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Organ harvesting from Falun Gong practitioners

Organ harvesting from Falun Gong practitioners is alleged to occur in the People’s Republic of China as part of the Chinese Communist Party’s campaign to eliminate the Falun Gong spiritual practice.

Reports on systematic organ harvesting first emerged in 2006, seven years after the suppression campaign against Falun Gong began. Several researchers—most notably Canadian human rights lawyer David Matas, former parliamentarian David Kilgour, and investigative journalist Ethan Gutmann—estimate that tens of thousands of Falun Gong prisoners of conscience may have been killed to supply a lucrative trade in human organs and cadavers, and that these abuses are likely ongoing. Because organs from live donors are more valuable and have a lower chance of rejection, the organs are likely harvested while victims are still alive. These conclusions are based on a combination of statistical analysis, interviews with former prisoners, medical authorities and public security agents, and circumstantial evidence such as the large number of Falun Gong adherents detained extrajudicially in China and the profits to be made from selling organs. [Others investigations were made by doctors, journalists and politics figure as Edward McMillan-Scott,, and lead to similar conclusion.]Different evidence also established the Chinese’s authorities objective of concealing these practice.

The failure of Chinese authorities to adequately address or refute the charges has drawn attention and public condemnation from governments, international organizations and medical societies. The parliaments of Canada and the European Union, as well as the Foreign Affairs Subcommittee of the U.S. House of Representatives, have adopted resolutions condemning organ harvesting from Falun Gong prisoners of conscience, and United Nations Special Rapporteurs have called on the Chinese government to account for the sources of organs used in transplant practices. The World Medical Association, the American Society of Transplantation and The Transplantation Society have called for sanctions on Chinese medical authorities. Several countries have also taken or considered measures to deter their citizens from traveling to China for the purpose of obtaining organs. Israel has banned insurance companies from providing coverage for organs obtains abroad, and legislation to ban organ tourism in China has been proposed in Australia and Canada.

In Europe, some investigations leads to the same result. =>Mc Millan Scott, Francis Navarro

=> reaction of medical association, denounce “unethical medical environment” in China and call to follow resolutions voted by AMM, TTS, and Declaration of Istanbul.

Background

Organ transplantation in China

China has one of the largest organ transplant programs in the world, with over 13,000 transplants a year in 2004, and as many as 20,000 per year in 2006.. As a matter of culture and custom, however, the country also has extremely low rates of voluntary organ donation. Between 2003 and 2009, for instance, only 130 people volunteered to be organ donors nationwide. In 2010 the Chinese Red Cross launched a nationwide initiative to attract voluntary organ donors, but only 37 people signed up -The Journal of the American Medical Association put the figure at 200 transplantations until May 2011.Due to low levels of voluntary organ donation, the substantial majority of organs used in transplants are sourced from prisoners. The Chinese government approved a regulation in 1984 to allow the removal of organs from executed criminals, provided they provided prior consent or if no one claims the body.

Despite the absence of an organized system of organ donation or allocation, China performs the second-highest number of organ transplants in the world annually, and wait times for obtaining vital organs in China are among the shortest in the world—often just weeks for vital organs such as kidneys, livers, and hearts. This has made it a destination for international transplant tourism and a major venue for tests of pharmaceutical anti-rejection drugs.Since 1999, there have been reports of systematic torture, mass imprisonment, forced labour, and psychiatric abuse against Falun Gong adherents, all with the aim of forcing them to recant their beliefs. As of 2009, the New York Times reported that at least 2,000 Falun Gong adherents had been killed amidst the persecution campaign; Falun Gong sources documented over 3,700 named death cases by 2013. Due to the difficulty in accessing and relaying information from China, however, this may represent only a portion of actual deaths.

Reports of organ harvesting from Falun Gong

Sujiatun

The first allegations of large-scale organ harvesting from Falun Gong practitioners were made in March 2006 by two individuals claiming knowledge of involuntary organ extractions at the Sujiatun Thrombosis Hospital in Shenyang, Liaoning province. One of the whistleblowers, the wife of a surgeon at the hospital, claimed her husband had performed numerous operations to remove the corneas of Falun Gong practitioners for transplant. The allegations were publicized by the Epoch Times, a newspaper group founded by Falun Gong practitioners.Representatives of the U.S. State Department were dispatched to the Sujiatun hospital to investigate the claims. They determined that there was insufficient evidence to prove the allegations, but said they remained concerned over China’s treatment of Falun Gong and the reports of organ harvesting. Soon thereafter, in May 2006, The Coalition to Investigate the Persecution of Falun Gong asked former Canadian parliamentarian David Kilgour and human rights lawyer David Matas to investigate the broader allegations of organ harvesting from Falun Gong adherents in China. Kilgour and Matas agreed to conduct an investigation as volunteers.

Further investigation showed that Sujiatun Facility was the former largest army munition warehouse ofn the region.. is the southern gate of Shenyang, and it is a hub of rail, road, and air transport, as well as a hub of communications, including underground fortification , railway station and airport. SO it would be very easy to provide food for thousands of prisonners kept in secret, as well as moving all installation in case of international investigation. David Kilgour noticed that Chinese regime kept silence for 3 week after the first allegation, which gave them enough time to make this move.

http://www.clearwisdom.net/html/articles/2009/12/4/112817.html

=Kilgour-Matas report

David Kilgour and David Matas released the results of their preliminary investigation on July 20, 2006, in a report titled "Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China". Although the pair were denied visas to travel to China, they nonetheless compiled over 30 distinct strands of evidence which were consistent with allegations of organ harvesting from Falun Gong practitioners. These included an analysis of statistics on organ transplantation in China, interviews with former Falun Gong prisoners, and recorded admissions from Chinese hospitals and law enforcement offices about the availability of Falun Gong practitioners’ organs. In the absence of evidence that would invalidate the organ harvesting allegations—such as a Chinese government registry showing the source of transplant organs—Kilgour and Matas concluded that the Chinese government and its agencies “have put to death a large but unknown number of Falun Gong prisoners of conscience. Their vital organs, including kidneys, livers, corneas and hearts, were seized involuntarily for sale at high prices, sometimes to foreigners, who normally face long waits for voluntary donations of such organs in their home countries.” They estimated that from 2000 to 2005, the source for 41,500 organ transplants was unexplained, and that Falun Gong practitioners were the most plausible source for these organs.

