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

Since David Kilgour and David Matas wrote Bloody Harvest and Ethan Gutmann wrote The Slaughter, we three have remained active in writing, researching, investigating and speaking on organ transplant abuse in China. We have a joint website – www.endorganpillaging.org – which posts our work as we do it. David Kilgour also has a website – www.david‑kilgour.com – which keeps up to date on this issue, also posting the work of all three of us.

We encourage readers, before they start this work, to read our previous works on transplant abuse in China. It is difficult, if not impossible, to appreciate an update without awareness of what is being updated. The information we have provided previously is not repeated here. Nonetheless, to make this text user-friendly we provide a brief recapitulation of our previous work here.

Recapitulation

Bloody Harvest came out in three versions, first in July 2006, second in January 2007 and third, in book form, in August 2009. The first report was prompted by a request David Kilgour and David Matas received from an NGO to investigate a statement that a woman (given the pseudonym “Annie”) had made. Annie told the newspaper the Epoch Times in a story published in its March 17, 2006 issue: “One of my family members was involved in the operation to harvest Falun Gong practitioners’ organs.” The requesting NGO was the Coalition to Investigate the Persecution of Falun Gong. (This NGO is similar in name to the World Organization to Investigate the Persecution of Falun Gong, but is a different organization.)

Falun Gong, also known as Falun Dafa, began in May 1992 with the teachings of Li Hongzhi. The two Davids have described Falun Gong as a set of exercises with a spiritual and ethical foundation. Ethan Gutmann in The Slaughter states: “Falun Gong, simply put, is a Buddhist revival movement.”

In 1999 the Communist Party of China decided to repress the spiritual practice and its practitioners. Those who did the exercises after the repression campaign was launched were arrested and asked to denounce the practice. Those who did so were released. Those who did not were tortured. Those who still refused to recant after torture disappeared into the Chinese gulag – China’s network of labour camps, detention centres, psychiatric hospitals, prisons, and black jails, sometimes referred to as the “Laogai System.”

Chapter one of the book Bloody Harvest set out the methods David Kilgour and David Matas used to do their research. Amongst the methodological principles used were an insistence on looking at all evidence and a refusal to jump to conclusions based on only some of the evidence; a refusal to rely on hearsay or rumour or third party evidence; and an insistence that any evidence which the two Davids saw independent researchers could see on their own to form their own conclusions.

Chapter two set out contextual information, the general repression of Falun Gong. Whatever one concludes about the killing of Falun Gong for their organs, the vilification and brutalization of practitioners of Falun Gong in China is incontestable.

Chapters three and four provided some Falun Gong witness/victim statements. These statements showed, in chapter three, that many detained Falun Gong practitioners refused to identify themselves to the authorities. The non‑self‑identified were more numerous than the self‑identified and with rare exceptions, were never released.

These statements also showed, in chapter four, that Falun Gong practitioners in detention were systematically blood tested and organ examined. Non‑Falun Gong detainees did not experience similar tests and examinations.

Chapter five set out statements of patients who went to China for transplants. These statements showed that organs were available on short notice, in secrecy, with a heavy involvement of military personnel and institutions.

Chapter six looked at Chinese transplant hospitals. Many of these hospitals on their websites actively promoted transplant tourism, advertising easy, quick availability of organs, at high prices.

Chapter seven detailed calls investigators made to hospitals. The callers pretended to be relatives of patients who needed transplants and asked for organs of practitioners of Falun Gong. The reason for the requests was that the exercises of practitioners meant the organs would be healthy. Hospitals throughout China told the callers, in calls which were taped, transcribed and translated, that they had organs of Falun Gong practitioners for sale.

Chapter eight attempted to estimate the sourcing of organs based on Chinese government statements of transplant volumes. The estimate was that, from 2000 to 2005, at a transplant volume of the official figure of ten thousand a year, approximately 41,500 organs during those six years came from practitioners of Falun Gong.

Chapter nine looked at Sujiatun hospital, where Annie’s husband worked. Some investigators went to the hospital several weeks after Annie’s statement and found nothing. The chapter pointed out that this sort of investigation had little probative value.

Chapter ten set out work from other researchers on the subject. All the researchers corroborated the results of the two Davids.

Chapter eleven provided the responses of the Government of China to the evidence of the killing of practitioners of Falun Gong for their organs. The responses have been harassment, bullying, spying, disinformation, and anti‑Falun Gong propaganda.

Chapter twelve went through foreign laws on transplant tourism and Chinese laws on transplant abuse. The conclusion was that the laws which should have been in place to prevent the killing of Falun Gong for their organs and selling the organs to transplant tourists were not in place.

Chapter thirteen examined ethical codes of conduct of transplant professionals on transplant tourism and relationships with Chinese transplant professionals. The chapter noted that there had been substantial development in these codes since the first report of the two Davids, but that there was still much to do.

Chapter fourteen asked the question “How does one best combat human rights violations in China?” The answer given was to go after the worst violations first ‑ in this instance, the killing of Falun Gong practitioners for their organs.

Chapter fifteen addressed the Chinese Communist Party claim that human rights values are Western. The argument of the chapter is that human rights values are universal.

Chapter sixteen addresses the question “How do we end organ transplant abuse in China?” The chapter made a number of recommendations, one of which is the need for an institutionally‑based independent investigation into organ transplant abuse in China.

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Ethan Gutmann devised a test to either confirm or reject the basic conclusions of Bloody Harvest: instead of relying on Chinese official transplant numbers, investigative phone calls, and other evidence that had previously come to light, the investigation would start with a blank page and attempt to fill the space with field research and witnesses who had never been spoken to. This created an environment where the goals of the investigation could be hidden from the subjects as well. Gutmann and his researchers Leeshai Lemish and Jaya Gibson ended up travelling across four continents, interviewing well over one hundred individuals over a six‑year period.

After his first ten interviews with Falun Gong refugees, Gutmann began to suspect that the conclusions of Bloody Harvest were true, and possibly even understated. However, Gutmann also wondered if evidence that only focused on the central question – “Are the allegations true?” – would fully persuade critical readers in the West. For example, it is simple common sense that murder requires a motive. Yet China is a complex culture; establishing a motive cannot always be reduced to a soundbite. Instead, Gutmann decided that, given a comprehensive history of the conflict between the Chinese Communist Party and Falun Gong, the readers themselves would be capable of answering certain basic questions: “Why did the Party attack Falun Gong? How did a relatively routine Party crackdown degenerate into mass murder?”

Critical readers might also want to understand how forced organ harvesting of prisoners of conscience began. So a new line of investigation was created focusing on the following questions: “Was Falun Gong the first victim group to be harvested? If not, how did the organ harvesting of prisoners of conscience begin? Was organ harvesting created as a “final solution” for Falun Gong or was it an improvised solution?

In August 2014, Prometheus Books published The Slaughter: Mass Killings Organ Harvesting, and China’s Secret Solution to Its Dissident Problem. Chapter one established that the first known cases of live organ harvesting – in essence, a surgeon extracting the organs from a living human being so that the surgeon becomes the executioner ‑ were performed in 1995 on the execution grounds of the Xinjiang Autonomous Region in Northwest China. For example, a Uyghur surgeon, Enver Tohti, recounted extracting the kidneys and a liver from a prisoner who had been shot in the chest with the objective not to kill the prisoner but to send the prisoner’s body into shock (and this update confirms that live organ harvesting using medical methods would actually become a routine procedure a few years later). The chapter also established that the first forced organ harvesting of prisoners of conscience – in this case, Uyghur Muslim activists – were administered in Urumqi, the capital of the Xinjiang Autonomous Region, in 1997. Another medical witness described being forced to administer blood tests of Uyghur political prisoners on behalf of a handful of aging, high‑ranking, Chinese Communist Party officials who needed tissue‑matched organs. Because the officials had travelled to Urumqi specifically for the operations, this can be seen as one of the first cases of “organ tourism,” albeit within China’s borders, while also underscoring that the Party was explicitly involved in the forced organ harvesting of political and religious prisoners from the very beginning.

It was during this period that the Chinese Communist Party began construction of the world’s largest labour camp in the Tarim Desert, where approximately 50,000 Uyghurs and hardened criminals (and ultimately Falun Gong) would be detained. Yet there was no guarantee in 1997 that organ harvesting would become the Party’s preferred method of eliminating prisoners of conscience, so the research question then turns from the “how?” to the “why?”

Chapter two is the first of six chapters that examines how the conflict between the Chinese State and Falun Gong evolved over time. Beginning in 1992, the chapter tracks various Falun Gong practitioners – a university student, a professor, a small business owner, and a female pensioner – to illustrate how the practice could spread so quickly throughout Chinese society and even into the upper echelons of the Chinese Communist Party. The chapter also reveals the testimony of a finance minister who is told to cooperate in the secret surveillance and repression of Falun Gong in 1996, demonstrating that the Party had already decided to eliminate Falun Gong and any remaining debate was largely over tactics. The author identifies three main factors in the Party’s decision to eliminate Falun Gong: its size (at least 70 million, and therefore slightly larger than the membership of the Party), its cross‑appeal (particularly in the upper echelons of the Party), and its values of truth, compassion, and forbearance (the nationalist wing of the Party believed these values harkened back to a period of Chinese weakness and thus were in conflict with China becoming globally dominant). The chapter ends in early 1999, shortly before the repression of Falun Gong became officially stated policy.

Chapter three traces the history of the Falun Gong crackdown from the spring of 1999 to the end of the year, when the repression was fully operational. The key points are that Falun Gong walked into several carefully laid‑out traps as the Chinese Communist Party prepared a massive public crackdown. The author also makes the controversial case that the crackdown was not the work of one man, President Jiang Zemin, but a systematic campaign with the tacit support of the majority within the politburo. It is germane to the development of forced organ harvesting in China that both the Falun Gong resistance and the lethal use of torture by state authorities had taken shape before the end of December 1999.

Chapters four, five, six, and seven follow individuals on opposite sides of the fence: an officer of the secret police, a prison camp director, and a series of Falun Gong practitioners demonstrating, printing leaflets, and hijacking television signals. The narrative of pursuit, arrest, torture, and, in several cases, execution, illustrates that Falun Gong was putting up an increasingly effective resistance ‑ even as the state’s structure of persecution was spinning out of control, and shedding any remaining inhibitions surrounding the mass exploitation of Falun Gong for their organs. The “self‑immolation” of Falun Gong practitioners on Tiananmen Square is also examined in detail, with the conclusion that it was not only a set‑up but a masterstroke of state propaganda.

Chapter eight takes a ground‑up approach to forced organ harvesting, focusing on Falun Gong practitioners who were given suspicious “retail organs only” physical examinations while they were in the Laogai System. What emerges is a picture of an organ harvesting regime that began giving discreet physical examinations of select Falun Gong practitioners in late 2000/early 2001, expanding into mass examinations (including Tibetan prisoners of conscience and the House Christian group “Eastern Lightning”) by 2003, and an organ harvesting regime wasn’t even being kept fully secret within the Laogai System by 2005. These findings are amplified by an extensive interview with an investigator (given the pseudonym “Crystal”) from the World Organization to Investigate the Persecution of Falun Gong, and an extended comparison with the findings of Bloody Harvest.

Chapter nine employs a top‑down approach to the evidence of forced organ harvesting beginning with the testimony of Dr. Ko Wen‑je, a Taiwanese surgeon who was offered Falun Gong organs from a Mainland hospital in 2005. (Dr. Ko subsequently ran for mayor of Taipei and during a heated campaign attempted to distance himself from his interview; the actual email correspondence between the author and Dr. Ko confirming his testimony is available for download at ethan‑gutmann.com). The evolution of Falun Gong harvesting after the Beijing Olympics is briefly explored, and there is also a detailed discussion of how organ harvesting played into the Chinese leadership crisis of 2102, specifically the revelation of how Wang Lijun (the right hand man to Communist Party leader Bo Xilai) experimented with mass organ harvesting in Liaoning Province.

Chapter ten explores the relationship between the growth of the plastination industry concordant with the acceleration of forced organ harvesting of prisoners of conscience in Liaoning province. Some of the evidence from that chapter will be referenced in this report.

