Eight doctors at the Tongji Medical College hospital in Wuhan, China, traveled 40 miles on March 18, 1994, to procure a heart from a death-row prisoner. But rather than wait until the judicial authorities had executed the prisoner, the doctors carried out the execution themselves—by heart extraction.
In a large-scale review we conducted of nearly 3,000 Chinese-language clinical reports and published in the American Journal of Transplantation, we find surgeons acknowledging such actions again and again.
The Wuhan doctors write: “When the chest of the donor was opened, the chest wall incision was pale and bloodless, and the heart was purple and beating weakly. But the heartbeat became strong immediately after tracheal intubation and oxygenation. The donor heart was extracted with an incision from the 4th intercostal sternum into the chest. . . . This incision is a good choice for field operation where the sternum cannot be sawed open without power.”
By casually noting that the donor was connected to a ventilator (“tracheal intubation”) only at midsurgery, the physicians inadvertently reveal that the donor was alive when the operation began.
For a declaration of brain death to be legitimate, the organ donor must have lost the ability to breathe spontaneously and have already been intubated. This is a well-established medical principle associated with a basic rule of transplant ethics: Donors must be deceased before vital organs are removed.
Yet our research finds scores of reports—over a three-decade period, at 56 Chinese hospitals, involving more than 300 medical workers—in which brain death was described as having been declared before the donor was intubated. They were often intubated immediately before surgery. In the 1994 Wuhan case, intubation took place after the surgery began. In other cases, there was no intubation at all.
It has long been known that China harvests organs from death-row prisoners and prisoners of conscience as part of a large-scale, lucrative trade. To the extent that such religious minorities as Falun Gong and Uyghur Muslims have been targeted, a London-based independent tribunal described it as a crime against humanity and potentially a component of genocide. Yet until now there has been no systematic study of the role of doctors in carrying out the executions themselves.
To perform the study, we wrote code to download 124,770 Chinese-language medical papers. We wrote custom algorithms to search them for evidence of these abuses. We found 71 clinical reports making explicit admissions of surgeon killing, and we suspect these were a tiny portion of a large, hidden population. Thousands of papers have been published in China about heart and lung transplantation, but most say nothing about how the donor was handled.
Our findings end in 2015, but we think the abuse likely continues. Medical papers like those we studied were first unearthed by Chinese grass-roots investigators in late 2014, and it would have been simple to command journals to stop publishing the incriminating details after that. While China claims to have stopped using prisoners in 2015, our previous research raises doubts. In a 2019 paper in the journal BMC Medical Ethics, we used statistical forensics to show that the official voluntary-organ donation numbers were falsified, inflating the success of a modest voluntary organ-donation reform program used to buttress the reform narrative.
Global medical leaders have largely dismissed such concerns. The World Health Organization took advice from Chinese transplant surgeons in the establishment of its anti-organ-trafficking task force—and then installed them on the membership committee. In 2020, WHO officials joined long-time apologists for China’s transplant system, attacking our previous research showing falsified numbers.
The Chinese state’s use of medicine as a tool of repression is well known, as seen in the use of psychiatry to repress dissent, conduct forced abortions and more. Most recently, medicine has been implicated in the genocide of the Uyghurs. Experts with the British Medical Association noted in its journal, the BMJ, that “the Chinese government systematically deployed medical professionals, medical skills, and medical technologies in pursuit of these crimes.”
Yet the global transplant community has largely accepted China’s claims of reform and ignored evidence to the contrary. Comparisons to the medical atrocities of the Nazis haven’t galvanized a response, perhaps having lost all potency due to overuse. Western political leaders have likewise shown little interest in investigating the abuse.
We hope this will begin to change with these most recent revelations. It is now known that highly trained surgeons have for decades been killing prisoners with their scalpels on the operating table. This is a novel and extreme deviation from global norms. With the publication of these findings in the leading transplant journal, perhaps the issue will no longer be so easy to ignore.
Dr. Lavee is the director of the Heart Transplantation Unit at Tel Aviv’s Sheba Medical Center and a professor of surgery at Tel Aviv University. Mr. Robertson is a research fellow with the Victims of Communism Memorial Foundation and a doctoral candidate in political science at the Australian National University.
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