The authors qualified their report by noting the inherent difficulties in verifying the alleged crimes. For example, no independent organizations are allowed to investigate conditions in China, eyewitness evidence is difficult to obtain, and official information about both organ transplantation and executions is often withheld or is contradictory.

In 2007, Kilgour and Matas presented an updated report under the title "Bloody Harvest: Revised Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China". The findings were subsequently rewritten as a book released in October 2009. The reports received international media coverage, and the authors travelled internationally to present their findings to governments and other concerned organizations. In 2009, they receive for their work the Human Rights Award from the International Society for Human Rights’ from the International Society for Human Rights, and were nominated by Borys Wrzesnewskyj and Balfour Hakak for the 2010 Nobel Peace Prize. In 2014, David Matas received the University of Manitoba Distinguished Alumni Award, Lifetime Achievement.

Ethan Gutmann

Ethan Gutmann, an investigative journalist and author specializing in China, initiated his own investigation into the allegations of organ harvesting from Falun Gong practitioners in 2006. Over the span of several years, he conducted interviews with over 100 refugees from China’s labor camp and prison system, as well as with Chinese law enforcement personnel and medical professionals. Based on his research, Gutmann concluded that organ harvesting from prisoners of conscience became commonplace in the northwestern province of Xinjiang during the 1990s, when members of the Uighur ethnic group were targeted in security crackdowns and “strike hard campaigns.” By 1999, Gutmann says that organ harvesting in Xinjiang began to decline precipitously, just as overall rates of organ transplantation nationwide were rising. The same year, the Chinese government launched a suppression of the Falun Gong spiritual group. Gutmann suggests that the new Falun Gong prisoner population overtook Uighurs as a major source of organs. He estimated that approximately 65,000 Falun Gong practitioners had been killed for their organs between 2000 and 2008, and notes that this figure is similar to that produced by Kilgour and Matas when adjusted to cover the same time period.

These findings have been published in a variety of journals and periodicals, including the World Affairs Journal, the Weekly Standard, and the National Review, among others. Gutmann has also provided testimony on his findings before U.S. Congress and European Parliament, and in August 2014 published his investigation as a book titled “The Slaughter: Mass Killings, Organ Harvesting and China’s Secret Solution to Its Dissident Problem.”

Evidence

Several distinct strands of evidence have been presented to support allegations that Falun Gong practitioners have been killed for their organs in China. Researchers, human rights advocates and medical advocacy groups have focused in particular on the volume of organ transplants performed in China; the disparity between the number of transplants and known sources of organs; the significant growth in the transplant industry coinciding with the mass imprisonment of Falun Gong adherents; short wait times that suggest an “on demand” execution schedule; and reports that Falun Gong prisoners are given medical exams in custody to assess their candidacy as organ suppliers.

Increase in nationwide organ transplants after 1999

The number of organ transplants performed in China grew rapidly beginning in 2000. This timeframe corresponds with the onset of the persecution of Falun Gong, when tens of thousands of Falun Gong practitioners were being sent to Chinese labor camps, detention centers and prisons.

In 1998, the country reported 3,596 kidney transplants annually. By 2005, that number had risen to nearly 10,000. The number of facilities performing kidney transplants increased from 106 to 368 between 2001 and 2005. Similarly, from 1999 to 2006, the number of liver transplantation centers in rose from 22 to 500. The amount of transplants performed in these centers also increased substantially in this period. One hospital reported on its website that it performed 9 liver transplants in 1998, but completed 647 liver transplants in just four months in 2005. The Jiaotong University Hospital in Shanghai recorded seven liver transplants in 2001, 53 in 2002, 105 in 2003, 144 in 2004, and 147 in 2005. . According tona testimony

Kilgour and Matas write that the increase in organ transplants cannot be entirely attributed to improvements in transplant technology: “kidney transplant technology was fully developed in China long before the persecution of Falun Gong began. Yet kidney transplants shot up, more than doubling once the persecution of Falun Gong started...Nowhere have transplants jumped so significantly with the same number of donors simply because of a change in technology.”

Furthermore, they note that during this period of rapid expansion in China’s organ transplant industry, there were no significant improvements to the voluntary organ donation or allocation system, and the supply of death row inmates as donors also did not increase. Although it does not prove the allegations, the parallel between rapid growth in organ transplants and the mass imprisonment of Falun Gong adherents is consistent with the hypothesis that Falun Gong practitioners in custody were having their organs harvested.

Discrepancy in known sources of organs

Chinese officials reported in 2005 and in 2010, that up to 95% of organ transplants are sourced from prisoners. However, China does not perform enough legal executions to account for the large number of transplants that are performed, and voluntary donations are exceedingly rare (only 130 people registered as voluntary organ donors nationwide from 2003 to 2009).