Finally, an appendix estimates the number of Falun Gong killed for their organs between 2000 to 2008, based on in‑depth interviews of a sample of approximately fifty refugees from the Laogai System. Because the intention was to fill in the full history of the Falun Gong persecution, the author was not actively seeking out Falun Gong practitioners who had experienced an unusual physical examination in detention. The author also rejected accounts of “retail physical examinations” if the subject gave too little detail, had been on hunger strike at the time, was clearly influenced by talking points, or had experienced too much trauma.

So the author’s confidence was high that he had a genuinely conservative sample. However, the author’s confidence in his final estimate: a range of 9000 to 120,000 Falun Gong were killed for their organs from 2000 to 2008 was not as high, as the size of the range implicitly acknowledges. Nonetheless, the mid‑range number that Gutmann chose as his best guess ‑ 65,000 Falun Gong killed for their organs ‑ has been widely accepted in the press. The reason for this has less to do with the author touting the accuracy of the figure, and more to do with a deep human need to contextualize tragedy with a specific number or benchmark.

The need for an update

We felt the need to produce an update to what we have done, for several reasons, seven in all. One is the need to make our own assessment of transplant volumes.

In looking at the sources for organ transplants in China, we have, in the past, taken Chinese government official statements of overall transplant volumes at face value and focused on attempting to identify the sources for those asserted volumes. However, Chinese government statistics for transplant volumes are not necessarily reliable. One effort which needed to be made and which we finally have made is to determine on our own what Chinese transplant volumes are..

We did that by looking at and accumulating the data from the individual hospitals where transplants occur. Some hospitals state their transplant volumes. For those who do not, we can, from their bed counts, personnel strength, potential patient groups, rate of growth, technological development, academic publications, and media reports, come to a conclusion on their transplant volumes.

A second task, flowing from the first, was the need to address cover-up. Cover-up is a standard reaction to wrongdoing. Chinese Communist Party coverup is not a new story. But, because we are dealing new data, we consequently have to address cover up anew, attempts to hide individual hospital transplant figures.

Deception in the data limits the yield of research from that data. Because of the Chinese corruption of the data with which we are working, we cannot make specific numerical conclusions with complete certainty. Accordingly, our estimates of Chinese transplant volumes are not expressed in single integers but in a numerical range.

Despite the cover up and corruption of data, despite our inability to produce an exact figure, we are convinced that transplant volume is substantially higher than the official figure. The high volume led us into a third component of this update, to explore the driving factors behind these volumes.

Once we started looking at what is generating the volume, we had to look at the extent to which the Chinese Communist Party is in the driver’s seat, the structure the regime has built around organ harvesting, and the culpability of some individual Party members. The update accordingly addresses that topic as well.

Fifth, we analyze the Party’s claims of recent transplant reform. The Chinese regime announces changes regularly on organ transplant sourcing, some of which are real, while some are not. Because the Party has moved since our last published works, we too have to move, to assess their claims of change and attempt to determine how real those claims are.

A sixth new feature of this work is incorporation of whistleblower evidence. In the past, we have tended to avoid reproducing that evidence, even though we had it. We have to protect the identities of whistleblowers. That protection, while understandable, means that an independent researcher cannot identify and question the whistleblowers him or herself. Whistleblower evidence nonetheless deserves to be presented publicly, albeit with the identities of the whistleblowers disguised, if for no other reason than to encourage other whistleblowers to come forward. So it is presented here.

Finally, this update addresses plastination, in addition to organ sourcing, a subject we have mostly not addressed before. In the past, we have shied away from addressing plastination, because plastination is different from our focus, organ transplantation. Nonetheless, there is compelling evidence that practitioners of Falun Gong are killed for both plastination and organ sourcing. The evidence supporting each abuse is also evidence in support of the other abuse.

No one in the West has witnessed organ transplant abuse in China; yet a large number have seen plastinated bodies from China on display. Furthermore, plastinated body parts from China have been sold to medical schools and universities throughout the Western world. Plastination gives an immediate, widespread, publicly visible reality to the abuse that the killing of innocents for their organs cannot.

A Note on Methods Used

We have had the benefit of work by a group of Chinese‑language researchers to whom we express our profound appreciation. The researchers:

• reviewed data from telephone surveys, hospital websites, and medical journals for the 865 hospitals in China which perform organ transplants (about 13% of all hospitals);
• tracked 712 liver and kidney transplant centres and collected and analyzed information about them from media reports, public and government websites, current and archived hospital websites, and medical journals;
• examined individually 165 hospitals approved by the Government of China to conduct transplantation and set down their features, qualifications, revenue, potential patient groups, bed counts, personnel, transplant capacity and volume, research projects, relationships with other hospitals and parties, funding, patents, and awards;
• made phone calls to a number of the hospitals to verify their current organ transplant status and to cross check information about the hospitals the searchers had previously obtained; and
• summarized the policies and regulations of the Government on organ transplants, reviewed the history of the industry in China, and provided information on the state military and civilian institutions which enable the industrialization.

This update has to be read forward but understood backwards. The ultimate conclusion is that the Chinese Communist Party has engaged the State in the mass killings of innocents, primarily practitioners of the spiritually‑based set of exercises, Falun Gong, but also Uyghurs, Tibetans, and select House Christians, in order to obtain organs for transplants.

Even with the volumes of transplants the Chinese government has asserted in the past, there is a substantial discrepancy between the number of transplants and the number of sources which the Government of China has identified – prisoners sentenced to death and voluntary donors. This discrepancy is one reason, among several, that had led us in the past to the conclusion that the above groups have been the source of many, and indeed most, organs for transplants.

The fact that the evidence we have now examined shows much larger volumes of transplants than the Government of China has asserted points to a larger discrepancy between transplant volumes and Government of China‑identified sources than we had previously thought existed. That increased discrepancy leads us to conclude that there has been a far larger slaughter of practitioners of Falun Gong for their organs than we had originally estimated.

The update begins, in chapter two, by introducing the examination of individual hospitals. It addresses the volume of evidence, the feature of the evidence and the numbers and classifications of transplant centres.

Chapter three focuses on national approved military transplant centres. Chapter four considers national approved civilian transplant centres. In chapter five, we turn our attention to regional approved transplant centres. Chapter six concludes this examination of individual hospitals by looking at non-approved transplant hospitals and cornea transplant centres.

Chapter seven looks at indicators of total volumes of transplants in China besides the figures which come from looking at particular hospitals. These other indicators and the examination of individual hospitals tell us that the total volume of transplants in China is a substantial multiple of the official figures.

Chapter eight canvasses the various forms that cover up of transplant data takes and considers how that impacts on our own analysis. We address deletion of data, falsification of figures, underreporting and restriction of access to data as well as various pretenses used.

Chapter nine then looks at what is generating this volume. In this chapter, we address the Communist Party and the Government as volume drivers, but not the criminality of the Party /State.

Chapter ten calculate a range of possibilities for the total number of transplants performed in China since 2000. This chapter approaches the range calculation from a variety of directions in order to cross check the totals reached.

Chapter eleven sets out evidence that organ sourcing in China is criminal, that innocents are being killed for their organs. In this chapter, we focus on the evidence of the fact of a crime, without attribution to a particular set of criminals.

In chapter twelve, we address finally who is committing this crime -the Chinese Communist Party – and why. This chapter, in effect, explains all that has been presented before. We have tried to avoid acronyms and technical terminology. Nonetheless, when dealing with a specialized medical field, such as organ transplantation, it is impossible to avoid all technical terms. We have, accordingly, provided a glossary.

We acknowledge that to begin the substance of a report with an accumulation of information drawn from the websites of particular hospitals and the biographies of particular doctors may not be gripping reading. Many of the phrases are translated directly from Chinese reports and websites; the language, however leaden, is preserved for accuracy.

Decontextualized, the presentation of this information may be mystifying. We ask the reader to keep in mind our purpose in presenting this material: to explore the scale and velocity of state‑sanctioned mass murder.

* * *

We understand the desire for a precise number ‑ particularly among the journalism community ‑ but we have collectively decided not to make such an estimate in this update; there are too many variables to make any new estimates other than annual volume of transplants and even that is expressed in a range. We are not in a position to come up with a specific figure of prisoners of conscience who have been murdered through organ harvesting.

Nor can we determine how many organs are extracted, on average, from each transplant source, although the evidence suggests that we are dealing with only one organ extracted from each donor source in many cases. China did not have any form of national organ distribution until 2013. The organ distribution system in place since 2013 is, according to Chinese officials, limited to organs donated voluntarily.

What we can say is that the evidence in this update suggests that our original estimates were far too low. And we can say that the end of this crime against humanity is not yet in sight.

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

The primary focus of this update is transplant volumes. Before getting into that, we need to address the volume of evidence about the killing of prisoners of conscience, primarily Falun Gong, for their organs.

Many claims of human rights abuses suffer from having too little evidence. With this claim of transplant abuse in China, the volume problem is the opposite – too much evidence.

There are now three books on the issue, our two and State Organs, a collection of essays which David Matas edited with Torsten Trey, published in 2012. There is an NGO dedicated to combating the abuse – Doctors Against Forced Organ Harvesting (DAFOH). There is a website focused on the issue alone – endorganpillaging.org. There have been five documentaries produced on the violation – Transmission 6‑10, Free China, Red Reign, Human Harvest, and Hard to Believe. About the killing of Falun Gong for their organs, there is more than just a collection of evidence; there is a field of knowledge.

In a world of thirty‑second soundbites and 140‑character messages, the volume of evidence is a problem. The gravity of the abuse would be a lot easier to communicate if less information were needed to show that it is happening. The number of people who have the patience to wade through all the information available on the killing of Falun Gong for their organs to come to their own conclusion is, unfortunately, comparatively small.

One reason that the abuse has not received the global attention it deserves is the sheer volume of evidence that needs to be marshalled to show that the abuse exists. If we had one smoking gun or, as David Kilgour has put it, one smoking scalpel, which we could brandish to show that the abuse exists, our efforts to combat the abuse would be comparatively easy. When we have volumes of evidence that have to be considered as a whole to conclude that the abuse exists, then our audience for the abuse is regrettably but also necessarily diminished.

It may seem counterintuitive in this context to add to this problem by presenting for consideration yet more evidence. What this update addresses is not more of the same – more data in fields already explored. Rather, it explores a whole new data field – the data from individual hospitals. We had in the past looked at particular hospitals to point out that their websites were promoting transplant tourism. Here, we look to them for transplant volumes.

Reliable transplant volume aggregates in China do not exist. The Chinese health system runs four transplant registries, one each for liver, kidney, heart and lung. Public access to the aggregate data for these four registries, which does not now exist, would be useful, if for no other reason than to cross check the proliferation of contradictory statements Chinese officials make about transplant volumes. Yet, any registry is only as reliable as the reports it receives. These registries accumulate their data from reporting hospitals. We cannot assume that every hospital reports all of its transplants to these four registries.

Considering transplant volumes, hospital by hospital, doctor by doctor is, in China, a mammoth task. There are almost nine hundred hospitals and between nine and ten thousand medical personnel engaged in transplants. Moreover, cover up is not just in China an aggregate, national phenomenon. It exists as well at the doctor and hospital level. Nonetheless, to get a grip on transplant volume figures, it is a task which must be undertaken and we do so in this update.

We do this not just to attempt to make more convincing the point we have made before. If you have gone through everything we have written up to now and are not already convinced that innocents in China are being killed for their organs, more data will not convince you. We make the additional effort to make an additional point – that the number of innocents killed for their organs in China is far larger than we had contemplated. The numbers stagger the imagination.

When we look at hospitals and doctors one by one, a number of features jump out. One is the sheer volume of transplants.

The total number of transplants which officials ascribe to the country as a whole, ten thousand a year, is easily surpassed by just a few hospitals. Whatever the total number is, it must be substantially more, by a multiple, than the official figure.

Second, many of the hospitals are relatively new or have new transplant wings or beds. This development would not have occurred without confidence in a continuing supply of organs for transplants. The transplant business in China has developed with not only an abundance of available organs from 2001 on, but also with a confidence that this abundance would continue into the indefinite future.

