abuse should be treated like international child sex tourism, an offence everywhere with extraterritorial effect. However, so far that is not the case.
On the one hand, we have organ transplant abuse which is possible without legal consequences. On the other hand, we have huge money to be made from this abuse, as well as desperate patients in need of transplants. This combination is a recipe for victimization of the vulnerable. Standards and mechanisms to prevent the abuse need to be introduced.
- There is no other explanation for the transplant numbers than sourcing from Falun Gong practitioners. China is the second largest transplant country in the world by volume after the US. Yet, until 2010 China did not have a deceased donation system and even today that system produces donations which are relatively small. Until 2013, China did not have an organ distribution system. The organ distribution in place today is limited to the relatively small donated organs, and does not distribute organs from prisoners. The living donor sources are limited in law to relatives of donors and officially discouraged because live donors suffer health complications from giving up an organ.
The Government of China at first took the position that all organs came from donations, even though at the time they did not have a donation system. They then acknowledged that the overwhelming proportion of organs for transplants in China came from prisoners but asserted that the prisoners who are the sources of organs are all sentenced to death. Falun Gong practitioners have been given short sentences for disrupting social order or sentenced to nothing.
Yet, the number of prisoners sentenced to death and then executed that would be necessary to supply the volume of transplants in China is far greater than even the most exaggerated death penalty statistics and estimates. Moreover, in recent years, death penalty volumes have gone down, but transplant volumes, except for a short blip in 2007, remained constant.
Going through all relevant evidence to come to an informed conclusion either one way or the other on the killing of Falun Gong for their organs is a time consuming task, and it may be unrealistic to expect everyone interested in the issue to do that. I do not expect all other interested in the issue to replicate our research, though I would be pleased if you had the time and inclination to do so. Nor do I expect you to trust our conclusions. But that does not mean that you should do nothing.
The onus does not fall on me to show that Falun Gong practitioners are being killed for their organs. I do not have to explain where China gets its organs for transplants. China does. It falls on the Government of China to explain the sourcing for their organs.
The World Health Organization, in an Assembly in May 2010 endorsed Guiding Principles on Human Cell, Tissue and Organ Transplantation. Two of these principles are traceability and transparency.
The Government of China refuses to provide death penalty statistics on the basis that they are state secrets. The connection between death penalty statistics and organ transplant abuse was made explicit by the UN rapporteur on torture, the UN rapporteur on religious intolerance and the UN Committee on Torture. All have asked China to explain the discrepancy between its volume of transplants and its volume of sources.
- Utah action
- i) Confucius Institute
For Utah, I have four suggestions to make. One is that the University of Utah should close its Confucius Institute[1].
McMaster University in Hamilton, Ontario, Canada announced on February 7th that it decided to close its Confucius Institute. The University had hosted the Institute since 2008. The Institute required six months notice for termination. McMaster gave that notice. The Institute closed in March 2013.
Hiring for Confucius Institutes is done by its headquarters in China, called Hanban. Hanban’s hiring policy excludes persons who practice Falun Gong. McMaster University determined that this policy violates its principles of equality.
Sonia Zhao was an employee of the Confucius Institute at McMaster University and a Falun Gong practitioner. When she was in China before joining the Institute, Zhao had to sign a statement promising not to practice Falun Gong. She made a complaint against McMaster University to the Ontario Human Rights Tribunal which was settled. The terms of the settlement agreement are confidential.
McMaster University a statement on May 2, 2013[2] which said in part:
“The decision to close the [Confucius] Institute was made after concerns were raised with the University regarding the screening process used in China for the selection of teaching assistants. The process excluded certain classes of applicants, which is not consistent with the University’s values of equality and inclusivity, nor with McMaster’s Anti‑Discrimination policy.
In particular, concerns were raised regarding the exclusion of practitioners of Falun Gong from the hiring process. Sonia Zhao, a former teaching assistant at McMaster’s Confucius Institute, brought a complaint against the University to the Human Rights Tribunal of Ontario. Her complaint, which alleged discrimination on the grounds of creed, proceeded to mediation and was resolved after discussions between Ms Zhao and the University.
McMaster gave official notice of the closure to its Chinese partners in December, 2012, naming a closure date of July 31, 2013. Following the decision of McMaster’s Chinese partners to withdraw the services of the teaching staff on March 21, the closure process was accelerated.”
The Canadian Association of University Teachers in December 2013 urged all Canadian universities and colleges urged to end ties with Confucius Institutes[3]. Confucius Institutes are academic units providing instruction in Chinese language and culture. They are most often physically situated on campuses and provide accredited courses.
CAUT executive director James Turk noted that the University of Manitoba rejected hosting a Confucius Institute out of concerns over political censorship, and McMaster University ended its agreement with the Confucius Institute earlier this year following a human rights complaint by an instructor who alleged discriminatory hiring practices against members of Falun Gong.
CAUT executive director James Turk said:
“In agreeing to host Confucius Institutes, Canadian universities and colleges are compromising their own integrity by allowing the Chinese Language Culture International to have a voice in a number of academic matters, such as curriculum, texts, and topics of class discussion …Such interference is a fundamental violation of academic freedom. …Simply put, Confucius Institutes are owned and operated by an authoritarian government and beholden to its politics.”