In 2004, over 13,000 transplants were performed in China; by 2006, the annual number of transplants rose to 20,000, according to the China Daily newspaper. In the same time period, however, the number of individuals sentenced to death and executed was far fewer than the number of transplants. Based on publicly available reports, Amnesty International documented 1,770 executions in 2006; high-end estimates put the figure at 8,000. Because China lacks an organized organ matching and allocation system, and in order to satisfy expectations for very short wait times, it is rare that multiple organs are harvested from the same donor. Moreover, many death row inmates have health conditions such as hepatitis B that would frequently disqualify them as organ donors. UN Special Rapporteur on Torture Manfred Nowak says “the explanation that most of these organs come from death row inmates is inconclusive...If so, the number of executed felons must then be much higher as so far assumed.” David Matas said that for 10,000 transplantation, 1000 comes from death condemned prisonners, 500 from Uïgurs, 500 from christian and 8.000 from Falun Gong practicionners.(State Organs)

In a statement before the U.S. House of Representatives, Dr. Damon Noto said “the prisoners sentenced to death cannot fully account for all the transplantations that are taking place in China [...] Even if they executed 10,000 and transplanted 10,000 a year, there would still be a very large discrepancy. Why is that? It is simply impossible that those 10,000 people executed would match perfectly the 10,000 people that needed the organs.”David Kilgour and David Matas similarly write that traditional sources of transplants such as executed prisoners, donors, and the brain dead "come nowhere near to explaining the total number of transplants across China." Like Noto, they point to the large number of Falun Gong practitioners in the labor camp and prison system as a likely alternative source for organs.

Minimal wait times

Wait periods for organ transplants in China are significantly shorter than elsewhere in the world. According to a 2006 post on the China International Transplantation Assistance Center website, "it may take only one week to find out the suitable (kidney) donor, the maximum time being one month...If something wrong with the donor's organ happens, the patient will have the option to be offered another organ donor and have the operation again in one week." Other organ transplant centers have advertised average wait times of one or two weeks for liver transplants. This is consistent with accounts of organ transplant recipients, who report receiving organs a matter of days or weeks. By comparison, median wait times for a kidney in developed countries such as the United States, Canada and Great Britain typically range from two years to over four years, despite the fact that these countries have millions of registered organ donors and established systems of organ matching and allocation.

Several researchers and medical professionals have expressed concern about the implications of the short organ transplant wait times offered by Chinese hospitals.> Specifically, they say these wait times are indicative of a pool of living donors whose organs can be removed on demand. This is because organs must be transplanted immediately after death, or must be taken from a living donor (kidneys must be transplanted within 24-48 hours; livers within 12 hours, and hearts within 8 hours).

Dr. Kirk C. Allison, Associate Director of the Program in Human Rights and Medicine at the University of Minnesota, wrote that the "short time frame of an on-demand system [as in China] requires a large pool of donors pre-typed for blood group and HLA matching," and notes that this is consistent with reports of Falun Gong prisoners having blood and tissue tested in custody. He wrote that China’s short organ wait times could not be assured on a “random death” basis, and that physicians he queried about the matter indicated that they were selecting live prisoners to ensure quality and compatibility.

Dr. Jacob Lavee, Director of the Heart Transplant Unit at the Sheba Medical Center in Israel, recounts one of

his patients traveling to China for a heart transplant. The patient waited only two weeks for a heart, and the surgery was scheduled in advance--meaning the organ could not have been procured on the basis of a random death.Dr. Franz Immer, chairman of the Swiss National Foundation for organ donation and transplantation, reports that during a visit to Beijing in 2007, he was invited by his Chinese hosts to observe a heart transplantation operation: “The organizer asked us whether we would like to have the transplantation operation in the morning or in the afternoon. This means that the donor would die, or be killed, at a given time, at the convenience of the visitors. I refused to participate.” Furthermore, westener surgeron testify their invitation to perform scheduled transplantations by Chinese authorities within the same amount of time. Dr. Noto writes that China’s organ transplant wait times and the ability to schedule transplants in advance can only be achieved by having a large supply of “living donors that are available on demand.” Death row inmates alone are not numerous enough to meet this demand, and under Chinese law they must be executed within one week of sentencing. 

Vulnerability of Falun Gong adherents

Since 1999, hundreds of thousands of Falun Gong practitioners have been detained in re-education through labor camps, prisons, and other detention facilities in China, making them the largest group of prisoners of conscience in the country. In 2008, the U.S. Department of State cited estimates that half of China’s official labor camp population of 250,000 were Falun Gong adherents,{cn} and a 2013 report by Amnesty International found that Falun Gong practitioners comprised between 30 to 100 percent of detainees in the labor camps studied.

Typology of the victims of alleged torture and ill-treatment in China(UN Report. .

Former Chinese prisoners have also reported that Falun Gong practitioners consistently received the "longest sentences and worst treatment" in the camps, and that they are singled out for severe torture and abuse. In 2006, a report by the UN’s Special Rapporteur on Torture noted that 66% of reported cases from China involved Falun Gong victims. Analysts and rights groups have pointed to several factors that drive the especially severe treatment against Falun Gong adherents in custody. These include directives issued from central government or Communist Party authorities; incentives and quota systems that encourage abuse; a sense of impunity in the event of deaths in custody; and the effects of the state propaganda that dehumanizes and vilifies Falun Gong adherents.

The large numbers of Falun Gong prisoners in custody has led researchers to identify them as a likely source for organs. According to Gutmann’s research, other marginalized prisoner groups may also have been targeted, including ethnic Tibetans and Uighurs who reside predominantly in China’s western regions. However, for reasons of geography, Falun Gong practitioners are more likely to be targeted. In addition, because their spiritual practice prohibits smoking or consumption of alcohol, they tend to be comparatively healthy. Dr. Torsten Trey noted for his part that a Falun Gong has "no right" and that his life is "worthless"; he can expect to face no legal defense to a free judge to sentence him to death or forced labor. In this context, from the perspective of the Chinese regime, there is a "small step" to transform living beings in "sources of organs".