Third, concomitant with the large number of transplants, there is a large number of qualified staff. The transplant industry in China employs a lot of people. The investment in people as well as buildings is another testimonial to the ready availability of high volumes of organs available for transplants, not only in the immediate past and present, but also, in the view of those who have committed their careers and the careers of others to this profession, into the indefinite future.

Fourth, the transplant professionals in China are engaged in substantial training and research. Research and training in transplants cannot be done without transplants. The high volume of research bespeaks itself a high volume of transplants and a ready availability of organs for transplants.

Fifth, the combination of a large professional corps, a substantial building stock and significant research speaks money. Transplantation in China means money, lots of it.

According to statistics from the Administration of Hospitals under the National Health and Family Planning Commission (NHFPC) in July 2015,¹ there were 20,918 hospitals in mainland China. ² Among them were 1,151 Class 3 hospitals and 4,321 Class 2 hospitals. ³

Class 3 hospitals are normally located in major cities. They are typically large-scale general or specialized hospitals with over 500 beds. Among them, 705 are Class 3 Grade A (“3A”) hospitals. ⁴

Huang Jiefu, former Deputy Minister of Health, said in March 2006, “For a hospital to pass the evaluation to become a class 3A hospital, it must have completed a fixed target of more than five organ transplants. Organ transplantation has become a resource for competition among hospitals to reach the standard and for their branding,” “At present, the country has too many, not too few, hospitals carrying out kidney, liver, heart, and other types of transplants.”⁵

In April 2015, Professor Ye Qifa from Central Medical University, Executive Chairman of the China Organ Transplant Alliance, who specializes in major organ transplantation, stated to a People’s Daily Online correspondent that, before the introduction of the “Human Organ Transplant Ordinance” in 2007, there were over 1,000 medical institutions in China performing organ transplants.⁶

The World Organization to Investigate the Persecution of Falun Gong completed a comprehensive investigation of both organ transplant hospitals and doctors and determined that 865 hospitals are involved in organ transplantation. The hospitals are to be found in 22 provinces, five autonomous regions, four centrally-administered municipalities, and 217 prefecture-level cities. ⁷

We have verified and confirmed 712 hospitals which carry out liver and kidney transplants. The qualifications and composition of the 712 liver and kidney transplant hospitals are:

In fact more than 1,000 hospitals in China applied for permits from the Ministry of Health in 2007 to conduct transplants, implying that they had met the Ministry’s minimum transplant bed count requirements.⁸ In April 2015, Professor Ye Qifa from Central Medical University, Executive Chairman of the China Organ Transplant Alliance, who specializes in major organ transplantation, stated to a People’s Daily Online correspondent that, before the introduction of the “Human Organ Transplant Ordinance” in 2007, there were over 1,000 medical institutions in China performing organ transplants.⁹

The Ministry of Health on May 23, 2007 announced a list of 87 transplant hospitals¹⁰ approved by the Review Expert Team of the Human Organ Transplantation Skills Clinical Application Committee, authorized by the Ministry of Health, to which we refer as “national level” hospitals. Essentially, these were the most qualified and capable national-level organ transplant centres at the time. At the same time, it announced a second list of hospitals designated to perform organ transplants, issuing 18-month temporary permits to 77 transplant centres with weaker qualifications, to which we refer as “regional level” hospitals. In total, 164 hospitals were given permits to conduct organ transplants.¹¹

On August 8, 2013, the National Health and Family Planning Commission (successor to the Ministry of Health) published a list of 165 hospitals approved to conduct organ transplants,¹² including Wuhan University Zhongnan Hospital Human Organ Transplant Centre, which performs transplants from bodies with no cardiac activity. Four more hospitals were added to the list by the beginning of 2014, bringing the number of qualified hospitals to 169.¹³

This report focuses on the 164 hospitals which received approval from the Ministry of Health in 2007, so that we can categorize their qualifications as either national or regional level. If we exclude the 18 heart and lung transplant centres, 146 transplant centres remain. These include 23 national-level military and armed police hospitals that were among the first batch approved in 2007, 58 national-level civilian hospitals, and 65 designated hospitals.

Among the 566 transplant centres which did not receive approval from the Ministry of Health, 405 were based in large-scale 3A hospitals. These included 56 military and armed police organ transplant centres, 349 mostly-3A civilian hospitals, and 161 medium-sized hospitals (including 55 Class 3 Grade C hospitals and 106 mostly-Class 2 hospitals).

In the next section, we set out examples of different types of transplant centres, showing their qualifications, characteristics, transplant volume and capacity, and rates of growth. These examples give us an indication of overall transplant volume.

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

National level transplant centres encompasses highly qualified and capable organ transplant centres selected from over 1,000 candidates and approved by the Ministry of Health in 2007. Among them are 23 military and armed police transplant centres and 68 civilian transplant centres.

The People’s Liberation Army (PLA) is one of the few militaries in the world that belong to a political party rather than the state. It is a tool used to sustain the Communist Party’s control over China.

After 2000, a large number of People’s Liberation Army Organ Transplant Centres were named and supported by the Central Military Commission and regional military commands. In December 2008, Zhang Yanling, director of the People’s Liberation Army General Logistics Department Health Division, told Xinhua News Agency, “In 1978, there were only three hospitals in the entire People’s Liberation Army capable of performing kidney transplants. Now, there are forty hospitals capable of liver, kidney, heart, lung and multi-organ transplants.”¹⁴

According to an investigation by the World Organization to Investigate the Persecution of Falun Gong, the military and armed police have developed over 100 transplant institutions. ¹⁵

The 23 top-level military transplant centres among the first batch approved by the Ministry of Health in 2007 were the core units that the evidence shows were carrying out live organ transplants.

Li Wenhua, a political commissar with the Beijing Garrison Area Army, received a liver transplant at No. 301 Hospital on July 27, 2007. Li was a division commander with the No. 27 Army who led troops to fire on students during the 1989 Tiananmen Massacre. He was later promoted to political commissar. According to Li’s relatives, Li was diagnosed with a liver disease in early 2007, which worsened despite treatment. The Central Military Committee ordered staff to treat his condition by whatever means necessary. Within eight days, doctors found a liver source (reportedly from a 32-year-old death row prisoner) and transported the organ to No. 301 Hospital on a 40-minute helicopter flight.²⁰

According to medical personnel who work in operating rooms at No. 301 Hospital, organ transplants are among the most frequent, common surgeries, and that transplants are performed there almost every day.²¹

The hospital’s former president and well-known medical expert Li Qihua was a Falun Gong practitioner. In the initial stages of the persecution, his high profile led to his being directly targeted by Jiang Zemin. Under daily visits from officials and constant duress, Li was forced to give up Falun Gong.²²

A surgeon at this hospital told an investigator in April 2006 that she did liver transplants herself. The surgeon added that the source of the organs was a “state secret” and that anyone revealing the source “could be disqualified from doing such operations.”²³

The number of transplants performed at this hospital is also a military secret. However, we can gain some insight from financial information of one of its clinical divisions, the No. 309 Hospital. The archived web page of the Organ Transplantation Centre at No. 309 Clinical Division of People’s Liberation Army General Hospital states, “Our Organ Transplant Centre is our main department for making money. Its gross income in 2003 was 16,070,000 RMB. From January to June of 2004 income was 13,570,000 RMB. This year [2004] there is a chance to break through 30,000,000 RMB.” Furthermore, its gross revenue rose from 30 million RMB in 2006 to 230 million RMB in 2010, an increase of nearly 8-fold in 4 years.²⁴ We should note that such figures are commonly face data underreported (for more details, see the “Cover-Up” section in Chapter Three).

According to a Xinhua report titled “People’s Liberation Army General Hospital Hepatobiliary Surgery Department’s Glorious History” on July 4, 2007:

“On the foundation of first-class technologies and strict organization operational program, [the hospital] advances liver transplant surgeries, perioperative management, and a series of management models for long-term postoperative follow-ups. Its one-year survival rate for liver transplants reached 91.4%, three-year survival rate was 80.2%, and five-year survival rate was 71.3%. Liver transplants have become our department’s routine surgery…Under the leadership of Professor Dong Jiahong, director of the hepatobiliary surgery department and currently one of our country’s military leaders in liver transplantation, the hepatobiliary surgery department has completed more than 500 liver transplant surgeries.” ²⁵

The department’s five-year survival data implies that it has performed liver transplants regularly since 2002 at the latest. It is also worth noting that Dong Jiahong was not transferred to this hospital until 2006,²⁶ so this report implies that the department performed more than 500 liver transplants that year; this is only the public figure.

No. 301 Hospital has not only conducted a large number of organ transplants by itself, but also has played a role in resolving core technical issues in organ transplantation and supporting civilian hospitals with organ sources and technical consultants.

The Kidney Transplant Centre at Yiyang Central Hospital collaborates with the People’s Liberation Army General Hospital and the kidney transplant centre affiliated with the First Military Medical University. The centre’s mandate states, “We select the best kidneys. We perform overall examinations of the donor kidneys to ensure that the best-quality matching kidneys are chosen. Patient treatment costs charged are lower than the standard of other hospitals within and outside of the province.”²⁷

The Hepatobiliary Surgery Department is a People’s Liberation Army Hepatobiliary Surgery Center and Liver Transplant Center. ²⁹ It claims to be the largest in northern China³⁰ and it is authorized to award Medical Doctor degrees. It also serves as a post-doctoral station, the People’s Liberation Army’s Hepatobiliary Surgical Research Institute (a national prioritized development subject), and one of the People’s Liberation Army’s major laboratories.

According to a report titled “The Hepatobiliary Department’s Battle Team” posted on July 10, 2007 on Xinhua Net, its Liver Transplant Center engages in academic exchanges from time to time with the University of Paris-Sud Hepatobiliary Center in France, the University of Pittsburgh Thomas E. Starzl Transplantation Institute in the United States, the University of Melbourne National Liver Transplant Center in Australia, and the Hong Kong University Hepatopancreatobiliary Surgery department, and other well-known international institutions. ³¹

In 2007 the Center had 7 chief surgeons and professors, as well as 11 associate chief surgeons and associate professors. The vast majority of its medical and research personnel hold PhD or postgraduate degrees and can independently complete various hepatobiliary surgeries. The Xinhua.net Report states:

“The People’s Liberation Army General Hospital Liver Transplant Center is a strong, multidisciplinary cooperative team. It includes the hepatobiliary surgery department, operating rooms, anesthesiology department, ICU ward, imaging center, blood transfusion department, pathology department, examination center, and others. Each liver transplant case must go through a careful discussion by the entire team to develop a detailed surgical and postoperative treatment plan. The hepatobiliary surgery department performs no fewer than 5 to 8 surgeries a day. In view of a shortage of beds, it is difficult to better arrange for more complicated patients to be hospitalized and given operations. Our hospital is now speeding up the construction of the new ward building, and estimates that the hepatobiliary department can be expanded to 200 beds by the end of the year.”

According to its official website, the hospital has 172 beds and conducted 3,260 surgeries in 2013.

The department’s former academic leader, Academician Huang Zhiqiang, was one of the founders of biliary surgery in China. Dong Jiahong, the department’s director from 2006 to 2013, used to be the president of the People’s Liberation Army’s Southwestern Hepatobiliary Surgery Hospital. His portfolio includes Vice President of International Hepatopancreatobiliary Association China Branch, a member of the Ministry of the Health Human Organ Transplant Expert Committee, a standing committee member of the China Organ Transplant Society, and a doctoral advisor at several universities, including the Third Military Medical University. His research has accumulated up to 40 million RMB of funding from the National 863 Plan—National Key Technology Research and Development Program of the Ministry of Science and Technology of China; Ministry of Health industry fund, and National Natural Sciences Foundation funding for key subjects.³²

Lu Shichun, the current director of the hepatobiliary surgery department and an advisor for doctoral students and post-doctorates, received his PhD in abdominal surgery and organ transplantation from the University of Freiburg in Germany. He formerly served as the director of the hepatobiliary surgery department and liver transplant centre at Beijing You’an Hospital affiliated with Capital Medical University. He was also the director of the Sino-US Liver Transplant Liaison Centre. In this position, he led over 700 liver transplants. He now sits on the Chinese Medical Association (CMA)’s Organ Transplant Division Liver Transplant Group, the CMA’s Surgery Division Liver Transplant Group, and the standing committee of the Chinese Medical Doctor Association’s Organ Transplant Group.

