Global organ black markets: The case of China
(Remarks for a symposium on organ harvesting and global organ black markets, 18 April 2018, University of Pennsylvania, Philadelphia)
by David Matas
A black market
The title of my topic is “Global organ black markets: The case of China”. In China, organs of prisoners of conscience are sold in every year in the tens of thousands. These prisoners are killed for their organs and their bodies cremated.
The prisoners of conscience most commonly killed for their organs are practitioners of the spiritually based set of exercises Falun Gong, a Chinese equivalent of yoga. Also targeted, in smaller numbers, are Uighurs, Tibetans and house Christians. The primary target among the house Christians is Eastern Lightning.
A black market, any black market, is a market in the shadows, a clandestine market. Participants in the black market attempt to hide their behaviour. Black markets typically use cash because cash transactions are not traceable. A black market is unreported and unrecorded.
The market in China for organs of prisoners of conscience has all of these features. But the typical black market is also illegal. In China, the law does not operate to prevent or punish the killing of Falun Gong for their organs.
Both of these features, the secrecy and the legality, require some elaboration. How do we even know that there is a market for organs of prisoners of conscience in China, if it is a market in the shadows, a clandestine market, if it is a market where participants attempt to hide their behaviour, if transactions are not traceable, if it is unreported and unrecorded?
A black market can not be so secretive that no one knows about it. The participants must know about it. A market, no matter how obscured in darkness, has to have sufficient visibility to function as a market. Otherwise its market function would be frustrated.
What visibility does a black market need in order to function as a market? Purchasers, vendors and suppliers have to know about it, or there would be no market. In a black market, the purchasers know something is for sale. The vendors know that they will have customers for a product. And the suppliers know that there is a demand for what they can supply. Where the market is human beings or their body parts, the victims will also have at least glimpses of their victimization.
What is not known in a black market? What is kept secret? First of all, there are identities. Purchasers may be able to locate vendors. But they may not know who the vendors are. Purchasers buy stock from vendors, but they are unlikely to know how that stock arrived. They will likely not know the suppliers or the source of the supplies. The victims are likely to be duped. Even if they are victimized in at least some ways that they will notice, they are unlikely to know their ultimate fate.
The darkness in a black market is not just ignorance. It is also partly cover-up. The market is hidden, as best as possible, from all those not participating in it.
But there is even more than just active cover-up; there is also wilful blindness. Those involved, purchasers, vendors and suppliers, do not want to know more than they have to know. They do not only delude others; they also delude themselves.
The secrecy of a black market is aided by compartmentalization. In bringing any goods to market, there is always a sequence of steps. With a black market, each step is shrouded. Typically, everyone knows only their own part in the market. Typically, no one knows what happens to make the market work beyond what they see.
Typically a black market is also run by non‑state actors. The Chinese black market in prisoner of conscience organs is distinctive in a number of ways, not least, in the fact that it is institutionalized, a state run system.
The secrecy surrounding a black market is compounded where the market is state run in a country without a free press or the rule of law. Both of these are true of China. When a state runs a black market, the state will, obviously, do nothing to shut it down. Where there is no free press, there is no media to expose the black market. Where there is no rule of law, the courts are not available to bring black marketeers to heel.
We descend even further into pitch darkness when we consider the type of black market we are addressing here. A black market of prisoners of conscience killed by organ extraction and then cremated means that there are no bodies to autopsy. There is no killing scene to examine other than operating rooms which are cleaned up after each operation. There are no documents other than official state documents which are either kept confidential or destroyed. There are no witnesses to the organ extractions other than perpetrators and victims.
The ability of black marketeers to keep a market black has, in part, something to do with the nature of the market. It also has something to do with the power of the marketeers. Gangster who control a neighbourhood, intimidate its citizens and bribe its officials are going to have an easier time of keeping a market black than a few fly-by-night individuals.
When it comes to an entity as powerful as the Government of China, that power is well and easily used in keeping an internal market black. For all too many, turning a blind eye is the easy way out. Those with lots to lose either politically or economically are easily compromised. Speaking truth to power, for all too many, conflicts with self‑interest.
Any black marketer will try to hide what they are doing. If they did not, the market would cease to be black. Black marketeers typically do not go beyond that and fabricate a pretend market, producing phoney statistics to disguise the reality. But the Government of China does.
Piercing the veil of secrecy which hides the Chinese black market in organs means going beyond the denials and cover-up. It means also confronting the active fabrications, the pretend explanations of what is happening with organ transplantation in China.