In the context of organ harvesting Kilgour and Matas point to a further source of vulnerability. Namely, in order to protect family members from punishment by security agencies, many detained Falun Gong practitioners refuse to give their names or other personally identifying information to police. “Though this refusal to identify themselves was done for protection purposes, it may have had the opposite effect. It is easier to victimize a person whose whereabouts is unknown to family members than a person whose location the family knows,” says their report. Kilgour and Matas wrote that they had yet to meet or hear of any Falun Gong practitioners who were safely released from custody after refusing to identify themselves, despite the prevalence of this practice. Similarly, Ethan Gutmann reports that in over a hundred interviews with former prisoners, he encountered only one Falun Gong practitioners who had remained nameless while in custody, and “her organs were even more worn out than my own.”

Medical testing in custody

Ethan Gutmann interviewed dozens former Chinese prisoners, including sixteen Falun Gong practitioners who recalled undergoing unusual medical tests while in detention. Gutmann says some of these tests were likely routine examinations, and some may have been designed to screen for SARS. R However, in several of the cases, the medical tests described were exclusively aimed at assessing the health of internal organs.   Rm 

One man, Wang Xiaohua, was imprisoned in a labor camp in Yunnan in 2001 when he and twenty other Falun Gong detainees were taken to a hospital. They had large quantities of blood drawn, in addition to urine samples, abdominal x-rays, and electrocardiogram. Hospital staff did not tend to physical injuries they had suffered in custody. This pattern was repeated in several other interviews. Qu Yangyao, a 30-something Chinese refugee, was taken from labor camp to a hospital in 2000 along with two other Falun Gong practitioners. Hospital staff drew large volumes of blood, conducted chest x-rays and probed their organs. There was “no hammer on the knee, no feeling for lymph nodes, no examination of ears or mouth or genitals—the doctor checked her retail organs and nothing else,” writes Gutmann. R

Another woman, Jung Tian, recounts comprehensive physical exams and the extraction of large volumes of blood—enough for advanced diagnostics or tissue matching—while in a detention in Shenyang city. At a women’s labor camp in Guangdong province, a former detainee says that 180 Falun Gong prisoners were subject to medical tests in early 2003, and that the tests exclusively focused on internal organs. Another female witness who was held at Masanjia labor camp in 2005 said that only young, healthy practitioners had comprehensive medical exams upon arrival at the camp; the old and infirm were given only cursory treatment.

In addition to Falun Gong practitioners, researcher Jaya Gibson identified three Tibetan prisoners who were subject to “organs-only” medical exams, all of them shortly after 2005. R

Phone call evidence

In March 2006, immediately after allegations emerged that Falun Gong prisoners were being targeted for organ harvesting, overseas investigators began placing phone calls to Chinese hospitals and police detention centers. The callers posed as prospective transplant recipients and inquired about the availability of Falun Gong organs. In several instances, they obtained recorded admissions that organs could be procured from Falun Gong prisoners. Several of these conversations were cited as evidence in the report by David Kilgour and David Matas.

In one such call to a police detention center in Mishan city, an official said that they had five or six male Falun Gong practitioners under the age of 40 who were potential organ suppliers. A doctor at the Minzu hospital in Nanning city said that the hospital did not currently have Falun Gong organs available, but that he had previously selected Falun Gong prisoners for organ harvesting. At the Zhongshan hospital in Shanghai, a doctor told investigators that all his organs were sourced from Falun Gong adherents. During an April 2006 phone call to a military hospital in Guangzhou, a doctor told investigators that he had “several batches” of Falun Gong organs, but that the supply could run dry after May 20, 2006. An official with the Jinzhou city people’s court told investigators in May 2006 that they would need to meet certain “qualifications” in order to obtain kidneys from Falun Gong practitioners.

Kilgour and Matas concede that in at least some instances, the hospital staff may have been supplying answers that the callers wanted to hear in order to make a sale. The results of these phone calls would also be difficult to replicate; as allegations of organ harvesting from Falun Gong gained attention, hospitals would become more reluctant to candidly discuss their organ sourcing practices.

This investigative tactic was revived in 2012, when Communist Party officials began investigating Politburo member Bo Xilai for a variety of crimes, including his role in the murder of a British business associate R . Bo had previously been governor of Liaoning province, which researchers believe was a major center for organ harvesting. The “World Organization to Investigate the Persecution of Falun Gong” made phone calls to mid- and high-level officials with prior connections to Bo, posing as members of the internal Communist Party discipline and inspection group that was building the case against him.R They asked questions about the chain of command involved in procuring organs from prisoners, including Falun Gong prisoners. When asked about Bo Xilai’s involvement in organ harvesting, one a high-ranking member of the Politburo reportedly told investigators that Politburo Standing Committee member and security czar Zhou Yongkang “is in charge of this specifically. He knows it.”A city-level official in Liaoning province was asked by investigators what direction Bo Xilai may have given regarding removing organs from Falun Gong prisoners. The official replied “I was asked to take care of this task. Party central is actually taking care of this...He [Bo] was involved quite positively, yeah it seemed quite positive. At that time we mainly talked about it during the meetings within the Standing Committee.” The official hung up after realizing that he had not confirmed the identity of the caller.

Commercial incentives

Human rights researches and medical practitioners have argued that the commercial nature of the organ trade in China promotes corruption and abuse. Namely, the profits to be made from selling organs may lead to more killings--both court sanctioned and extrajudicial--than would otherwise occur. Although this argument is not specific to the Falun Gong practitioners, it has been used as circumstantial evidence to support claims that Falun Gong prisoners could be targeted for organ harvesting.

The growth of a commercial organ trade is linked to economic reforms in the late 1980s and early 1990s that saw a steep decline in government funding to the healthcare system. R Healthcare moved toward a more market-driven model, and hospitals devised new ways to grow their revenue. This pattern also applies to military hospitals; the People’s Liberation Army has long engaged in commercial and profit-making ventures to supplement its budget.