The Urology Department started allogeneic kidney transplants in 1977 and claims to have been leading the country in kidney transplants, with a high reputation in the field. This department has 140 beds and 63 medical personnel, including 14 with senior professional titles and 5 doctoral and master’s advisors.³³

The People’s Liberation Army No. 309 Hospital and the No. 304 Hospital were clinical divisions of the aforementioned No. 301 General Hospital (PLA General Hospital) between May 2004 and August 2009.³⁶

The People’s Liberation Army No. 309 Hospital, which established its organ transplant centre in 2002, is a leader in kidney transplants. It has hosted the data centre for the Chinese Scientific Registry of Kidney Transplantation (CSRKT) Management Committee since 2009. ³⁷ It conducted its first kidney transplant in 1988. The number of kidney transplants performed here ranked No.1 in the country for three consecutive years, from 2007 to 2009. ³⁸

Shi Bingyi, director of the National Kidney Transplantation Study Group, is credited with solving a number of technical issues in kidney transplantation. The centre under his direction has led 20 major research projects, some of which have been part of national-level Five Year Plans, received over 30 million yuan in funding, hosted national-scale organ transplant conferences, lodged national and international transplant-related patents, and received a number of awards. Shi is also chief editor of nine organ transplant books, and set key industry standards. He has trained 51 doctoral and master’s students, while the centre has trained at least 120 who went on to play key roles in other transplant facilities. ^{39 40}

Shi Bingyi’s team did much work on immune response and combating rejection—research that requires many clinical trials of actual transplants.⁴¹

Organ Transplantation Team

The centre has 231 medical and research personnel, including 53 with doctoral and master’s degrees, 31 senior professionals, 17 PhD and master’s advisors, and 28 post-doctoral fellows, doctoral and Master’s students. ⁴²The team at the centre once completed 12 kidney transplants overnight. ⁴³ In February 2012, a Xinhua Net report revealed that the team had recently performed 13 transplants in one night. ⁴⁴

According to statistics from the Ho Leung Ho Lee Foundation, Shi Bingyi had completed at least 2,130 kidney transplants,⁴⁶ 380 liver transplants, and many heart, lung, pancreas, small intestine, and multi-organ transplants by 2011, making the centre one of the institutions in China that offers the greatest variety of transplants.

Director Qian Yeyong of the transplant surgery department had also completed over 2,000 kidney transplants and many multi-organ transplants by 2013.⁴⁷ Cai Ming completed about 1,000 kidney transplants, 100 liver transplants, and several hundred organ procurement surgeries.⁴⁸

Annual Transplant Capacity

In 2010, the People’s Liberation Army No. 309 Hospital’s transplant centre had 316 beds and claimed to lead in annual capacity and bed utilization rate among similar departments in the military.⁴⁹ In 2012, this organ transplant centre had its own building and expanded to 393 beds. ⁵⁰ However, its current website shows only 330 beds with the same number of medical and research personnel. It is unlikely for the centre to reduce its bed count, since Shi Bingyi indicated in September 2013 that his institute had five to six thousand patients waiting for transplants each year. ⁵¹

A kidney transplant normally requires fewer than three weeks of hospitalization; they usually require one or two weeks in China (refer to Chapter 3 for details). For example, West China Hospital of Sichuan University requires about 20 days of hospitalization.⁵² Based on 316 beds, 20 days of hospitalization time and 100% utilization rate, the number of transplants in this centre per year would be 5,767. If we count 393 beds, 20 days of hospitalization time and 100% utilization rate, the number of transplants per year would reach 7,172. On Nov.17, 2010, the Centre’s website showed that its transplant volume “ranked first in the country for the last three years,”⁵³ in which case the centre would have performed no fewer than 5,000 transplants annually.

Nanjing General Hospital of Nanjing Military Command, (also known as Jinling Hospital of the Medical School of Nanjing University⁵⁴) had the earliest Military Nephrology Research Institute (the “Mayo Clinic of China”) and the first transplant center in China.^{55 56} It was the first institution in the national health care system that was approved to set up a postdoctoral research station in 2000.⁵⁷ Its People’s Liberation Army Kidney Diseases Research Centre was designated as “the priority among priorities” in 2000 by the Chinese Communist Party Central Military Commission.⁵⁸

It assembled leading kidney specialists, including Li Leishi, the pioneer of kidney medicine in China and the first kidney specialist to be appointed to the Chinese Academy of Engineering.⁵⁹ The team had two Academy members and currently has seven professors, eight associate professors, five doctoral advisors, and fourteen master’s advisers. It has graduated more than 150 post-doctoral, doctoral, and master’s students since 1980s. It has established sister relationships with the Johns Hopkins University School of Medicine and Brown University in the U.S.

A Model for Organ Transplantation for the People’s Liberation Army

Li Leishi was the founder of this kidney research centre, the leader of its field in the People’s Liberation Army.⁶⁰ In 2007, the Chinese Communist Party issued a “decision to learn from Li Leishi.”⁶¹ The document stated that he combined Chinese and Western medicine, enabled China’s diagnosis and treatment of kidney disease to quickly reach international standards, and trained numerous top students. Li was named a “Master of Medicine.”⁶²

In 1993, this research centre established China’s first organ transplant centre. Li Leishi was trained in internal medicine, but he sent students to kidney transplant hospitals overseas and went on to direct China’s first kidney transplant surgeries.

Initially performing dozens of transplants per year in the early 1990s, the centre grew into one of the largest kidney transplant centres in China,⁶³ claiming that it had conducted over 1,000 kidney transplants by 2004.⁶⁴ The Communist Party made Li Leishi a “model” for others to emulate. The first and second editions of The Chinese Renal Transplant Manual by Li Leishi have become the working guide for the kidney transplant industry in mainland China.^{65 66}

Liu Zhihong Carries On Li Leishi’s Legacy

Liu Zhihong is the hospital’s current vice president, director of its Military Nephrology Research Institute, and president of the Medical School of Nanjing University.^{67 68} As Li Leishi’s protégé, she published more than 50 papers with him, ^{69 70}many of them on kidney transplantation. Liu has held various leadership positions at this hospital over the years. After Li’s death, she became director of its People’s Liberation Army Institute of Nephrology. ⁷¹

According to a publication co-authored in 2008 by Liu Zhihong, “From January 1995 to December 2004, 1,000 patients had undergone cadaveric renal transplants” at this hospital. ⁷² Interestingly, the warm and cold ischemia times were limited to 10 minutes and 24 hours, respectively. All transplants were ABO blood-type-compatible, and donor age ranged between 18 and 50 years old. ⁷³ Among these 1,000 transplants, 653 were performed between April 1997 and August 2003. ⁷⁴

In 2011, Liu Zhihong co-authored a paper in the Open Journal of Organ Transplant Surgery reporting a study with 93 renal transplant recipients prospectively enrolled at her hospital from June 2002 to December 2005 who had received conversion-to-SRL-based immunosuppressive therapy. ⁷⁵ The paper claims explicitly, “no prisoners or organs from prisoners were used in the collection of data for this study.” In these years, nearly no voluntary organ donations of deceased or living donors existed; even a pilot project for voluntary organ donation in Jiangsu Province that was started in 2010 attained only 11 voluntary donations in its first two years.⁷⁶ Therefore, this claim is likely deceptive.

Liu Zhihong is a Councilor of the International Society of Nephrology (ISN), a board member of KDIGO (Kidney Disease: Improving Global Outcomes), Adjunct Professor of Medicine at Brown University, associate chief editor of AJKD, and international Advisory Board Member of Nature Review Nephrology, and possibly other international bodies. ⁷⁷

During the term of the most recent Five-Year Plan (2011 to 2015), this institute has presided over and completed a number of major initiatives under the National “863 Program,” National Natural Science Foundation projects, and designated military medical study and research projects. It has published more than 1,000 medical works and study papers, including 180 in Science Citation Index. Two volumes of China Nephrology, with a total of 3.7 million words, are specified in the Eleventh Five-Year Plan (2006-2010) as national key books. This institute has won over 70 national, provincial, and military awards. ⁷⁸

The archived website of this research centre boasts: Led by fundamental studies and research, clinical technologies at this institute have made great progress. Kidney transplantation has come to epitomize an institute where kidney disease expertise, blood purification, transplant, and fundamental research are organically integrated into one. The institute’s clinical treatment centre has 210 beds; the average length of stay is 9 days; there are over 8,000 admissions each year, and the institute provides outpatient kidney transplant clinic aftercare service 7,216 times per year. ⁷⁹

Volume at a Research Institute

Li Leishi once said, “Because we are a research institute, we don’t do too many surgeries.”⁸⁰ This statement appears to be accurate, at least in comparison to the other 40+ military transplant centres that concentrate more on operations. Yet, during an “Interview with Academician Li Leishi” on “China Military Online,” ⁸¹ Li told the 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.” In 2008, when Li was 82 years old, he said “In the past, I myself used to do 120 kidney transplants per year. Now I only do 70 cases.”⁸²

The institution had close to 30 experts before 2001, amongst whom eleven chief surgeons and six associate chief surgeons carried out kidney transplants.⁸³ If the three doctors Li mentioned carried out hundreds of kidney transplants a year, the other fourteen surgeons each year would have conducted well over a thousand collectively.

Fuzhou General Hospital also belongs to the Nanjing Military Command. It expanded upon its transplantation of major organs (kidney, liver, and pancreas) to eleven types of transplants, including stem cells, corneas, and multi-organ transplants. Its cumulative number of kidney transplants ranks first in the country, and its annual transplant volume ranked among the top three for six consecutive years.⁸⁴

On February 27, 2011, its urology surgery department’s website showed that it had seven chief and associate chief surgeons, one post-doctorate, and two Master’s students.⁸⁵ The department director Tan Jianming 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 Centre. He had personally performed over 4,200 kidney transplants by 2014.⁸⁶

Liver transplant surgery became a routine procedure. On February 18, 2014, sixteen doctors of the Hepatology Centre at Fuzhou General Hospital of Nanjing Military Command simultaneously carried out five liver transplants within seventeen hours.⁸⁷ This centre claimed that it had performed “the first, most, and best liver transplants in Fujian Province.”

Construction began on the new ward complex in 2011, which is scheduled to be put into use at the end of 2016. With a total area of 154,900 square meters and 1,680 beds, the ward complex is the largest in Fujian Province.

Not-So-Rare Achievement

Nanjing General Hospital’s claim of 1,000 kidney transplants in 2004 was not, in the Chinese transplant landscape, an unusual achievement. Many hospitals had already performed over 1,000 kidney transplants long before that year. If the Hospital really was one of the largest transplant centres in China as it claimed, its numbers must have been far greater than 1,000.

Xinqiao Hospital, affiliated with the Third Military Medical University in Chongqing, recorded on page 157 of its qualification document, “History of Renal Diseases Research Centre, Department of Urology in Xinqiao Hospital,” that it had “conducted 2,590 kidney transplants by 2002 … The Centre once carried out 24 kidney transplants in one day.⁸⁸

Southwest Hospital, its sister hospital, claims to be one of the largest Hepatobiliary Surgery departments both domestically and overseas. Beginning with its first liver transplant in 1999, it was designated as a key experiment of the Centre of People’s Liberation Army Liver Transplantation by 2001. ⁸⁹ In 2004, the newly-formed Southwest Hospital of Hepatobiliary Surgery established the International Cooperative Liver Transplant Centre with the University of Pittsburgh Thomas E. Starzl Transplantation Institute.

In 2004, the Centre’s director Dong Jiahong claimed that the facility could conduct six liver transplants simultaneously.⁹⁰ By the end of 2004, the facility had expanded to 168 beds. ⁹¹ It accommodated 3,000 hepatopancreatobiliary patients from home and abroad, and conducted 2,400 liver and gallbladder transplants annually. ⁹² By 2011, it had increased to 200 beds.⁹³ Its kidney department possessed the leading technology in kidney transplants in southwestern China. In 2010, it had 64 standard beds and 22 dialysis beds.⁹⁴ In 2001, the department of ophthalmology at this hospital established the first People’s Liberation Army eye bank which met national standards and began carrying out corneal transplants.⁹⁵

In addition, according to a report in the Medical Journal of the Chinese People’s Armed Police Forces in June 2004, ⁹⁶as early as the year 2000, Beijing Friendship Hospital and Guangzhou Nanfang Hospital had already conducted more than 2,000 kidney transplants. The First Clinical Hospital of Sun Yat-sen, the People’s Liberation Army General Hospital, the First Affiliated Hospital of Xi’an Jiaotong University, the Beijing Chaoyang Hospital, and others all had carried out more than 1,000 kidney transplants each.