In China, sourcing of organs from prisoners without their consent was made explicitly legal by a 1984 law. After David Kilgour and I produced the first version of our report in July 2006, which concluded that practitioners of the set of exercises Falun Gong were killed for their organs, China introduced a new law in 2007, making the procuring of organs without consent illegal. However, the 1984 law which said this practice was legal was not repealed. It is still the law in China.
Which law now prevails is an issue the courts in China have never addressed, since the courts operate according to the dictates of the Communist Party, which has no interest in resolving this issue. Not one case of the killing of a prisoner of conscience for their organs has ever been brought to court.
Cover-up is not a once for all phenomenon. The research in which I and others have been engaged has been continuous since 2006. How we came to the conclusion we did I will get to in a moment. Before I do that I want to mention one other feature of the darkness into which we have been flung, the progressive nature of the cover-up.
Whenever we identify a data stream from Chinese official sources indicative of the black market, it disappears. We archive everything so that any researcher can see what we see. The disappearance of the data stream is nonetheless significant because it means that those inside China can not see what we saw. In addition, updating which would rely on that data stream becomes impossible. The data stream is useful for the past, but ceases to exist beyond the point of publication in our research.
How researchers came to the conclusion we did that prisoners of conscience are being killed en masse in China for their organs is the subject of several books and reports, running to hundreds of pages and thousands of footnotes. The conclusion comes from a wide variety of cross checked data streams and interviews.
It is impossible to do full justice to all this research in the time allotted here. I will give you a few indicators of evidentiary trails which led to the conclusion we reached. However, I would invite anyone who has a further interest in the issue and particularly anyone who questions our conclusions or wants to see the original source material on which it is based to go to the works we wrote and their citations.
Some of the evidence on which our conclusions were based we were able to garner despite the black market. Some of the evidence on which our conclusions were based was evidence of the black market itself.
Here is some of the evidence on which our conclusions were based which we were able to garner despite the black market.
1) From patients we receive information about waiting times. In short, there are none. Everywhere else patients wait for donors. In China, organ sources wait for patients to arrive. They are then killed for their organs.
Transplants are booked at the convenience of the patients, weeks or months in advance, even for vital organs – heart, lung and liver. That means that someone is being killed on order after the arrival of the patient.
2) Those who get out of detention and out of China, both common prisoners and prisoners of conscience alike, tell us that practitioners of Falun Gong and other targeted prisoners of conscience, as well as death penalty prisoners, are systematically and periodically blood tested and organ examined. Other prisoners are not. The testing is not done for their health, since they have been tortured to recant their beliefs. Moreover, no health measures flow from these tests.
3) The target victims are the subject of extreme vilification in Chinese Communist Party propaganda. This propaganda has the effect of dehumanizing the victims in the eyes of their jailers, rendering them non-persons.
4) Those who get out of detention and out of China tell us about the large population in detention of the non‑self‑identified, those arrested in Beijing while protesting and who refuse to identify themselves to their jailers to protect their friends, family, neighbours and work environment back home. Though the non-self-identified are, according to those we interviewed, a larger population than the self-identified, we almost never come across them outside of detention. They are a disappeared and vulnerable population. Their family does not know where they are and their jailers do not who they are.
5) When we first began our work, Chinese hospitals posted prices for organs. Until April 2006, the China International Transplantation Network Assistance Centre in Shenyang City posted this price list:
Kidney U.S. $62,000
Liver U.S. $98,000 – 130,000
Liver‑kidney U.S. $160,000 – 180,000
Kidney‑pancreas U.S. $150,000
Lung U.S. $150,000 – 170,000
Heart U.S. $130,000 – 160,000
Cornea U.S. $30,000
One can see from this list that there is a lot of money to be made from transplants.
6) Before the publication of our report, hospitals and brokers advertised freely about transplantation in China. Many of them continued for quite some time even after our report came out.
7) National and international law, and national and international professional ethical standards are all worth noting, not for what they said, but for what they did not say. When David Kilgour and I produced the initial version of our report in 2006, there was more or less nothing -neither in law or professional ethics, neither in local or international standards which dealt with cross border organ transplant abuse. A vulnerable, demonized population, huge money to be made and legal and professional ethical impunity made for a deadly combination.
8) Hospital telephone calls gave telling information. Investigative callers, claiming to be relatives of patients who needed transplants, called hospitals throughout China, asking if the hospitals had Falun Gong organs for sale. The explained basis for the calls was that practitioners of Falun Gong are healthy because of their exercises; so their organs would be healthy. About 15% of the hospitals called stated that they did indeed have organs of Falun Gong for sale. The calls were taped, transcribed, translated and posted.