In their report on organ harvesting from Falun Gong adherents, Kilgour and Matas describe transplant hospitals in China that cater to wealthy foreigners, who paid upwards of $100,000 for liver, lung, and heart transplants. For instance, they cited the website of the China International Transplantation Network Assistance Center, which posted the following price list on its website in 2006: Kidney: $62,000; Liver: $98,000-130,000; Liver+kidney: $160,000-180,000; Kidney+pancreas: $150,000; Lung: $150,000-170,000; Heart: $130,000-160,000; Cornea: $30,000 . In a statement before the U.S. House of Representatives, Dr. Gabriel Danovitch of the UCLA Medical Center said “the ease in which these organs can be obtained and the manner that they may be allocated to wealthy foreigners has engendered a culture of corruption.”

Recommendations of the Declaration of Istanbul

The Declaration of Istanbul is a collection of guiding principles destined to prevent organ trafficking throughout the world117; and was written in conclusion of the Istanbul summit in 2008 by a large number of organisations and medical professionals from all over the world118, one being the l'Agence française de biomédecine and the TTS. The contributors of this declaration firmly condemned the attitude of the Chinese authorities and denounced the “culture of corruption” that sustains organ trafficking. Chinese law for example forbids organ transplantation from the deceased to foreigners, but this is simply ignored by the authorities119.

The American Journal of Transplantation (AJT) is the official review of the American Society of Transplantation (AST) and of the American Society of Transplant Surgeons (ASTS). In an editorial commentary120, the AJT recommends a certain number of measures approved by the Declaration to fight against organ trafficking in China:

• The censure or ban by medical journals and national professional medical societies of all publications from Chinese transplant centres; unless the authors clearly indicates the data presented are in line with governmental laws and indicate the source of the organs.

• The membership of Chinese transplants professionals to professional international societies can only be accepted if the ethical characteristics of Chinese transplantations is globally accepted.

• The pharmaceutical companies must insure that the source of organs used for research must not be that of executed prisoners and that the medical rules should be strictly followed in the case of transplant tourism in China

• Laying out regulations for the training of Chinese transplants professionals by surgeons of the international community; the trainees must not be engaged, directly or indirectly in using organs from executed prisoners.

Since Mai 2011, several American medical journals have declared that they would not publish any article coming from the Chinese medical professionals that are implicated in organ transplantation. The Journal of Clinical Investigation, a prestigious publication on biomedical research declared: “The practice of organs transplantation from executed prisoners in China seems widespread. We vigorously condemn this practice (of organ transplantation from executed prisoners) and, starting from now, we will ignore without exception all articles concerned with human organ transplantation in our publications, who cannot provide a justified and non coercive donor consent.” 121 A similar declaration was also published by the American Journal of Transplantation (AJT) 122. This position, supported by the Declaration of Istanbul, was introduced as an ethical guide line at the International Society for Organ Donation and Procurement (ISODP) meeting in Buenos Aires in November 2011 and similarly at the World Transplant Congress in Berlin in July 2012119. The journal The Lancet equally published as an editorial letter in October 2011, entitled “It is time to boycott Chinese Science et Medicine on the subject of organ transplantation”123. The Declaration of Istanbul suggest to health professionals, during a meeting or in medical journals, to put pressure on the Chinese authorities to demand the application of ethical criteria in their policies on transplantation. Because the Chinese medical authorities had changed their initial promise in November 2014, the annual meeting of the Chinese Society of Transplantation received no support from the medical community124.

The doctors of the Declarations also called upon the United States Congress and the American government, who should according to them, give the example on the type of rules and regulations that are necessary for ethical transplantation, needed to avoid the crimes of organ trafficking in China.

Clinical Trials by the pharmaceutical companies in China

In the follow-up treatment of a transplant patient, the anti reject immunosupressors play a vital role125. Often expensive and indispensible for the remaining life of the patient, their efficacy is responsible for the success of transplant medicine and its propagation. In China, where the market of medication registered a lightening expansion, the demand for immunosuppressors has never ceased to increase126. In 1994, the NGO Human Rights Watch published an exhaustive rapport, Organ Harvesting and Judicial Execution in China127. The authors have observed that since 1983, the exponential development of the transplant programs in China is due to the combination of two factors: on the one hand the drastic increase in the death row prisoners, which has increased the number of potential organ donors in the country and on the other hand, the introduction of Ciclosporine A(CsA), “miracle medication” present in all of todays post operative medical treatment and which greatly increases the chances of acceptation of the transplant organs127. For the first time, Human Rights Watch underlined the important role played by the world pharmaceutical companies in “stimulating the Chinese transplant program”. Later on, companies like Novartis, Roche, Astellas, Pfizer and Isotechnicahave jumped onto the chinese immunosuppressors market. Several of them have as well as sold and promote their treatments directly in China, have also carried out research to study the effects of their anti reject medication128.

Between June 2004 and December 2010, there exists documents proving that these companies have carried out clinical essays on a total of 1200 transplanted organs in civil and military hospitals129,130. According to David Matas, circumstantial evidence establishes that in at least two of these hospitals, the organs came from Falun Gong practitioners129. In the years 2000, about 40 supplementary essays were carried out on 2000 organs by university and military hospitals; these tests used the medical treatments developed by these companies. The collaboration between the Chinese Ministry of Health and the laboratories Roche and Astellas goes further: these companies help the creation of a database to improve the logistics of the Chinese transplant program131. In 2006, the Roche Company opened a factory to produce its immunosuppressor CellCept in Chine. Franz Humer, the company CEO, declared to German journalists to have “built this factory in China, because unlike Japan, there does not exist any ethical or cultural blockages for transplant medicine”132. No information whatsoever has been provided on the origins of the organs used in these essays. A little later, Arne Schwartz, a researcher and analyst in the domain of human rights, asked to the Roche director of deontology if he knew the origins of the organs used in their essays. The company declined all responsibilities and maintained its programs in China133; other laboratories, like Novartis, have distanced themselves and condemned the practices of Chinese transplant medicine.