The Eastern Hepatobiliary Hospital, affiliated with the Second Military Medical University, is a People’s Liberation Army Hepatobiliary Surgery Centre and Research Institute and considered a top priority in this field of development. According to its website, in 2015, it had 742 beds before it moved to the Pudong New District.⁹⁸ Most of its surgical departments can perform liver transplants, including the liver transplant department itself ⁹⁹, two special treatment departments (designed for foreign patients) ¹⁰⁰, and at least half of its six liver surgery departments. ¹⁰¹ Over the past 20 years, it has administered more than 6 million liver disease treatments and conducted more than 300,000 surgeries.¹⁰²

Since 1978, it has trained 22 post-doctorates, 112 doctoral graduates, and 223 graduate students with master’s degrees. It also trains international, undergraduate, professional, and vocational students. Over the years, it has trained more than 1,000 visiting scholars from various regions.¹⁰³ It has won more than 100 awards at national, provincial and ministerial levels, such as the National High Scientific Achievement Award, the National Science and Technology Conference Award, the National Scientific Improvement Award, and the National Natural Science Foundation Award. ¹⁰⁴ It is currently conducting research in 150 projects, with total funding of 130 million RMB. ¹⁰⁵

Wu Mengchao, a member of the Chinese Academy of Sciences and China’s “Father of Hepatobiliary Surgery,” served as the chief consultant of the People’s Liberation Army Organ Transplant Committee. In 2005, Wu won the nation’s highest science and technology award for his solution for major technical issues associated with liver transplant rejection. Former Communist Party leader Jiang Zemin met with Wu five times and personally proclaimed Wu an Exemplary Medical Expert. As of 2010, Wu had presided over 14,000 liver surgeries, including 9,300 hepatectomies.¹⁰⁶ The remaining 4,000+ surgeries remain unidentified and are likely to be liver transplants.

In 2009, the Shanghai municipal government cooperated 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.¹⁰⁹

This new 3A comprehensive hospital emphasizes hepatobiliary surgical treatments. The hospital covers a construction area of 200,000 square meters and contains 1,500 beds. It is one of the largest hospitals constructed in one phase. The hospital is currently a national top-priority field of development, a national-level continuing education base, a People’s Liberation Army Hepatobiliary Surgery Centre, a People’s Liberation Army Hepatobiliary Surgery Research Institute, a top-priority People’s Liberation Army development project, a major research subject in Shanghai’s medical industry, and a top-priority clinical medical centre for the city of Shanghai.¹¹⁰

Headed by Academician Wu Mengchao, the hospital’s staff includes 95 personnel with senior professional titles, a member of the Chinese Academy of Sciences, a member of the Chinese Academy of Engineering, 26 doctoral advisors, 51 master’s advisors, and 30 leading figures in various fields from Changhai Hospital and Changzheng Hospital. The department has 30 operating rooms with air purification, including 6 hundred-level laminar flow operating rooms and a digitally integrated operating room.

The National Liver Cancer Science Centre located next to the hospital is a national-level research centre for liver cancer, which was founded under the leadership of Academicians Wu Mengchao and Wang Hongyang, a leading figure in China’s precision medical treatment.

Changzheng Hospital’s organ transplantation centre was approved to establish the People’s Liberation Army’s first organ transplant research institute in December 2003. It has since developed into the PLA’s highest-ranking institution for organ transplantation that combines medical treatment, education, and research. The research institute officially opened on May 16, 2004 and started conducting kidney, liver, heart, combined liver-kidney, combined pancreas-kidney, and other types of transplants. It claims to lead the country in the total number of transplants performed.¹¹¹

In 1978, the hospital became one of the first in China to start conducting kidney transplants. It is also among hospitals that have performed the most kidney transplants, yet it claims to have performed only 4,500 to date.¹¹² This figured is exceeded by just two of its doctors. Zhu Youhua, who is considered a leader in the People’s Liberation Army on kidney transplantation, had successfully completed 3,680 kidney transplants as of 2010.¹¹³ Li Shenqin has also conducted more than 1,000 transplants.

Zhu Youhua’s team was the first in China to develop a preservation solution for kidney and other organs, and this has now been applied clinically for two decades. This research put China among the world’s pioneering countries in this field.¹¹⁴ The organ preservation solution is being used in 98% of Chinese hospitals.¹¹⁵

The hospital started conducting liver transplants in 1996. According to academic papers published by doctors at this hospital, within the three years leading up to April 2006, “our department treated 120 patients with serious hepatitis using emergency liver transplants.” The shortest wait time was 4 hours between hospitalization and surgery.¹¹⁶ Between April 22 and April 30, 2005, the hospital conducted 16 liver transplants and 15 kidney transplants.¹¹⁷

Since 1991, when the Eighth Five-Year Plan started, the hospital has undertaken 349 scientific research projects at the national, military, and provincial levels, including many projects under the National 973 Program and the National 863 Program. Its research funding totals 110 million RMB. Over the years, it has made 279 research achievements, including eight second-class National Scientific Improvement Awards, 14 first-class provincial and ministerial awards, 35 patents, and 212 published Science Citation Index papers.¹¹⁸

In 2015, the 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.¹¹⁹

This hospital worked overtime to conduct a large number of transplants. In a phone call made by a reporter of Sound of Hope Radio, ¹²¹ a doctor at the hospital said “We have several shifts working 24 hours a day. We have four teams that can do [transplants].” When asked about the source of donor organs, the doctor said, “We [use] a unified national source. This, how do we say this…only doctors know.”

Xijing Hospital, with 3,218 beds, is considered one of China’s top five hospitals in terms of its comprehensive capabilities. It has won numerous awards, grants, and citations.¹²²

This hospital is accredited for all organ transplant types that are conducted in China and has numerous records identifying itself as the first or only institution able to do certain procedures, including the first reconstituted bone xenograft, first partial living-donor liver transplant, first partial living-donor intestine transplant, and China’s first assistive living-donor liver transplant between adults with non-matching blood types. ¹²³

Established in 2000, Xijing Hospital Organ Transplant Center has become the largest organ transplant center in Northwestern China. It specializes in transplantations of the liver, kidney, heart, lung, small intestine, pancreas, and combined organ transplants, as well as the related clinical and basic researches. In 2005 it became the Military Organ Transplant Center with the approval of PLA Department of General Logistics, and then became the Military Organ Transplant Research Institute in 2012. It claims to lead the country in transplantations of liver, kidney and heart. ¹²⁴

With Professor Dou Kefeng, a well-known expert on hepatobiliary-pancreatic-spleen surgery and liver transplants, as the director of the Organ Transplant Research Institute, and Professor Tao Kaishan as the director of the Organ Transplant Center, the transplant center has a professional team of surgeons, ICU doctors, anesthesiologists, pathologists, and nurses. The center has a total of 110 beds, including 15 ICU beds equipped with the most advanced automatic disinfection laminar flow system in China and negative pressure rooms, and 95 advanced transplant beds. ¹²⁵

The Research Institute’s online introduction states that it conducted China’s first partial living-donor liver transplant in 1997. The patient survived for 13 years, the longest-surviving living liver transplant recipient. The Institute later conducted China’s first auxiliary orthotopic living-donor partial liver transplant, the first partial liver transplant between adults with different blood types, China’s first high-altitude piggyback liver transplant, Asia’s first combined liver-heart-kidney transplant, Asian’s first and the world’s fourth combined liver-pancreas-kidney transplant, the world’s second and China’s first face transplant, and other operations, such as heart and combined heart-lung transplants. ¹²⁶

The Research Institute has long-term partnerships and regular collaboration with internationally acclaimed organ transplant centers, including the Thomas E. Starzl Organ Transplant Center at the University of Pittsburgh in the U.S., the Organ Transplant Department of Kyoto University in Japan, the Bismuth Liver Center in France, and the Das Deutsche Herzzentrum (Germany Heart Center) in Berlin.

In recent years, the center has undertaken 37 important projects, including key scientific projects under the nation’s “Eleventh Fifth-Year Plan”, three projects under the National “863 Program”, one key project and 16 general projects under National Natural Science Foundation, and two key breakthrough projects under the People ’s Liberation Army’s “Eleventh Fifth-Year Plan.” It has total research funding of 26.5 million RMB. The center has published 126 SCI papers and 593 articles in domestic journals. It has won a multitude of national, provincial, and military scientific development awards.¹²⁷

The Hepatobiliary, Splenic and Pancreatic Surgery Department of Xijing Hospital is an important location for the study of the subject in Shaanxi Province. It also serves as a People’s Liberation Army Organ Transplant Centre. According to a Xinhua report in 2010, published with the collaboration of the People’s Liberation Army, the department had 120 hospital beds and performed more than 200 operations per month. Its inpatient department treats more than 2,800 patients per year, with over 80% of operations being major surgeries. ¹²⁹

The department has conducted nearly all types of liver transplants: traditional, piggyback, from living-donor to split liver to heterotopic liver transplants in the spleen fossa. It conducted China’s first living-donor liver transplant, Asia’s first combined heart-liver-kidney transplant, the world’s first heterotopic liver transplant in the spleen fossa, the world’s first dual split heterotopic liver transplant with one supplied liver, Asia’s longest-surviving combined liver-kidney-spleen transplant, the living-donor liver transplant on the youngest recipient, and the liver transplant at the highest elevation.¹³⁰

The director of this department, Dou Kefeng, successfully conducted China’s first living-donor liver transplant in 1997. Dou currently serves as the vice director of the Chinese Medical Association (CMA)’s Surgery Division, vice director of the CMA’s People’s Liberation Army Organ Transplant Division, and holds a range of other professional roles. These positions have led him to preside over major national research projects connected with the 863 Plan and a variety of other important research programs under civilian and military auspices. Total funding for his current research projects exceeds 20 million RMB. ¹³¹

The hospital’s urology department claims to be the largest and most comprehensive in northwestern China. Its official website says it has 80 beds, performs 50,000 outpatient services per year, and conducts about 2,000 operations per year, 70% of which are large or medium-scale operations. In 1978, the department conducted the first allograft kidney transplant in northwestern China. It claims to lead the country in survival ratios with its kidney transplant patients and the transplanted kidneys. Combined multiple-organ transplantation is one of its specialties. In January 2005, it conducted the first combined liver-kidney-spleen transplant, which became the sixth case in the world. However, its official website states that it conducts only 40 to 60 kidney transplants per year since it completed the first allograft kidney transplant in northwestern China in 1978.¹³²

The extent of its pioneering surgeries, however, would indicate that there is far more activity going on.

The cardiovascular surgery department of Xijing Hospital is a nationally prioritized discipline and a post-doctoral station. It maintains frequent academic exchanges with some of the world’s best cardiovascular hospitals in the U.S., Germany, France, United Kingdom, Australia, Japan, and Mexico, employing 12 internationally- renowned experts as guest professors and providing clinical internships to international students. ¹³³

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

Organized and directed first by the Ministry of Health and later by its successor, the National Health and Family Planning Commission, civilian transplant centres also grew rapidly after 2000. This growth is apparent especially for the 55 national-level civilian transplant centres in the first batch approved by the Ministry of Health.

Before 2000, these institutions had matured in their technology in kidney and liver transplants. After 2000, the technology was applied to massive numbers of patients. Within a few years, liver and kidney transplants became routine clinical surgery; organ transplantation techniques and volume increased rapidly. These hospitals became the largest transplant centres in their areas, the country, and Asia. These national-level transplant centres popularized their clinical technology throughout the country, trained a large number of transplant doctors, and led the exponential growth of China’s transplant industry.