9) Hospital data were another source of information. In our update of June 2016, we calculated hospital by hospital, total transplant volumes in China. The figure we reached was a range, from 60,000 in the earlier years to up to 100,000 in the later years. This figure is a multiple of the official statistics for transplant volumes. The high volumes raised the question: what could possibly be the sources for all these organs, other than prisoners of conscience?
10) We, the researchers, have received and recorded individual stories of prisoners of conscience being threatened with organ transplant abuse. Some victims slated for organ extraction managed to escape their pending doom and lived to tell about it. The details of these individual stories can be found in our published work. These individual stories can not give us statistical information. But they provide graphic insights.
11) Similarly, we had a number of cases of whistle-blower evidence, people who participated in some component of institutionalized organ transplant abuse in China and then told what happened. Again, this whistle-blower evidence is found in our published works.
12) The militarization of transplantation is one unusual feature amongst many in China. In China, the military is a conglomerate business and one of its businesses is selling organs. The involvement of the military in the organ transplant business made them natural partners of the prison and detention system where the prisoner organ sources were held.
The Chinese black market
Here is some of the evidence on which our conclusions were based which was evidence of the black market itself.
13) When China moved from a socialist to a market economy, the health system was a major part of the shift. From 1980, China began withdrawing government funds from the health sector, expecting the health system to make up the difference through charges to consumers of health services. From 1980 to 2006, government spending dropped from 36% of all health care expenditure to 17%, while patients’ out of pocket spending rocketed up from 20% to 59%. Reductions in public health coverage were worsened by increases in costs by the private sector.
According to cardiovascular doctor Hu Weimin, the state funding for the hospital where he works is not enough to even cover staff salaries for one month. He stated: “Under the current system, hospitals have to chase profit to survive.” Human Rights in China reported: “Rural hospitals [have had] to invent ways to make money to generate sufficient revenue”.
14) One indicator, as noted, of a black market system is cash transactions. In China, cash payments, in red envelopes, are pervasive, not just for transplants, but throughout the health system. In 2014, the Government made a pretence of trying to stop the practice by requiring doctors and patients to sign contracts agreeing not to give or accept red envelopes. However, the practice did not stop.
15) Patients we interviewed who went for transplants to China tell us about the secrecy surrounding the operations. They are given the names of no one, including the operating doctors. They are not told the source of organs, or told in a vague way that is unverifiable. Some patients bring with them their own doctors or family members from back home. These accompanying doctors and family members are also told nothing.
Before the first version of the report David Kilgour and I wrote was published, doctors in China used to provide foreign patients with letters indicating operative findings, a clinical summary, information on the type and dose of drugs given, the best drug results achieved and standard test results. After our report came out, those letters stopped. Malaysian transplant doctor Ghazali Ahmad wrote that the ending of those letters was “part of deliberate attempts by the syndicate members to remain anonymous, unaccountable and leave absolutely no trace of their illegal activities.”
16) Before the first version of the report David Kilgour and I wrote came out, the official Chinese explanation for sources of organs for transplants was donors, even though there was no donation system. After our report came out, the official explanation shifted. The source of organs for transplants was, so Chinese officials said, prisoners sentenced to death and then executed. How many such persons were there? The Government of China would not say.
At the United Nations Universal Periodic Review Working Group in October 2013 in response to questions about death penalty statistics, China asserted that they do not keep statistics on the number of those subject to the death penalty who are executed. That was, perhaps, not surprisingly, not an honest response. Under the Chinese State Secrets Law, death penalty statistics are top secret. Chinese officials would be breaking the law by disclosing death penalty statistics.
17) After the first version of our report came out in 2006, brokerage ads and posted price lists progressively disappeared. Now there are none. However, the disappearance of the ads does not, in itself, mean disappearance of the abuse. All that it does mean is that a black market has become even blacker.
The brokerage advertising which survived the longest was the Omar Health Care Service, offering transplants to foreigners at The Tianjin Oriental Organ Transplant Centre. Its website no longer exists, but it did exist to at least April 16, 2014, to almost eight years after the release of our report. You can still see what the website was through an internet archiving service.
18) Transplant registries tell their own story. For our research, David Kilgour and I were able to garner useful information about transplant volumes from the China Liver Transplant Registry in Hong Kong. After our work was published, the China Liver Transplant Registry shut down public access to statistical aggregate data on its site. Access is available only to those who have a Registry issued login name and password.
At The Transplantation Congress in Vancouver in August 2010, Haibo Wang, who was then assistant director of the China Liver Transplant Registry, presented at the same session I did. I asked him why public access to the data on the Registry website was shut down and if it could be restored. His answer was that public access was shut down because people were, so he said, ‘misinterpreting’ the data. If anyone was now to get access, the Registry had to know first the purpose for which the data was being used and some confidence that the data would not be, in his view, ‘misinterpreted’.