Investigations have been carried out in Switzerland, to establish the level of responsibility and the degree of implication of the Roche and Novartis companies134. In January 2010, NGO like the Swiss Green Peace and the “Declaration of Berne” awarded Roche with the “Prise of Shame” for not having been able to state the origins of the organs implicated in the essays of their CellCept treatment 135; following this, 5723 internet users attributed to Roche the “Public Eye’s People Award”136. Following this, Roche was severely criticised during a shareholders meeting in March 2010 and the Tridios Bank declare having removed all its investments from this company, followed by the Dutch Bank ASN. According to the French Biomedical Agency, “By having carried out these clinical essays in China without being able to guaranty that the organs did not come from prisoners, Roche is undermining all the efforts of the international community to put an end to a practice that opposes the principals of ethical medicine.”137

In august 2010, Amnesty International followed by DAFOH, published several declarations against the use of organs coming from prisoners and called upon the pharmaceutical companies to respect human rights. The following year, in the United States, the Member of Parliament Joe Pitts asked the sensitive question on the opening of pharmaceutical companies on Chinese soil, and quoting TFP Ryder Healthcare, strongly suggested to the American companies to “seriously consider the non ethical climate that rules in China” 138

Reflections on ethical medicine

The first specific guideline on human organ donor and transplantation were adopted in 1985 by the World Medical Association (WMA) and refused to accept the use of organs from prisoners139 . In 2000, and then in 2006, the WMA refined and reiterated its principles 140 , and the World Health Organisation equally proposed guiding principles for transplanted human tissues, cells and organs 141. The Declaration of Helsinki142, followed by the Declaration of Istanbul finished defining these guiding principles and followed their reflexion on which procedures should be carried out by the international medical and public authorities.

The practice of organ harvesting can be elucidated by the particularly degraded level of ethics in the Chinese medical system. According to Maria A. Fiatarone Singh, geriatrician and member of the Royal College of Asia Australian medicine, the practices such as forced sterilisation, late abortions, infanticide to satisfy the one child policy or even the sale and exportation of “curative” pills obtained from crushed foetuses does not give any reassurance on the fact of obtaining the recognition of forced organ harvesting by the Chinese regime143. The dissimulation of this practice in China also permits its existence and protects the authorities of the public’s disapproval. Medical societies and a large number of Western Doctors have noted that the level of international attention on organ trafficking in general and in particular China, is far from equalling that on human trafficking, workers trading and sexual trafficking144 . According to them, one of the major difficulties is the awareness of the politicians and the medical experts on this subject. The recognition of the crime of organ harvesting is itself difficult to accept and is even more difficult to imagine the existence on a large scale of such a horrible practice in China. Professor Jacob Lavee quotes “the extent of the process that is taking place today in China is so big that people sometimes cannot believe that it is actually happening”. Doctor Torsten Trey dared a comparison with Felix Frankfurther, the Chief of the Court Supreme of Justice, charged with investigating the Nazi crimes. He would have apparently answered to the testimony of Jan Karski, on the crimes committed in the concentration camps, “I am not saying that you are lying, but I just cannot believe what you have just said” 145. Many doctors underline the particularly horrible crime of organ harvesting, evoking a “crime against humanity”146 or an “ultimate attack on human rights”147. During the international congress on transplantation held in San Fransisco in 2014, the faculty professor Fikre Jesus Amahazion remarked:

“ “This represents the ultimate violation of human rights. If we think about diverse attacks to physical integrity, murder, violation of human dignity, of the fundamental rights, the rights of prisoners, the convention against torture, they violate all these kinds of things.” ”

Follow-up treatment for transplant patients outside of China

Doctor Gabriel Danovitch, a contributor to the Declaration of Istanbul, alerts us to the dangers to which patients expose themselves to by desiring being transplanted in China. The rate of mortality and infections due to post-operative complications are high. According to his personal experience and the statistics provided by the American Society of Nephrology, he indicates that a number of transplantees have had to be hospitalised after returning to the United States148 .

“The Americans that choose to go to China or elsewhere to buy an organ run a great risk. There is sufficient evidence proving that the medical results of such operations are bad; following post-operative complications and infections putting at risk ones life, many transplantees necessitate long and complex hospitalisation and medical treatment.”

In Malasia, if a good number of patients have benefited from a transplantation in China and have well recovered, others however, have had serious complications to their state of health. According to Doctor Ghazali Ahmad, the “serious complications with fatal consequences have occurred”, going from acute reject to cases of bacterial infections, resistance to steroids necessitating costly treatments, serious septicaemias or even fungal or viral infections like hepatitis B or C. The doctors indicates that the not having the means to return to China had to pay for a very costly treatment and depended on public health. Similar cases were reported by the American Journal of Transplantation in August 2010; an editorial describing patients from Saudi Arabia who’s state of health rapidly diminished as soon as they returned from China; indicating that there was “ increasing concern on the incertitude of the results of such (transplant) operations “149.

Doctor Jeff Zaltzman, who directs the transplantation department of the St Michael Hospital in Toronto, indicate having received patients having been to China and who transplant failed150. A second transplant was programmed a few days later, a situation that according to him is unthinkable in Canada. Following a discussion with his peers during a forum held by the Institute of Health Policy, Management, and Evaluation, it was revealed that certain Canadian doctors were against the fact of treating the patients having been to China. The directive of the Canadian Transplant Society allows for such a refusal uniquely if there is another doctors that is able to take care of the patient. Other doctors favoured the idea that if a patient was not treated and should complications arise, these patients should return to China. Finally, according to Linda Wright, director of bioethics at the University Health Network (UHN) « this quagmire put the doctors in an impossible situation ». Later on, a law was proposed for vote, punishing anyone that would go to China to illegally obtain an organ. Although the experts show little hope for the final adoption of such a law, this last is supported by a part of the Canadians doctors hoping to denounce the situation provoked by the Chinese regime150.