(Oriental Organ Transplant Centre)

Tianjin First Central Hospital’s Organ Transplant Institute is the largest transplant center in Asia and ranked first in China in the cumulative volume of transplants performed for sixteen consecutive years through the end of 2013.²⁴¹

In September 1998, the hospital established its Organ Transplant Surgery Department, which became the Tianjin Organ Transplant Centre in December 2000 and the Oriental Organ Transplant Institute in November 2003. It integrates clinical practice, teaching, and research.²⁴² The Centre gained influence worldwide and was the first in mainland China to be included in the Clinical Transplants registry.²⁴³

Shen Zhongyang is known as the founder of China’s liver transplant field. From the time he graduated from China Medical University in 1984 until 1998, Shen twice studied in Japan. According to data from the Ho Leung Ho Lee Foundation,²⁴⁴ after Shen returned to China in 1998, he began to build an organ transplant division and a transplant institute at Tianjin First Central Hospital, which became the Oriental Organ Transplant Centre. Since then, Shen has been the director of the centre. He became president of the hospital in 2007.

In 2001, Shen set up the transplant centre at the Tianjin Armed Police General Hospital and established the Liver Transplant Institute at the Armed Police General Hospital in Beijing in April 2002. The latter quickly topped the rankings in the Beijing area for the volume and success rate of liver transplants performed.²⁴⁵ He also assisted in the creation of the Jinan Armed Police Organ Transplant Institute and the Qianfoshan Hospital Liver Transplant Centre in Shandong Province.

Shen was a chief expert for transplant research under the 863 Project, a transplant expert in the Central Committee of the Health Core Group, and vice chairman of the Chinese Medical Association Organ Transplant Society.^{246 247}

In mainland China, liver transplantation was still in its clinical exploration stage until the end of the last century. It is the only effective treatment for end-stage liver disease. In May 1994, Shen completed the first orthotopic liver transplant after he returned to China; by the end of the century, liver transplants were slowly becoming routine.²⁴⁸

Shen Zhongyang was the first doctor in China to establish a modern transplant centre incorporating multiple disciplines, including anesthesia, transplant pharmacology, and pathology. He also implemented cooperation in treatment before, during and after surgery, as well as quality control.²⁴⁹

Shen pioneered and improved a variety of liver transplant surgical procedures. He developed an integrated prevention system that reduced the recurrence rate of the hepatitis B virus (HBV) after liver transplants from over 80% to under 5%. This advance overcame the main obstacle to the development of liver transplantation in China.

Shen also established a multidisciplinary liver transplant standard and procedure, with surgery as the central component. His books include Clinical Liver Transplantation, Modern Clinical Liver Transplantation, China Liver Transplantation, and Liver Transplantation Manual addressing the new theories and technologies he was exploring. Shen also provided training for dozens of transplant units across the country, helping liver transplantation become routine surgery.

According to the 2009 edition of the Tianjin Medical Journal, between January 2004 and August 2008, Shen participated in 1,600 liver graft procurements.²⁵⁰ The now-standard procedure for grafting the liver from a donor lowered the time necessary for the organ to remain at body temperature to under five minutes and reduced the time for procurement operations to thirty minutes.²⁵¹ His development of this procedure which, according to the Journal article, “suits the characteristics of China,” indicates that Shen very likely participated in a large number of live organ procurement operations, given that the five-minute procurement time indicates that the involuntary organ donor had not yet died when the liver was removed.

In July 2006, the Oriental Organ Transplant Centre became China’s liver transplant training centre. It trained over 385 transplant doctors for other transplant centres, who became the backbone of their departments in hospitals across the country. The Centre also performed a large number of transplants.²⁵²

The fifth edition of Phoenix Weekly in 2006 published an article entitled “Investigation into tens of thousands of foreigners going to China for organ transplants; China has become the world’s organ transplant centre.”²⁵³ The article also stated that Oriental Organ Transplant Centre is the world’s largest transplant centre.

The Centre’s high bed utilization is reflected in its head nurse’s statement: “The hospital began to accept and treat South Korean patients in 2002. A large number of South Korean patients poured in, making existing facilities insufficient. Now, the hospital has turned the fourth to seventh floors of the 12-floor building into transplant patient wards. It also borrowed the eighth floor of the Tianjin Economic Development Area International Cardiovascular Hospital as a hospitalization area for Korean patients. It has also converted the 24th and 25th floors of a nearby hotel into wards for patients waiting for transplants. Even so, we’re still short of beds.”

The article says that 85% of its patients came from over 20 countries and regions, including South Korea, Japan, Malaysia, Egypt, Europe, Israel, Pakistan, India, Saudi Arabia, Hong Kong, Macao, and Taiwan. The café in the ward on the fourth floor became an “international conference club,” where patients of different ethnicities gather to exchange their treatment experiences.

Using incomplete data, in the three years prior to the date of the article, over 3,000 patients from South Korea alone underwent organ transplants in mainland China. More than 1,000 people from other countries and regions underwent organ transplants in China every year.

This was not the only hospital with an influx of overseas transplant patients; transplant centres all over the country were attracting and receiving foreign patients. Documented cases include the First People’s Hospital of Zhejiang Province and the Guangdong Nanfang Hospital. The latter facility opened its doors specifically for overseas Chinese and was called the “model medical department for benefiting overseas Chinese” in 1995. It had received over 110,000 patients from over 91 countries and regions for hospitalization and examination. ²⁵⁴ The hospital had completed 2,123 kidney transplants by as early as November 2001.²⁵⁵

The same Phoenix Weekly article²⁵⁶ stated, “According to family members of patients, the Organ Transplant Centre carries out up to 24 liver and kidney transplants in one day. The hospital once set a record of completing 44 liver transplants within one week in December.

Because its 120 hospital beds were insufficient, the Oriental Organ Transplant Center rented a large number of rooms from nearby hotels and a hospital for foreign transplant patients. At the time, the facility had seven liver and kidney transplant teams. They had almost no rest days: “…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. The end of the year is particularly busy.”

Because of its growth after 2000, the Center broke ground in 2002 on its new building with 500 transplant beds. The project was funded by the Tianjin municipal government, which aimed to build Asia’s largest integrated organ transplant center.

According to a special interview with Shen Zhongyang in February 2006 by the Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care, the newly completed Oriental Transplant Center building had actually opened with 700 beds.²⁵⁷ This was 200 more than the plan.²⁵⁸

In September 2006, Xinhua News Agency reported that this new building officially entered operation. The report stated that its transplant surgery center could simultaneously carry out nine liver transplants and eight kidney transplants.²⁵⁹ The report added that, while focusing on the development of liver transplants, the Center would also develop kidney, pancreas, bone, skin, hair, stem cell, heart, lung, cornea, and larynx transplantation.

Three years later, by October 2009, its bed utilization rate reached 90%;²⁶⁰ utilization reached 131% after it added more beds in 2013.²⁶¹ According to a report by Enorth Netnews on June 25, 2014, Tianjin First Central Hospital had made progress in its various departments in 2013, with a bed utilization rate of 131.1%, an increase of 5.7% from the same time in the previous year. Based on developmental needs, it had added 300 beds and adjusted the number allocated for several departments, including the organ transplant center.²⁶²

The average hospitalization time for liver transplants at this center was 25-30 days but was later shortened to 20-23 days.²⁶³ In general, hospitalization times for kidney recipients are much shorter. Even if we count the new building as 500 beds instead of 700, when it achieved a 100% bed utilization rate (around 2010 by its growth trend), the transplant volume may have reached 6,000 to 8,000 per year. With its 131% bed utilization rate in 2013, the corresponding annual volume may have been as high as 7,800 to 10,400. It also added beds later, pushing the annual transplant volume even higher.

The hospital has 17 operating rooms. If these 17 operating rooms were in use at the same time, at least 30 liver and kidney transplants could be completed in one day. Then 30 x 360 = 10,800 transplants could be done in one year. This calculation is based on only a regular utilization rate and a workload of fewer than two operations a day per transplant operating room.

After evidence of live organ harvesting in China attracted international attention, the authorities deleted web pages and claimed that the number of organ transplants had decreased after 2006. It used Tianjin First Central Hospital as an example to promote this story.

On December 18, 2007, Southern Weekly published the article “China is calling a stop to ‘transplant tourism,”²⁶⁴ which claimed that, starting from 2007, the number of transplants at the hospital suddenly dropped significantly due to lack of organ supply, that it conducted only 15 liver transplants in the first half of the year, and that the donors were all patients’ relatives.

Yet, in April 2009, the hospital’s official web page said that it ranked first in the country for the number of liver and kidney transplants for the four preceding years.²⁶⁵ The hospital could not have performed only fifteen liver transplants in the first six months of 2007 and still rank first in the country in volume for liver transplants in 2007.

The current official website shows a bed count less than the number before the new building was put into use in 2006 – only 120 transplant surgery beds and seven liver and kidney transplant teams.²⁶⁶ However, its archived webpages since 2003 show that the Centre, funded by the Tianjin municipal government, would include 500 transplant beds and aim for 500 liver transplants, 300 kidney transplants, and other types of transplants per year.²⁶⁷ This suggests that each transplant bed would accommodate only one to two patients per year, an unlikely scenario.

The transplant volume of this centre can be cross-checked with those conducted by individual doctors. Based on published papers, the Centre has 110 doctors participating in liver and kidney transplants, among whom 46 are chief or associate chief physicians and 13 are attending physicians.²⁶⁸

Shen Zhongyang’s biography shows that he had completed close to 10,000 liver transplants by the end of 2014.²⁶⁹ His colleagues and the majority of the doctors he had trained had each independently completed approximately 1,000 transplants.²⁷⁰ Thus, while the centre claims that it has completed 10,000 organ transplants in total, this figure is surpassed by just a few doctors.²⁷¹

By 2011, Vice President Zhu Zhijun of Tianjin First Central Hospital had completed 1,400 liver transplants and 100 liver transplants from relatives’ donors. ²⁷² Cai Jinzhen, the deputy director of the liver transplant department, had completed 1,500 liver transplants; Cai has worked in the centre since 2000 and had developed in-depth experience in liver transplantation.²⁷³

As of July 2006, associate chief surgeon Pan Cheng had independently completed over 1,000 liver transplants, over 100 liver transplants from relative donors.²⁷⁴

Chief surgeon Song Wenli from the renal transplant department had completed over 2,000 kidney transplants and over 100 combined transplants.²⁷⁵Associate chief surgeon Mo Chunbo had completed over 1,500 kidney transplants.²⁷⁶ Chief surgeon Gao Wei had completed over 800 liver transplants and 100 from relative donors after he graduated from the university; he joined the Oriental Organ Transplant Centre in 1999.²⁷⁷

Zhongshan Hospital of Shanghai Fudan University was one of China’s first hospitals to conduct heart, liver, and kidney transplants.²⁷⁸ It has set several records as the first hospital to carry out certain types of organ transplants in China and in the Shanghai region. Over the years, the hospital has seen all-around development in kidney, liver, heart, and lung transplantation. It claims to be the most comprehensive organ transplantation centre in China, with its transplant volume growing rapidly each year.²⁷⁹ A report in 2004 showed that its transplant volume had been increasing at a rate of 50% a year. ²⁸⁰ In December 2003, it partnered with the world’s largest organ transplant institute and jointly established the Fudan University Zhongshan Hospital – University of Pittsburgh Thomas E. Starzl Transplantation Institute Liaison Centre.²⁸¹

Zhongshan Hospital’s kidney transplant unit includes 27 doctors, 6 senior professionals, 5 associate chief physicians. The liver transplant unit includes 10 senior professionals and 9 associate chief surgeons and physicians. The heart surgery department has 3 senior professionals.