The University of Utah, I am pleased to see, has an Equal Opportunity and Nondiscrimination Employment policy[4]. The University, I am confident, if it investigates the matter will find that its Confucius Institute functions in violation of the policy by discriminating in hiring against Falun Gong as McMaster University has done. The University should not maintain the Institute in violation of that policy.
- ii) Transplant training
The University of Utah has a Transplant Center[5]. That Center needs to develop a policy of not training any Chinese surgeon in any transplant surgical technique without a commitment that the trainee will not engage in organ transplant abuse.
Neil Laurie, Clerk of the Queensland Parliament, by letter dated November 1, 2006, sent a petition to Stephen Robertson, the Minister of Health for the Queensland Government in Australia, asking for an investigation of the forced organ harvesting from Falun Gong. The Minister of Health, on December 1, 2006 in response, wrote that the Prince Charles Hospital has “a policy of not training any Chinese surgeon in any transplant surgical technique’.
The Prince Charles Hospital is one of the major transplant hospitals in Queensland. I have been told informally that, though no other Australian State Health Minister has issued a similar statement, other transplant hospitals in Australia now follow a similar policy.
Doctors Danovitch, Shapiro, and Lavee, in a 2011 article[6], wrote
“Training of Chinese transplant professionals by the international community must be conditioned on commitments that trainees will not engage, directly or indirectly, in the use of organs from executed prisoners.”
At the very least the University of Utah Transplant Center needs a policy that the Center will not train Chinese transplant professionals unless the trainee commitments that he or she will not engage in the use of organs from prisoners.
iii) Legislation
Utah representatives and Senators in Congress should propose and enact legislation to combat international organ transplant abuse. Legislative initiatives in this area would highlight the importance of ending this abuse and strengthen the position of those in China who are themselves seeking to end it.
Congress has prohibited the knowing purchase and sale of organs through the National Organ Transplant Act of 1984[7]. This law should be given extraterritorial scope so that Americans who buy and sell organs abroad can be prosecuted in the US for organ trafficking.
Congress has passed legislation giving extraterritorial reach to American prohibitions against sex trafficking[8]. That sort of legislation should be enacted for organ trafficking. The legislation should encompass brokers as well as purchasers and sellers.
- iv) Ethics
My fourth suggestion is an elaboration of ethical standards. The American Medical Association Code of Medical Ethics has Organ Transplantation Guidelines[9] which simply do not address the many ethical problems posed by American interaction with Chinese transplant abuse. The Guidelines need considerable expansion to address these problems. Doctors from Utah should be asking the American Medical Association to do that.
I have a number of suggestions to make of more detailed and specific ethical standards. All of these suggestions are drawn from either international codes or national codes in other countries.
Sources of organs
1) There should be no recovery and no complicity in the recovery of organs or tissues from executed prisoners.
2) Medical personnel should not go abroad with a patient for organ transplantation and receive compensation.
Referrals
3) In the case of a referral for an organ transplant outside the country from any donor, a doctor would be acting unethically if he made the referral without ascertaining the status of the donor or following these principles:
- a) The benefit and welfare of every individual donor should be respected and protected in organ transplantation.
- b) Consent must be given freely and voluntarily by any donor.
- c) If there is doubt as to whether the consent is given freely or voluntarily by the donor, the doctor should reject the proposed donation.
4) Medical personnel should not, with or without charge, introduce patients to intermediaries or organ transplant brokers.
5) Medical personnel should not, with or without charge, refer patients to a country where either
– the local law does not prohibit the sale of organs,
– information on the source of organs is not transparent,
– there are gross human rights violations and absence of the rule of law or
– there are known violations of medical ethics in organ transplantation.
Advertising and brokerage
6) There should be no advertising (including electronic and print media), soliciting, or brokering for the purpose of transplant commercialism, organ trafficking, or transplant tourism.
7) Medical personnel should not contact foreign organ transplant institutions to broker organ transplantation.
Patient counselling
8) All patients with end‑stage organ failure who are candidates for transplantation should receive information about the dangers and ethical concerns regarding transplant tourism and organ trafficking.
9) Patients should be told that individuals who purchase transplants overseas are at an increased risk for complications, including death, organ failure, and serious infections.
10) Patients should be told that those who obtain a transplant overseas may receive sub-optimal care even when they return because:
– health care providers often receive little or no advance notice or documentation of commercial transplantations making the post-transplant care of recipients of commercial transplantations more difficult.
– Without documentation of the surgical procedure, post-transplant course and complications, health care providers may not have the necessary information to provide optimal care, diagnoses may be delayed, and the patient’s well- being may be compromised.
– health care providers may not be able to obtain reliable clinical information from the centres which performed the transplantations.
– the information which is obtained cannot be trusted or verified.
– health care providers have no ability to validate the accuracy of any documents that may be provided by individuals or centres engaging in transplant tourism and have no professional relationship with individuals who may be performing illegal activities in their countries.
