Editor’s Note: For many years, stories have circulated about instances of alleged involuntary organ harvesting in the People’s Republic of China. However, due to the difficulty of confirming these accounts—and due perhaps as well to their lurid and disturbing nature—the veracity of these alleged accounts has long been left as an unresolved question. Matthew P. Robertson, research fellow with the Victims of Communism Memorial Foundation (VOC) and a PhD candidate in political science at the Australian National University, is engaged in an effort to direct an analytically rigorous approach towards this controversial topic—which has long been a marginalized issue in diplomatic and human rights discourses connected to the PRC. Mr. Robertson is the author of a detailed report on the topic published in March 2020 by VOC, available here.
Our previous issue contained the first part of this series (Examining China’s Organ Transplantation System: The Nexus of Security, Medicine, and Predation / Part 1: The Growth of China’s Transplantation System Since 2000), which detailed the development and expansion of China’s policy architecture and medical infrastructure for organ transplants over the past two decades. In this article, the second part of a planned three-part series in China Brief, Mr. Robertson examines the available evidence as to whether prisoners of conscience and targeted ethnic minorities in the PRC have been made subject to extrajudicial killing as part of this system of organ harvesting and transplantation.
The third and final part, to appear in a near-future issue, will examine the ways that PRC authorities have sought to leverage influence over international medical organizations in order to manage the narratives surrounding this issue.
Part 1 of this series profiled the dramatic growth of the organ transplantation infrastructure in the People’s Republic of China (PRC) since the year 2000, and also detailed the difficulty in plausibly explaining the sourcing of organs on a scale that could support such a large system. The discrepancies between the observed growth of China’s transplant sector, and official explanations regarding the organ supply necessary to support a system of such scale, have raised significant questions as to the source of these organs. These discrepancies lead to the need for an alternate explanation, and into this breach a range of theories have been proposed: to include rogue doctors operating organ trafficking gangs (Associated Press, March 15, 2018), and voluntary sales of kidneys for iPads and other consumer electronics (BBC, April 6, 2012).
Reaching a judgment as to the source of this large supply of human organs requires evaluating competing hypotheses and making a judgement as to which is the most plausible. One of the most plausible—and disturbing—explanations is that prisoners of conscience in the PRC have been medically tested on a systematic basis while incarcerated, and subsequently executed in order to harvest organs that can be monetized for substantial profits by Chinese Communist Party (CCP) officials (China Tribunal, March 1). Incarcerated persons represent the only population that can plausibly explain the sourcing of healthy organs on the scale observed in China’s transplant sector: these persons are held in captivity; pre-screened for organ function, health, blood-type, and (for kidney transplants) tissue-type; and they are available to be executed on demand. Furthermore, the generally higher state of health found among prisoners of conscience may make them more desirable as an organ source, as compared to regular criminal inmates—who are more likely to be affected by health issues such as drug abuse. When examining possible captive populations, prisoners of conscience are among the most numerous, suitable, and vulnerable.
Analysis of PRC transplant data, as well as admissions by officials, suggests that tens of thousands of transplants take place in China annually (VOC Appendix 4, March 10). Death row prisoners are only estimated to number a few thousand, and only a portion of them would make suitable donors. The size of the voluntary donation system at present is unclear, but the systematic falsification of data (see discussion further below) suggests that it must be much smaller than claimed—meaning that there is still a gap in transplant volume that has not been explained.
Prison Populations That Could be Exploited as Organ Sources
The allegation that organs have been harvested from prisoners of conscience first emerged in 2006 from diaspora practitioners of Falun Gong, an indigenous Chinese spiritual practice suppressed by the PRC authorities since 1999. Prior to the emergence of the Falun Gong allegations in 2006, there was no legislation (or official regulations) regarding organ transplantation in the PRC; however, the first public interim guidelines on the issue were announced two weeks after the Falun Gong claims in March of that year (Ministry of Health, March 14, 2006). The year 2006 was also significant in terms of official narratives: PRC officials initially denied that death row prisoners were used as a source for organs, then in April 2006 revised this claim to state that such prisoners were in fact a source (see Part One of this series).