The hospital’s Zhu Tongyu carried out the fourth highest-difficulty kidney transplant and Asia’s first combined heart, liver, and kidney transplant. Fan Jia, the president of Zhongshan Hospital and founder of the “Shanghai Fudan Criteria,” has led over 7,000 difficult liver cancer surgeries over 20 years; among them were over 1,300 liver transplants.²⁸²

The hospital performed its first liver transplant in 1978. Since 2001, liver transplantation at this hospital has seen rapid development, with increased variety, more innovations, shorter operating times (4 to 6 hours on average), less bleeding, and fewer complications. Some patients are discharged 9 days after their operation. Transplant recipients extend from patients of liver cancer to those of hepatitis, congenital liver diseases, and other end-stage liver diseases. Its quantity and success rate of liver transplantation lead both the Shanghai region and the country.²⁸³

The Liver Surgery Department of Zhongshan Hospital serves as the Shanghai Liver Cancer Clinical Medical Centre, one of China’s two major liver cancer research facilities. It recently started immediate outpatient follow-up treatments with its liver transplant patients, such that a patient receives their operation immediately after an exam and hospital admission, accelerating the treatment cycle. It has attracted patients from more than ten countries and regions and seen dramatic growth in surgery volume. In February 2015, the department moved into the new Shanghai Liver Cancer Medical Centre building. It now has 230 beds, with its scale and medical capabilities among the world’s best.²⁸⁴

The department’s leading figures are Professor Fan Jia and Professor Zhou Jian. It currently has a faculty of 41 members, including 22 with senior professional titles and 16 surgeons qualified to perform liver transplants. ²⁸⁵ Over 90% of its staff hold doctoral degrees.

The hospital’s president, Fan Jia, also serves as the director of the Fudan University Organ Transplant Centre and the director of the Shanghai Liver Cancer Clinical Medical Centre. Between 1999 and 2000, Fan went to the University of Pittsburgh Starzl Transplantation Institute as a senior visiting scholar for clinical surgical research on liver transplantation and liver surgery. For the past 5 years, he has presided over 14 major research subjects at the national, provincial, and ministerial levels, including the 973 Program, 863 Program, the Eleventh Five-Year Plan, and more. He also helped create the Shanghai Standards for transplantation.²⁸⁶ By 2012, he had completed more than 7,000 liver cancer surgeries, including over 1,300 liver transplants.²⁸⁷

The Urology Department of this hospital completed its first cadaveric kidney transplant in January 1970 and was one of China’s first to carry out an allogeneic kidney transplant. In August 1983, the department published China’s first book on organ transplantation, entitled Kidney Transplantation. In 2000, the department made a breakthrough in kidney transplantation and continues to innovate in its clinical work. The department currently has 4 full professors and 5 associate professors, including 2 doctoral advisors and 3 master’s advisors.²⁸⁸

The department’s director, Zhu Tongyu, is currently in charge of China’s organ transplantation clinical research programs. He successfully conducted a very challenging fourth kidney transplant and Asia’s first sequential heart-liver-kidney transplant.²⁸⁹

Its Heart Surgery Department presides over China’s heart transplantation access ordinance. In May 2000, it successfully conducted a heart transplant on the youngest recipient in China. The department has developed a complete set of standard procedures for heart transplantation. All of its heart transplant patients achieve ambulation within 3 days. It claims to account for approximately half of all heart transplants in China. It also innovated in the field of heart preservation technology and set a record for safely preserving a heart for 7 hours. ²⁹⁰

The Thoracic Surgery Department stated on its website that lung transplantation is so far the only effective treatment for end-stage lung diseases. The department has accumulated abundant experience in lung transplantation with significant achievements. It still holds the record of performing a lung transplant for the oldest recipient in Asia.²⁹¹

On March 1, 2015, Zhongshan Hospital’s east campus officially opened, after an investment of 1.6 billion RMB and 6 years of construction. The new campus has 16 wards, 19 operating rooms, and 4 ICUs.²⁹²

Zhongshan Hospital operates Shanghai’s key laboratory for organ transplantation. According to incomplete data, the lab is currently working on 18 research projects under the National Natural Science Foundation and 12 research projects at the provincial and ministerial levels, with total funding of over 10 million RMB. In 2013 and 2014, it published 45 Science Citation Index papers and was granted 3 national patents.²⁹³

After the public release of information in 2006 about organ harvesting, a doctor at the transplantation center stated to an investigator who called in the name of a patient relative that its organs came from Falun Gong practitioners:²⁹⁴

Shanghai’s Zhongshan Hospital Organ Transplant Clinic (16 March 2006):

Investigator: Hi. Are you a doctor?

Doctor: Yes, I am…

Investigator: … So how long do I have to wait [for organ transplant surgery]?

Doctor: About a week after you come…

Investigator: Is there the kind of organs that come from Falun Gong? I heard that they are very good.

Doctor: All of ours are those types.

On February 8, 2015 the director of Zhongshan Hospital’s liver disease department, Tan Yunshan, stated to an overseas reporter, “All the donor livers are directly extracted at the source. Because we do the extraction ourselves and have access to the original information of the donor organ, we would know for sure whether a donor liver can be used or not…”^{295 296}

When asked whether the hospital used organs from Falun Gong practitioners, Tan answered, “We don’t care whether it’s from a Falun Gong practitioner or not. We don’t get involved in politics. As doctors, we only care about the donor liver, about whether it meets the requirements of transplantation. If it meets the requirements, we don’t care who it’s from.”

The First Affiliated Hospital of Zhejiang University has the largest organ transplantation centre in eastern China and one of the largest in China. ^{298 299} The hospital has 682 experts with senior professional titles and 2,500 beds. The hospital also contains the Ministry of Health Key Research Lab for Multiple Organ Transplantation.

Its Department of Hepatobiliary Pancreatic Surgery and Liver Transplantation Centre claim to be China’s largest and most technologically advanced facility of its kind, with more than 340 beds, coupled with a leading number of combined liver-kidney transplants and combined pancreas-kidney transplants completed. Its transplantation team is headed by Zheng Shusen of the Chinese Academy of Engineering, with a staff of 134 medical personnel, including 39 with senior titles. About 60% of these personnel hold doctoral degrees.³⁰⁰

Zheng Shusen is the president of the First Affiliated Hospital of Zhejiang University, the director of the China Organ Transplantation Society, and the only committee member of the International Liver Transplantation Society (ILTS) from mainland China. He twice served as the chief scientist presiding over the only two projects in the field of organ transplantation under the National Key Basic Research Program (“973 Program”). In 2006, he helped to create the Hongzhou Criteria, the first of its kind to guide the selection of Chinese liver cancer patients to receive liver transplants. With influence in over 20 provinces, he has helped the Beijing Union Medical College Hospital, the Fudan University Huashan Hospital, the Shanghai Xinhua Hospital, and the First Affiliated Hospital of Xinjiang Medical University with their liver transplantation practices. He has trained 6 post-doctorates and more than 160 postgraduates with doctoral and master’s degrees.³⁰¹

Zheng wrote in a paper that, between January 2000 and December 2004, he had conducted 46 emergency liver transplants, with all of the patients receiving orthotopic liver transplants within 72 hours.³⁰² Zheng claims that he has led over 1,400 liver transplants to date.³⁰³

In recent years, the liver transplantation centre has undertaken and completed more than 40 national-level research projects, including two projects under the National 973 Program with Zheng as its chief scientist; one was completed between 2003 and 2008, and the other between 2009 and 2013.³⁰⁴ The team also completed three projects under the National 863 Program, among others.³⁰⁵

Its Kidney Disease Centre claims to be one of China’s largest kidney transplantation centres,³⁰⁶ with 5 personnel with senior professional titles, 12 professors and associate professors, a doctoral advisor, and 6 Master’s advisors. The World Organization to Investigate Persecution of the Falun Gong verified from published medical papers that at least 35 surgeons at this centre have conducted organ transplants. 307

The Centre’s director, Chen Jianghua, specializes in kidney transplantation and combined multiple organ transplantation. He serves as the vice director and secretary for the Ministry of Health Administrative Committee of Scientific Registration System of Kidney Transplantation.³⁰⁸ He has presided over more than 50 research projects at the national, provincial, and ministerial levels, including two projects winning second-class national scientific improvement awards, 6 first-class scientific improvement awards in Zhejiang Province, and 3 second-class provincial awards. He has published more than 280 professional papers, 72 of which were listed by Science Citation Index.

The First Affiliated Hospital of Sun Yat-Sen University leads the nation in vital organ transplantation projects. It claims to have the most types of transplants and to rank second in total volume.³⁰⁹ It conducted the first kidney transplant in China in 1972 and the first liver transplant in 1993. It is described as the birthplace of China’s second surge of liver transplants.³¹⁰

Alongside transplants of liver, kidney, heart and lung, it also conducts upper abdominal multi-organ transplants on a routine basis. It is one of the most renowned kidney transplants centre inside and outside of the country.³¹¹ In addition to patients from China, it also provides kidney transplants to patients from over ten countries and regions, including the U.S., Japan, Hong Kong, and Taiwan.

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 set for 6 liver transplants and one multi-organ transplant in one day.³¹²

Huang Jiefu previously worked at this hospital with Zheng Keli, the team leader of the National Kidney Transplant Team who established the hospital’s Organ Transplant Department. Its current director is He Xiaoshun who has reportedly completed 1,300 liver transplants.³¹³ In 2006, it became one of the three liver transplantation training centres of the China Medical Board, with 42 organizations having visited and studied there.³¹⁴

The Sun Yat-Sen Ophthalmology Centre of the Sun Yat-Sen University has conducted over 40,000 ocular surgeries, including cornea transplants. Both its cumulative and annual volume rank near the top nationwide.³¹⁵ The Ophthalmology Centre has led over 20 national or provincial key scientific and technological research projects, including the 973 Project, the 863 Project, the Eleventh Five-Year National Scientific and Technological Research plan, key clinical research projects for Ministry of Health, and more than 20 major projects for Guangdong and other provinces. It has also won numerous research grants and published over 200 papers in the past five years.

In mainland China, medical universities are affiliated with hospitals. In an education reform, a large number of hospitals were also placed under universities. For example, Capital Medical University has 20 affiliated hospitals,³¹⁶ including Friendship Hospital, Chaoyang Hospital, Anzhen Hospital, YouAn Hospital, and Tongren Hospital. Because these hospitals are so well-known, they maintained their independent names rather than being renamed as affiliated hospitals of Capital Medical University.

Beijing Friendship Hospital was named by the Health Bureau as the Beijing Organ Transplant Matching Centre in 1997. It is Asia’s largest kidney transplant centre and had completed the first 1,000, 2,000, and 3,000 transplants in China. In 1998, it established the Sino-U.S. Terasaki Matching Centre.³¹⁸

Yu Lixin, the director of the Guangzhou Nanfang Hospital Organ Transplant Centre,³¹⁹ the number of kidney transplants completed at Friendship Hospital had already exceeded 2,300 by the year 2000. At that time, many other organ transplant centres had also completed over 1,000 kidney transplants, including Guangzhou Nanfang Hospital, the First Affiliated Hospital of Sun Yat-sen University, People’s Liberation Army General Hospital, the First Affiliated Hospital of Xi’an Jiaotong University, and Chaoyang Hospital. Between 2000 and 2006, the number of transplants rose quickly. Because October 2000 was only the beginning of this exponential growth rather than its peak, we conclude that the number of transplants conducted at these hospitals after 2000 was even more substantial.

(China International Transplantation Network Assistance Centre)

The First Hospital of China Medical University is located in Shenyang, Liaoning Province. It is the largest organ transplant centre in northeastern China and also the first hospital to develop liver and pancreas-kidney transplants in the region.³²¹

In 2003, the hospital established its China International Transplantation Network Assistance Centre (CITNAC), a transplant institution for foreigners, with customers mainly coming from Japan, South Korea, and other countries. The hospital ran a strong advertising campaign in Japan, promoting targeted services. The campaign stated, “The Organ Transplant Institute not only has several doctors and head nurses who studied in Japan and are familiar with Japanese culture, but most nurses can also speak Japanese, which is convenient for Japanese patients. Post-surgery patients will all be admitted to the Senior Cadre Ward for special care.”³²²

After the exposure of organ harvesting crimes in Sujiatun hospital in 2006, CITNAC removed information regarding living donors from its website.³²³ In an archived version of the website from September 2004, the Centre had emphasized, “In China we carry out living donor kidney transplants. It is completely different from the deceased body [corpse] kidney transplants you hear about in Japanese hospitals and dialysis centres…Compared to cadaver kidney transplants in Japan, what is offered here is much safer and more reliable.”³²⁴

CITNAC listed its prices for living organs: over $60,000 USD for a kidney transplant, about $100,000 for a liver transplant, and over $150,000 for lung or heart transplants.³²⁵

In a 2006 report published in the The Asia-Pacific Journal: Japan Focus, Chairman Suzuki Masanori of the Japan Transplant Recipients Organization said that a Chinese hospital had conducted 2,000 organ transplants in 2005 alone.³²⁶ According to an investigation by the World Organization to Investigate the Persecution of Falun Gong, Masanori was referring to the China International Transplantation Network Assistance Centre of the First Hospital of China Medical University, located in Shenyang, Liaoning Province, which is close to Japan.