Mobilization and public reactions

Diverse reactions of governments and of politicians

In December 2011, a Russian court of appeal confirmed that the writings of David Kilgour and David Matas are considered extremist literature. The judgement refers to the article 13 of the Russian federal law 114 concerned with “the prevention of extremist activities” including the dissemination of document promoting terrorism, breach of Russian security, “ incitation to racial, religious or national hate”, and “degradation of national dignity”. Both authors are susceptible to be pursued by Russian justice if they go to the country to speak about their report151.

In January 2013, Edward McMillan-Scott, Vice-President of the European Parliament, declared himself convinced that the members of the Falun Gong movement were being killed for their organs152. On the 27th of January 2014 at the occasion of the commemorative day of the Shoah, Edward McMillan Scott published an editorial in the Epoch Times newspaper. He saluted the different resolutions adopted by the Congress of the United States and the European parliament, maintaining that the term “at the lack of credibility concerning the chosen genocidal crime and prisoner assassination, in particular the Falun Gong practitioners, to harvest their organs”. He declared equally that to hold an international register of the torturers and the assassins, so that legal proceedings could be engaged under the rule of the International Criminal Court153.

In December 2013, in a conference against organ harvesting and transplant tourism held at the French National Assembly, the MP Valérie Boyer, condemned forced organ harvesting on the practitioners of Falun Gong and regrets the evolution of the mentalities that has led to the “merchandising of the human body154,8.

Humanitarians Organisations and the United Nations Organisation (UNO)

In March 2007, Manfred Nowak, the special rapporteur of the UNO, asked the Chinese authorities to answer the different observations between the number of transplants accomplished and the number of acceptable sources. According to him, it becomes obvious “ that the Falun Gong practitioners receive injections to induce cardiac arrest and are thus assassinated during the operation of forced organ harvesting or immediately afterwards. The response time of the Chinese authorities was long and the answers according to him were poorly convincing155 he thus estimates that the chain of evidence as documented by Mr David Kilgour and Mr David Matas form a ‘coherent picture that provokes concern”90.

In Mai 2008, two special rapporteurs of the United Nations repeated the official demand to the Chinese authorities to respond conveniently to the accusations of forced organ harvesting on Falun Gong156.

In November 2008, the United Nations committee against torture underlined their concerns in the face of the allegations and called on China to “immediately carry out or order an independent investigation on the allegations”, and to take the necessary measures “to ensure that those responsible for such violations be pursued and punished”157.

International resolutions against forced organ harvesting

In Mai 2010, the European Parliament adopted a resolution on the communication of the commission entitled “Plan of action on Organ Donation and Organ Transplants (2009-2015)” and mentions the accusations of Mr David Matas and David Kilgour: “taking act of the report of David Matas and David Kilgour on the assassination of Falun Gong practitioners for their organs and asked the commission to present to the European Parliament and to the Council, a rapport on these allegations and on other affaires of the same order” 158. Again in 2010, the United States congress voted a resolution mentioning such practices16

In December 2013, the European Parliament adopted a resolution condemning the state sanctioned forced organ harvesting by the Chinese state, a practice that particularly touches the Falun Gong practitioners. In the resolution, the European Parliament “manifests its profound concern in relation to the constant and credible rapports of systematic and state sanctioned non consenting organ harvesting from prisoners of conscience in the Popular Republic of China, and include on a great number of Falun Gong practitioners” and “demand from the Chinese authorities to respond in a detailed manner to the special rapporteurs of the United Nations”. The resolution also calls for the liberation of the prisoners of conscious in China, including the Falun Gong practitioners17. Henri Malosse, president of the Economic and Social European Committee (EESC), equally held a conference in Brussels on March 2014 and called for Europe to act and condemn this practice159.

In March 2014, the members of the Italian commission on human rights received David Kilgour and David Matas. On hearing their presentation, they declared to be “distressed”, and adopted unanimously a resolution inviting the Italian government to demand from the Chinese regime “the immediate liberation of all the prisoners of conscious in China, including all the Falun Gong practitioners”. The resolution also calls for “ the collection of data and available information throughout the diplomatic network, to determine as complete as possible and as transparent as possible the situation of organ transplant on the Chinese territory”, and envisage to “reconsider the training of Chinese doctors in the techniques of organ transplantation in Italian Hospitals, as well as research collaboration with China on the subject of transplantation” 160,161.

International resolutions against forced organ harvesting

In Mai 2010, the European Parliament adopted a resolution on the communication of the commission entitled “Plan of action on Organ Donation and Organ Transplants (2009-2015)” and mentions the accusations of Mr David Matas and David Kilgour: “taking act of the report of David Matas and David Kilgour on the assassination of Falun Gong practitioners for their organs and asked the commission to present to the European Parliament and to the Council, a rapport on these allegations and on other affaires of the same order” 158. Again in 2010, the United States congress voted a resolution mentioning such practices16

In December 2013, the European Parliament adopted a resolution condemning the state sanctioned forced organ harvesting by the Chinese state, a practice that particularly touches the Falun Gong practitioners. In the resolution, the European Parliament “manifests its profound concern in relation to the constant and credible rapports of systematic and state sanctioned non consenting organ harvesting from prisoners of conscience in the Popular Republic of China, and include on a great number of Falun Gong practitioners” and “demand from the Chinese authorities to respond in a detailed manner to the special rapporteurs of the United Nations”. The resolution also calls for the liberation of the prisoners of conscious in China, including the Falun Gong practitioners17. Henri Malosse, president of the Economic and Social European Committee (EESC), equally held a conference in Brussels on March 2014 and called for Europe to act and condemn this practice159.