The allegation that prisoners of conscience are exploited for their organs is composed of many parts of evidence—many of which, although not all, are connected to practitioners of Falun Gong.  The most salient include the following:
- Falun Gong detainees have reported being made subject to unusual blood tests, chest X-rays, and ultrasounds of abdominal organs while in custody; some refugees have reported that only Falun Gong detainees were called out by guards for such physical exams and blood tests, without explanation. Subsequent to this testing, these prisoners began disappearing.
- There is an extensive catalogue of telephone calls made to Chinese transplant hospitals by investigators outside China posing as potential patients, relatives of patients, and doctors. These investigators have elicited admissions from nurses and doctors that organs are available on demand. In a number of these calls, hospital personnel have stated that the organs come from practitioners of Falun Gong. 
- China’s transplantation sector began its rapid transformation (in 2000) approximately six months after the campaign against Falun Gong began (in 1999), at a time when China’s death-row prison population was going into decline.
- Many cases have been documented of summary cremations of young, healthy Falun Gong detainees who die mysteriously in custody. No information is provided to the family, who receive an urn of ashes.
- Cases have also been documented of family members of deceased detainees seeing the bodies with scars consistent with organ removal. In one case in Chongqing, the police admitted that the organs were removed immediately after death, but claimed that this was done in order to take medical specimens.
The Overlap Between Medical and “Anti-Cult” Officials
In addition to the list above, a further salient point of evidence is found in the overlap between medical personnel performing transplants, and the CCP cadres carrying out the ongoing anti–Falun Gong campaign. One prominent example of this overlap is found in the case of Dr. Zheng Shusen (郑树森), a leading liver surgeon and vice-president of the China Medical Association. Until 2017, Dr. Zheng was also chairman of the Zhejiang Provincial Anti-Cult Association, a party-led body established to pursue the CCP’s campaign of repression against Falun Gong and other religious organizations proscribed by the state. In the preface to a 2009 internal circulation anti-Falun Gong book, Dr. Zheng (in his security role) described Falun Gong as an “evil religion,” a “virus,” and a “cancer.”  In recent years Dr. Zheng co-founded a private hospital with his wife (a leading health official in Zhejiang), which offers organ transplantation as a therapy (Zhejiang News, May 13, 2017). The couple advertises a specialty in short-notice, emergency organ transplants (Sina, December 20, 2017).
|The Suspicious Nature of the PRC’s Official Data on Organ Donations
As discussed in Part 1 of this series, the PRC’s official narratives regarding the sourcing of transplant organs have shifted in an inconsistent and evasive manner over time. Furthermore, official PRC statistics are implausible: forensic statistical analysis of China’s organ donor registry data (performed by the present author, in collaboration with a statistician and a cardiac transplant surgeon) indicates that the country’s medical authorities have falsified the data associated with their voluntary donor system. This finding, which was published in a leading medical ethics journal late last year, found that China’s official donor datasets conform at a 99.9% level to a quadratic equation. China’s figures are thus between one and two orders of magnitude smoother than comparable transplant data from any other country, even those whose transplant systems have grown at a rapid pace (BMC Medical Ethics, November 14, 2019).
A range of subsequent statistical findings bolstered this initial discovery (including a significant simplification of the initial model when the PRC published more data). This further corroborated our argument that the data was in fact generated in accordance with a simple model, rather than from actual transplant activity. A range of other qualitative findings cast further doubt on the integrity of the data, including a range of implausible and impossible anomalies in China’s Red Cross figures (such as a claim of 21.3 organs per donor for a two week period in 2016). Provincial Red Cross offices appear to have been involved in the scheme: we conducted five detailed provincial case studies that found implausible leaps in reported donations (such as simple doublings, erratic organ/donor rates, and more), and mismatches between transplants and transplant capacity as reported by hospitals and the respective provincial Red Cross offices.