– Uncertainty regarding the details of commercial transplantations may compromise individual patient care.
– Patients are transferred before they are clinically stable:
– Immediate post-transplant care is complicated and is best directed by the original transplant team.
It is worth here noting a bit of what Malaysian doctor Ghazali Ahmad wrote in the book State Organs, in the chapter he contributed titled “The Spoils of Forced Organ Harvesting in the Far East”. He set out:
“Even though the number of renal transplant patients returning from China had dwindled significantly since 2006 (see table 1) the management of such patients became unfortunately more complicated and challenging. The main reason for this circumstance is due to the fact that ALL new returning transplant recipients from China since 2006 no longer bring along with them any form of documentation to guide the clinicians in Malaysia to provide optimal follow up care. Such a practice is a part of deliberate attempts by the syndicate members to remain anonymous, unaccountable and leave absolutely no trace of their illegal activities. However, the absence of any information on the perioperative as well as postoperative findings, clinical summary, necessary information on the type and dose of the induction agents given, the best serum allograft function achieved and the lack of many other standard test results had caused a serious gap in the ability of the local clinicians to deliver a quality and effective care deserved by such patients who had not only risked their lives and parted with their hard earned life savings to obtain a new, safer and better quality of life but now faced real and potentially serious transplant related complications.”
11) Patients should be educated about the harms that may come to those who provide organs through transplant tourism.
12) When it comes to transplant tourism into China, patients should be advised that organs may have been taken by force, and individuals may even been killed to obtain their organs.
13) Patients should be advised that the transplant tourism industry relies on secrecy, making it is impossible to determine whether donor information provided by organ brokers, who are motivated by financial gain, is accurate.
14) Physicians should advise patients, where this is the case, of their unwillingness to provide post-transplant care for patients who obtain transplants through transplant tourism.
Insurance
15) Insurance coverage for medical or surgical expenses should not be extended to patients in jurisdictions outside the country related to the transplantation of an organ obtained through transplant tourism.
16) Nationals who travel abroad for organ transplants provided on a commercial basis should not be allowed to get a free supply of immunosuppressant drugs from government hospitals.
17) Health care providers should inform patients that, where this is the case, insurers will not extend insurance coverage for medical or surgical expenses incurred by patients in jurisdictions outside the country related to the transplantation of an organ obtained through transplant tourism.
Pre-transplant care
18) The fiduciary responsibility of physicians to do what is in the best interest of their patients does not include the performance of investigations in preparation for transplantation of a purchased
organ.
19) Physicians should not prescribe medications or otherwise facilitate obtaining medications which will be used during the transplantation of a purchased organ.
20) Individual physicians may elect not to provide medical records to patients if they believe the information will be used in support of an abusive transplant performed in a system which violates international human rights standards and that there is a significant risk of harm to the patient or organ source.
Post-transplant care
21) In non-emergency situations, individual physicians may elect to defer to another physician care of a patient who has returned from transplant tourism abroad. In such situations, the physician should ensure that the patient has reasonable access to the proposed alternative care provider.
Research and collaboration
22) Only those doctors who conduct clinical practice ethically should be permitted to become members of professional associations.
23) Collaboration amongst transplant professionals in different countries must protect the vulnerable, promote equality between donor and recipient populations, and not violate other basic organ transplant principles.
24) Collaboration within clinical studies should only be considered if the study does not violate ethical principles, for example through the sourcing of organs or tissues from executed prisoners.
25) Collaboration with experimental studies should only be considered if no material derived from executed prisoners or recipients of organs or tissues from executed prisoners is used in the studies.
26) Clinical scientific studies which analyze patient outcome or entail therapeutic or mechanistic approaches should be considered for acceptance only if they have been performed under ethical principles.
27) Presentations of studies involving patient data or samples from recipients of organs or tissues from executed prisoners should not be accepted.
Conclusion
The ability of those outside of China to stop the killing in China of prisoners of conscience for their organs is limited. Yet, there are two practical steps we can take. One is to do nothing to be complicit in the Chinese abuse. The second is to avoid giving any status to the abusers.
A significant driver for change of transplant practices in China is the desire to achieve international respectability. Giving Chinese transplant professionals any form of international status while transplant abuse continues in China undermines the efforts to end the abuse.
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David Matas is an international human rights lawyer based in Winnipeg, Manitoba, Canada
[1] http://confucius‑institute.utah.edu/
[2] http://dailynews.mcmaster.ca/worth‑mentioning/update‑confucius‑institute/
[3] http://www.caut.ca/news/2013/12/17/universities‑and‑colleges‑urged‑to‑end‑ties‑with‑confucius‑institutes
[4] http://regulations.utah.edu/human‑resources/5‑106.php
[5] http://healthcare.utah.edu/transplant/
[6] G.M. Danovitch, M.E. Shapiro, and J. Lavee “The Use of Executed Prisoners as Sources of Organ Transplants in China Must Stop” Volume 11 pages 426 428.
[7] Public Law 98-507 section 301 at
http://history.nih.gov/research/downloads/PL98‑507.pdf