In March 2014, the members of the Italian commission on human rights received David Kilgour and David Matas. On hearing their presentation, they declared to be “distressed”, and adopted unanimously a resolution inviting the Italian government to demand from the Chinese regime “the immediate liberation of all the prisoners of conscious in China, including all the Falun Gong practitioners”. The resolution also calls for “ the collection of data and available information throughout the diplomatic network, to determine as complete as possible and as transparent as possible the situation of organ transplant on the Chinese territory”, and envisage to “reconsider the training of Chinese doctors in the techniques of organ transplantation in Italian Hospitals, as well as research collaboration with China on the subject of transplantation” 160,161.

Petitions against forced organ harvesting

In September 2012, a petition of nearly 25 000 signatures demanding that the United States to put pressure on China at the United Nations Organisation to end forced organ harvesting. The petition delivered to the office of Susan Rice, the American ambassador at the United Nations Organisation, also demanded the United States government to divulge the information’s that they obtained from Wang Lijun (en)Note 6 implication as the ex head of police in Chongqing162

In 2013, the international NGO DAFOH (Doctors Against Forced Organ Harvesting) initiated a petition addressed to the high commissioner of the United Nations human rights council, calling for an immediate end to organ harvesting on prisoner of conscious in China. The petition equally called for the ending of the “persecution” of the Falun Gong spiritual movement, the most important victims of organ harvesting. Between July and November 2013, the petition was signed by nearly 1,5 Million people, 1 million in Asia163 and in more that 50 countries of the world164.

Fight against transplant tourism

According to DAFOH, transplants are primarily used by rich Chinese or Western. Following reports publishing, some governments and transplant organizations have strengthened "transplant tourism" restrictions, expressing their concern and distancing themselves with organ transplants practices without consent.

Taiwanese chairman of the Mainland Affairs Council condemned "in the strongest possible terms" China's harvesting of human organs from executed Falun Gong practitioners. Ministry of Health urged Taiwanese doctors not to encourage patients who want to pay for an organ transplant in mainland China · . In november 2012, Taiwan has taken measures to dissuade its 2,000 citizens travelling every year in China for transplantation.

Israel, 2005, a patient announces Dr. Jacob Lavee - cardiac surgeon and director of the Heart Transplant Unit Medical Center of Shebva - that he planned a heart transplant in China. Dr. Lavee is alerted by the fact that such an operation cannot be planned in advance and conducted its own investigation. The results of his research are first published in the Journal of the Israeli Medical Association . He writes that Israelis were the only tourists visiting China for organ transplant to be fully reimbursed by their insurance companies. This fact "recognize de facto the activities of Chinese transplants were legal and ethical". The appeal was heard and a large-scale survey was conducted and published in the most circulated Israeli newspaper.

In 2007, Jacob Lavee and Pr. Eytan Mor organize a major conference on "ethical dilemmas to solve the shortage of organs in Israel". The Chinese Embassy then pressure the Israeli Ministry of Foreign Affairs to cancel the presentation of David Matas. The presentation is maintained and, as a balance, a Chinese speaker appointed by the embassy is included; he will be booed by the audience.

Then, there is an increasing public debate and a special meeting of the Health Committee held in Parliament. The committee added a chapter to a passed law forbidding "any refund for organ transplants performed abroad if transplants involve the illegal removal of organs or organ trafficking" · . Insurance companies follow the new rules in March 2008. According to Jacob Lavee, these rules have significantly decrease the number of abroad transplants by Israelis - from 155 in 2006 to 26 in 2011. The passed law also opened new possibilities for transplants in Israel, allowing to reach a state of self-sufficiency, as advised by the Istanbul Declaration.

December 2006, the australian Ministry of Health canceled organ transplantation training programs for Chinese doctors. In November 2013, a petition signed by more than 70,000 people of New South Wales was presented to this state's Parliament. It asks to end illegal organs harvesting from Falun Gong practitioners and supports the project law to limit obtaining organs from unwilling victims, prohibit training of doctors involved in trafficking organ and penalize those who receive organ through illegal means.

Canadian doctors and members of parliament - the first to have filed a petition to the government - introduced in February 2008 a law to prohibit Canadians to receive organs from unwilling victims.

In France, a law filed by Valérie Boyer, Member of Parliament, and signed by 48 other MPs was issued on September 16, 2010. It aims to fight against transplant tourism and organs "obtained from living donors against their will and under the threat" and mentioned the "plight of Falun Gong practitioners in China".

Petitions against forced organ harvesting

In September 2012, a petition of nearly 25 000 signatures demanding that the United States to put pressure on China at the United Nations Organisation to end forced organ harvesting. The petition delivered to the office of Susan Rice, the American ambassador at the United Nations Organisation, also demanded the United States government to divulge the information’s that they obtained from Wang Lijun (en)Note 6 implication as the ex head of police in Chongqing162

In 2013, the international NGO DAFOH (Doctors Against Forced Organ Harvesting) initiated a petition addressed to the high commissioner of the United Nations human rights council, calling for an immediate end to organ harvesting on prisoner of conscious in China. The petition equally called for the ending of the “persecution” of the Falun Gong spiritual movement, the most important victims of organ harvesting. Between July and November 2013, the petition was signed by nearly 1,5 Million people, 1 million in

References

<refname=”jcl”> Arthur L. Caplan, Howard A. Rockman, andLaurence A. Turka

, Editorial position on publishing articles on human organ transplantation, January 3, 2012.</ref>

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