In a review of the paper, Sir David Spiegelhalter, former president of the Royal Statistical Society and professor at the University of Cambridge, noted that “the anomalies in the data… follow a systematic and surprising pattern,” and that “the close agreement of the numbers of donors and transplants with a quadratic function is remarkable, and is in sharp contrast to other countries who have increased their activity over this period… I cannot think of any good reason for such a quadratic trend arising naturally” (Spiegelhalter, March 19, 2019).
Questions Surrounding the Incarceration and Exploitation of Uyghur Detainees
The current mass internment of Uyghur Muslims (China Brief, May 15, 2018; China Brief, November 5, 2018) has also led to questions about the vulnerability of this population to execution and organ harvesting. As compared to the Falun Gong allegations, a similar constellation of evidence exists in the case of Uyghur Muslim prisoners of conscience, though it is not yet as fully developed. In this case, too, Uyghurs have reportedly been subjected to systematic and coercive blood and DNA tests. Former detainees report forced medical examinations of the health and functioning of thoracic and abdominal organs. There are also many instances of disappearances of Uyghurs in custody.  Multiple reports and leaked video footage indicate secret transfers of Uyghur detainees on rail to different parts of China (see image below)—which does not, in itself, prove that these persons are being exploited for organ harvesting, but does demonstrate extrajudicial and unaccountable state control over this vulnerable population.
The fact that religiously observant Muslims are more likely to abstain from drinking alcohol and smoking tobacco may make them—similar to members of Falun Gong, underground churches, and other religious groups—potentially more desirable as an organ source, as compared to regular criminal inmates who are often more affected by drug abuse and other health issues. If Uyghur detainees are indeed being targeted in this fashion, it would be another instance of the CCP “learning” lessons from its two decades-old campaign against Falun Gong (China Brief, February 1, 2019).
While it may be difficult at present to arrive with absolute certainty at a conclusion as to the truth of these allegations, in a recent report for the Victims of Communism Memorial Foundation we addressed this question with a straightforward argument: that extrajudicial execution and organ sourcing from prisoners of conscience is the most plausible explanation for the majority of China’s transplant activity since 2000 (VOC, March 10). If PRC officials have an alternate and more compelling explanation, they should present it, rather than obfuscating the issue with falsified data.
Within the organ transplantation system that has developed over the past two decades, the CCP thus promotes its objective of cleansing the social body of groups thought to pollute it—while CCP members are enabled to reap personal profits as they carry out the task. As this takes place, Beijing leverages key relationships it has cultivated with international medical elites in order to win praise for its transplant reforms. This latter issue will be the subject of the third and final article in this series.
Matthew P. Robertson is a research fellow in the China Program at the Victims of Communism Memorial Foundation and a doctoral student in political science at the Australian National University. His dissertation research examines the political logic of state control over and exploitation of the bodies of Chinese citizens, with a focus on the case of the organ transplantation industry.
 The evidence in this section is adapted from the author’s previous work in: Organ Procurement and Extrajudicial Execution in China: A Review of the Evidence (Victims of Communism Memorial Foundation, March 2020), pp. 35-36. This document also contains a list of supporting references. https://static1.squarespace.com/static/5aa6d4759772aebd11e6fe04/t/5e628619cf65b0241d5b0020/1583515189395/Organ+Procurement+and+Extrajudicial+Execution+in+China_VOC+2020.pdf.
 For a full discussion of these telephone calls, including the means by which they were verified and evaluated, see: Matthew P. Robertson, “Authentication and Analysis of Purported Undercover Telephone Calls Made to Hospitals in China on the Topic of Organ Trafficking,” China Studies Working Paper 1/2020 (Victims of Communism Memorial Foundation, Feb. 11, 2020). https://papers.ssrn.com/abstract=3536155.
 Zheng Shusen et al eds., Selected Academic Papers on Evil Religion Prevention Research in the New Era (新时期邪教防治研究学术论文精选, Xinshiqi Xiejiao Fangzhi Yanjiu Xueshu Lunwen Jingxuan) (Zhejiang Anti-Cult Association / Science and Technology Press, 2009).
 Sources and details are treated in Robertson, Organ Procurement and Extrajudicial Execution in China: A Review of the Evidence, pp. 36-40.