The Centre’s website stated, “To be able to complete such a large number of organ transplant surgeries every year, we need to give all of our thanks to the support given by the government. In particular, the Supreme People’s Court, Supreme People’s Procuratorate, Public Security system, judicial system, Ministry of Health, and Ministry of Civil Affairs have jointly promulgated laws to establish that organ procurement receives government support and protection. This is one of a kind in the world.” ³²⁷

Professor Liu Yongfeng is a doctoral advisor and the director of the Centre’s Organ Transplant Division. According to its archived version of the “famous doctors list” from October 23, 2004,³²⁸ Liu had studied liver and pancreas transplants at the University of Minnesota Transplant Centre in the U.S. and had mastered techniques in graft procurement, organ transplantation, and postoperative management. He established the Centre’s organ transplant division in 1992 ³²⁹ and developed kidney, liver, combined liver-kidney, and combined pancreas-kidney transplants. The web page indicates that the Centre has become one of the largest comprehensive organ transplant centres in China and is the largest multi-organ transplant centre in northeastern China. Liu trained over twenty doctoral students and over thirty master’s students. He also guided many units to develop kidney transplant surgeries. The posting indicates that he had been promoted to vice president of the First Hospital of China Medical University for his achievements.

According to its archived web pages,³³⁰ the Centre in 2004 had two professors, two associate professors, four doctorates, seven doctoral students, and two master’s students. In total, it had sixteen people with graduate degrees, with over half of them having studied or received training overseas. The Centre was the only hospital in China at the time capable of simultaneously conducting multiple organ transplants, including kidney, liver, combined pancreas-kidney, and combined liver-kidney transplants. The hospital claims to have performed more than 1,000 kidney and liver transplants as of April 2016,³³¹ giving an average of 45 per year, or less than one per week. This number is derisory, considering the Centre’s staff complement and capacity.

Between 2003 and 2008, Wang Lijun was the Police Commissioner of Jinzhou City in Liaoning Province. He established an “On-Site Psychology Research Centre” with the main purpose of experimenting with organ transplantation from living donors. Its collaborative partners included seven foreign universities and seventeen domestic universities and hospitals. Chinese Medical University and the People’s Liberation Army No. 205 Hospital in Jinzhou were among them.³³²

On September 19, 2006, at the award ceremony of China Guanghua Science and Technology Foundation’s Innovation Special Contribution Award, Secretary-General Ren Jinyang of the foundation said in his presentation:³³³ “Professor Wang Lijun and the research centre has conducted basic research and clinical trials on the difficult issue of organs that cannot easily be transplanted after lethal injection. Through animal testing, in vitro experiments and clinical application, they have developed a brand new formula for a preservative solution. After injecting the solution into the liver and kidney in vivo or in vitro, the organs can be used for transplants.” Wang Lijun also commented while receiving the award, “Our technological achievement is the result of several thousand on-site intensive trials and is through efforts of many people…”³³⁴

The People’s Liberation Army 205 Hospital in Jinzhou is the largest organ transplant centre in western Liaoning Province, though it has not been approved to perform transplants by the Ministry of Health. On May 23, 2006, Western Liaoning Business Daily published a report stating that Chen Rongshan, the director of its urology department, had completed 568 kidney transplants. Patients from Taiwan, Singapore, South Korea, Malaysia, and that patients from other places “flock there because of its reputation.”³³⁵ By December 2006, Chen had participated in at least 632 kidney transplants.³³⁶

On May 25, 2012, when an investigator of the World Organization to Investigate the Persecution of Falun Gong called Chen, he stated that he had participated in Wang Lijun’s human experiments, and so did China Medical University and its affiliated hospitals.³³⁷

This is a partial transcript, translated, of the conversation between them:

Investigator: Wang Lijun had a post-drug-injection transplantation project. Have you collaborated with him on this?

Chen R.S.: Not only us, China Medical University, and its affiliated hospitals, were also involved in this.

Investigator: Some of the organs were from detained Falun Gong practitioners. Can you confirm this?

Chen R.S.: Those were all handled through the courts.

Director Liu Yongfeng of China Medical University’s Organ Transplant Institute stated that he participated in the research and development of organ preservation solutions and developed kidney preservation solutions that led the field in China. His account further stated that his technique of multiple abdominal organ procurement reduced damage to organs and has become the most widely used procurement technique in China. Liu led various scientific research projects, including four National Natural Science Foundation projects, and won a first prize of the National Science and Technology Progress Award.³³⁸

Shanghai Jiaotong University has fourteen affiliated hospitals,³⁴⁰ including Renji Hospital. Other affiliated hospitals, such as Shanghai Ruijin Hospital, Shanghai First People’s Hospital, and Shanghai Xinhua Hospital are all organ transplant centres designated by the Ministry of Health. This university is former Chinese leader Jiang Zemin’s alma mater.

Shanghai Renji Hospital conducted its first liver transplant in 2001.³⁴¹ After several years of development, its volume of liver transplants ranked first in Shanghai for eight consecutive years. It claims to have ranked first in China for liver transplants in 2011, 2012, 2013 and 2014 and first in the world for pediatric liver transplants. Renji has become one of the top liver transplant centres in China.³⁴²

According to an online posting, “Renji Hospital Liver Transplant Centre was officially established on September 20, 2004. Its main leader is Xia Qiang, who was recruited by the hospital. Though he had completed several hundred liver transplants successfully, Xia was still inexperienced within the transplant circle in China at the time.”³⁴³

In a report by Jiefang Daily on January 26, 2005, Xia said, “I’m obsessed with liver transplants. It’s like I’m addicted to it. I would feel uncomfortable if I don’t go to the ward to see patients for one day. I do at least two to five liver transplants a week. I’m not afraid of failures. I would carefully analyze and summarize and continue to do it the next day.” Exactly how many liver transplants had he done? Xia had lost count. He remembers only his record of six liver transplants in one day.³⁴⁴ Even now, a classical liver transplant takes four to six hours to complete; back in 2005, the operation time was even longer.

Xia said, “The management of my team is militarized. Every medical staff member must keep their cell phone turned on 24 hours a day, because liver transplants may require going out for graft procurement or preparing for surgery at any time. We doctors must be on standby at all times.”³⁴⁵ Among media reports, “busy” seems to be the most common word. In 2013, a Wenhui Daily article wrote, “Renji Hospital conducts liver transplants surgeries continuously, and doctors could not get out of the hospital all night long.”³⁴⁶

In October 2004, Renji Hospital expanded the beds available for liver transplants less than ten days after the Centre was established. “The fourth day after I arrived at Renji Hospital, I performed the first liver transplant. The next week, we successfully completed 4 liver transplants.” As the hospital executives saw the strength of this young team, they immediately decided to expand from 13 beds to 23 beds for liver transplant during the October 1^st long holiday.³⁴⁷

In less than three years, the China Organ Transplant website showed in June 2007 that Renji Hospital had 90 beds for liver transplants and can carry out 6 liver transplant operations simultaneously.³⁴⁸ By 2014, Renji Hospital’s Liver Transplant Surgery Department had 3 wards, 110 beds, and over 70 medical personnel. It has become a national key clinical discipline, a key discipline for development under the national “211 Project,” and a key clinical medical discipline under the Shanghai Health and Family Planning Commission.³⁴⁹

In 2007, the hospital website showed that it “completed close to 200 liver transplants per year.” In 2013, it stated that the number of annual liver transplants was “over 200.” If that figure were true, the 23 beds in 2004 would have been more than sufficient. Yet, its bed count was increased to 110.

In Shanghai, where hospital beds were in short supply, Renji Hospital innovated many methods to increase their utilization rate, including the well-known “daytime surgery centre,” where patients need to stay for only 24 to 48 hours.³⁵⁰ A variety of factors affect individual patients’ hospitalization times. The shortest hospitalization times for liver transplants are listed at or below two weeks, including 9 days at Fudan University³⁵¹ and 12 days at Shandong Provincial Hospital Organ Transplant Center. ³⁵²

Even assuming a 30-day hospitalization time and a 100% utilization rate, 90 beds would allow 1,080 transplants per year, and 110 beds would allow 1,320 transplants per year. If Renji Hospital had also achieved a three-week hospitalization time and if we deduct a small number of beds used for other purposes, its annual liver transplant quantity would have reached over 1,500.

Renji was one of the first hospitals in Shanghai to conduct kidney transplants.³⁵³ Its urology department established a new wing and renal transplant ward in Pudong in November 1999 and later expanded to 70 beds. Its new medical team and distribution system allowed its number of surgeries to increase by 300%.³⁵⁴ The medium-sized department performs over 5,000 surgeries per year, with over 60% being large and extra-large operations. The average hospitalization time is five days.³⁵⁵ These data points suggest that the hospital performs as many kidney transplants as liver transplants.

Xia Qiang said, “If there is a sufficient supply of livers, we will not start liver transplants from living donors [referring to patients’ relatives], since, after all, it requires healthy donors to bear the risk of surgery.”³⁵⁶ According to a Wenhui Daily report, among the 1,500 surgeries completed at the hospital between 2004 and 2013, just over 300 were from living relative donors. The hospitals realistic capacity is over 1,000 transplants per year and the number of relative donors (33 per year on average) represent a fraction of its total volume.

A page on Good Doctors Online, a widely used medical directory for Chinese doctors, states, “In 2013, with the strong support of hospital officials, it [the hospital] set up the first Organ Procurement Organization (OPO) in Shanghai. By June 2014, it has already obtained 22 organ donations, including from 14 adults and 8 children, providing 17 livers and 34 kidneys, accounting for two-thirds of all organ donations in the Shanghai area.”³⁵⁷ If we consider only the officially published volume of transplants, the sources of more than 1,100 transplants among the 1,500 are unexplained.

In an investigative report broadcast by New Tang Dynasty (NTD) TV on February 7, 2015, the head nurse on duty at the liver transplant department of Renji Hospital acknowledged that the procurement of living organs was done through military sources.³⁵⁸

Nanjing Drum Tower Hospital was originally established as a Christian hospital in 1892. It now has about 3,000 beds, more than 400 chief physicians and associate chief physicians, more than 220 full and associate professors, over 40 doctoral advisors, and over 180 master’s advisors. It employs 40 experts who receive special allowances from the State Council. The hospital’s liver transplantation capability is claimed in a leading position in China. ³⁵⁹

In 1995, its hepatobiliary department successfully conducted China’s first piggyback liver transplant, which was considered an advanced operation at the time. In 2001, it performed the first combined liver-kidney transplant in Jiangsu Province. The department currently has 180 beds. Its subordinate departments include transplantation, liver surgery, and biliary-pancreatic surgery. This department is a national key discipline and serves as the Jiangsu Province Hepatobiliary Clinical Medical Centre. ³⁶⁰

The department’s academic leader, Ding Yitao, now serves as director of the organ transplant centre, honorary president of Nanjing Drum Tower Hospital (he was president between 1996 and 2014), and vice president of Nanjing University Medical School. He has received research grants from the National Natural Science Foundation, National 863 Program, and Chinese Academy of Sciences special projects. He has published more than 500 papers and books, including around 200 papers as the primary author. He has received 16 awards at the national and provincial levels. He also received advanced training at the Australian National Liver Transplantation Unit.

In addition, the hospital’s urologic surgery department is approved by the Ministry of Health to perform kidney transplants. It is a Jiangsu provincial medical and clinical key specialist department. The department is assigned 120 beds and has 3 wards.³⁶¹

The hospital’s gigantic, modern General Medical Building was put into use on December 15, 2012. The building is equipped with amenities akin to that of a five-star hotel, including a grand piano worth 7 million RMB. The building can accommodate 15,000 outpatients per day and has close to 3,000 beds. The building has won a World Architecture News award and China’s top architecture award, the Lu Ban Award.