Execution by Heart Removal in China Occurred for Decades, Study Claims

A study published in an American medical journal has claimed that surgeons working at state-run civilian and military hospitals in China executed numerous prisoners over a period of decades by removing their hearts for transplant purposes.

The authors of the study, published in the American Journal of Transplantation, identified 71 Chinese medical journal publications dated between 1980 and 2015 describing cases in which the removal of the heart appeared to be the cause of the prisoner's death.

In these cases, the prisoners were supposedly braindead before surgeons removed their hearts. "Braindead" is a classification referring to someone who will never regain consciousness or start breathing on their own again without a ventilator.

But the authors of the latest study—Matthew Robertson from the Australian National University and Dr. Jacob Lavee, a cardiac transplant surgeon at the Sheba Medical Center in Israel—said the evidence they have uncovered suggests this was not the case.

The researchers said their findings indicate that the operations were unethical because they breached the "dead donor rule."

"The dead donor rule is fundamental to transplant ethics," the authors wrote in the study. "The rule states that organ procurement must not commence until the donor is both dead and formally pronounced so, and by the same token, that procurement of organs must not cause the death of the donor."

For their paper, Robertson and Lavee created a code to download and analyze more than 120,000 medical publications from official Chinese databases. The researchers then used a custom algorithm to scan the reports, revealing "clear signs" of unethical conduct.

In 71 of the reports—involving 56 hospital and more than 300 medical workers across the country—the authors argue the prisoner donors had not properly been pronounced dead before their hearts were removed.

In many of the cases the authors found that a declaration of brain death took place before it was assessed whether the patient can breathe without a ventilator—a key factor in classifying someone as brain dead.

In other cases in which donors were ventilated, medical staff used a face mask rather than inserting a tube into the patients' windpipe—a procedure known as intubation. The authors said this was evidence of a clear breach of the dead donor rule.

"This was one of the strongest pieces of evidence of failure to adhere to the dead donor rule because ventilation via intubation is a key step in being able to diagnose brain death," Lavee said in a statement.

"There were several other problematic features of these clinical case reports. For instance, the donors did not have intravenous lines established until moments before surgery, and several papers referred to acute brain death. This evidence suggests that the donors' organs were procured before they could have been properly diagnosed as brain dead."

In these cases, they say, the removal of heart during organ procurement must have been the cause of the donor's death.

"This abhorrent conduct is a grievous violation of medical ethics, human rights and basic human dignity," said Arthur Caplan, head of the Division of Medical Ethics at New York University's (NYU) Grossman School of Medicine, who reviewed the findings.

"Killing for parts cannot be accepted as a part of the field of transplantation by governments, NGOs, health care providers, scientific journals or the general public. The evidence is plain and I hope the requisite action will follow."

It is not known how many people were killed in this manner, but the researchers argue that the organ donors would almost certainly have been prisoners, indicating that physicians in China had effectively conducted executions via organ removal.

"While we don't know exactly how these prisoners end up on the operating table, we can speculate there are multiple troubling scenarios as to how this happens," Robertson said in the statement.

"These include a bullet to the prisoner's head before being immediately rushed to hospital, or a drug injection that paralyzes the prisoner. We found that the physicians became the executioners on behalf of the state, and that the method of execution was heart removal."

The authors said hospitals decided to execute prisoners in this way because it was highly profitable for the doctors and institutions involved. Human rights researchers have previously made similar claims.

Since the 1980s, China has developed one of the largest transplantation systems in the world, primarily based on organs from prisoners supplied by the state security and judicial systems.

This practice has been condemned by international medical organizations, although China considers the number of judicial executions and the true number of transplants to be official secrets.

Human rights researchers claim that China performs even more transplants that the U.S, even though the medical literature suggests it comes in second place, according to the study.

In comparison to the U.S., where transplant waiting times are measured in months and years, in China, many hospitals advertise wait times of weeks. Chinese authorities say they will be performing 50,000 a day transplants by 2023—allegedly sourced from voluntary donors.

"If this transpires, China will be operating the most successful and rapidly growing voluntary transplant program in the world," the authors wrote. "But Chinese governmental accounts of its organ transplantation sector are often contradictory, and the state has published confusing and demonstrably manipulated datasets to the international community."

The data the authors relied on in their study involves transplant surgeries that took place from 1980 to 2015—a period during which there was mostly no voluntary donation system in China and very few voluntary donors, they said.

In the study, the authors cite statement from three official Chinese sources, including the current leader of the transplant sector, providing evidence that the number of voluntary (i.e. non-prisoner) organ donors during this period was tiny.

For example, this official wrote in 2007 that effectively 95 percent of all organ transplants were from prisoners.

"The papers we examine typically do not say anything about the donors' identity and do not identify the donors as prisoners," the authors wrote in the study.

"However, based on the above official statements, it logically follows that almost all the organ transplants in the papers we consider must have been from prisoners. Presumably this includes both death row prisoners and prisoners of conscience."

By 2015, Chinese authorities were claiming that the use of prisoners for organ donors had ceased, while a voluntary organ donation system was also set up. But some researchers have since questioned that claim, with the authors of the latest study noting that there seems to have been falsification of official datasets.

"While more voluntary donations are taking place in China than ever before, there are as yet no reliable data on the true scale of the reforms," the authors wrote in the study. "It is also unclear whether and to what degree death row prisoners and prisoners of conscience are still being utilized as organ sources."

"Given the lack of sanctions and accountability for procurement of prisoner organs in the past, the strong financial incentives to continue such activity, and the difficulty of external observers of detecting it, it is unclear why Chinese hospitals would cease engaging in this profitable trade."

The researchers said it is also unclear whether violations of the dead donor role are continuing to this present day.

Newsweek has contacted The National Health Commission of the People's Republic of China for comment.