The Chinese health system runs four transplant registries, one each for liver, kidney, heart and lung. The other three are located in Mainland China ‑ kidney and heart in Beijing and lung in Wuxi. The data on the other three sites is also accessible only to those who have registry issued login names and passwords.
What we see in the organ transplant file is not initial secrecy and evolving openness, but rather the reverse. Data, like the Hong Kong Liver Transplant Registry aggregate figures, which were once available have since ceased to be available. There is not just secrecy; there is cover‑up.
19) There is a similar story for waiting times. There has been a progressive dismantling of Chinese website information which gives waiting times for transplants.
The China International Transplantation Assistant Centre website used to say, “It may take only one week to find out the suitable (kidney) donor, the maximum time being one month…”. It went further, “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.”
The website of the Changzheng Hospital in Shanghai in early January, 2006 said “the average waiting time for liver transplant patients in our hospital is one week.” The site of the Oriental Organ Transplant Centre in early April 2006, claimed that the average patient waiting time for a liver transplant was two weeks.
If you go to those sites now, those statements are not to be found. They are available through internet archiving, but not on the websites from which they originally came.
20) China has set up an Organ Transplant Response System (COTRS) which is meant to allocate donated organs. However, its website, like the specific organ registries, is available only to those who have issued login names and passwords. It is impossible, by looking at the website, to figure out what the system does.
21) China has a massive arbitrary detention system. It is perhaps not surprising to find out that China does not publish information about whom it arbitrarily detains. It does not name individuals; nor does it publish aggregate statistics. The information we have about this arbitrary detention system comes from detainees who get out of detention and out of China and report what they see around them.
The NGO the Laogai Research Foundation estimated in 2008 that the number in camps then currently arbitrarily detained were between 500,000 and two million souls. Falun Gong are, according to the United States Department of State, more than half of those held in Chinese forced labour detention camps.
22) Transplantation involves both extraction and insertion teams. The insertion teams are willfully blind to what the extraction teams have done.
In an interview with Phoenix TV, posted in January 2015 on their website ifeng.com, Huang Jiefu, the official voice of the Chinese transplantation system was asked these questions and gave these answers:
“Reporter: Minister Huang, have you ever taken organs from executed prisoners?
Huang: I said I went there once, but I was not the one who did the extraction. But after that one time, I did not want to go again. I am a doctor. Doctor has a moral bottom line, which is respecting life and helping the sick. This must be done in sacred places, otherwise, it is against the moral bottom line of a doctor.
Reporter: Was that the first year you did human organ transplant?
Huang: First year. Because organ transplant is divided into two teams. One is the donor team, who extracts the organs. One is the recipient team, who transplants the organs.
Huang: I am in the recipient team. I’ve never been in the donor team. But I did go once to see how they do it. So, I have only been there once. After that time, I never wanted to have anything to do with the donor team. But I feel that I need to change it.
Reporter: When you help the recipient, you think it is saving a life. But do you try not to think about the donor?
Huang: Majority of the transplant surgeons feel helpless. On the one hand, you face the patient who has a failing organ. As a doctor, you have the technique and responsibility to save people. But the other side of the story, when you think about the organ source, you feel helpless.”
23) The transplantation system is compartmentalized. No one person goes from the patient in the hospital to the prison to select the prisoner with the right matching organ and then accompanies the organ from the prisoner in his prison cell to the patient in the hospital. This compartmentalization allows for wide scope for the sort of wilful blindness Huang Jiefu expressed.
Tom Treasure, a transplant surgeon writing in the Journal of the Royal Society of Medicine, wrote:
“The designated retrieval team, usually trainee surgeons or so called ‘research’ or transplant fellows, go where they are sent. It is nearly always at the dead of night, when the operating theatres are free and road and air routes are clear, and it is always under extreme time pressure to maximize the quality of the organs. Meanwhile the transplant teams call recipients on waiting lists and set up urgent transplant operations, in several different hospitals ‑ all against the clock. The time pressure, the geographical dispersion, the complexity of the matching of multiple organs, the need to respect confidentiality and the anonymity of donor and recipient, and the sheer logistics of it all, means that no member of the medical staff has an overview of the whole process. Nor would they be expected to in China. This is what makes it plausible that it [organ harvesting of Falun Gong practitioners] could happen and that doctors themselves could be largely unaware of it, or at least sufficiently distant to turn a blind eye and a deaf ear.”
24) The Chinese government is far from silent about organ transplant abuse. A large part of the shroud thrown over transplant activity in China is diversionary verbalism.
Some of that diversion is phoney statistics about transplant volumes, already mentioned, and drug volumes. The Government of China claims that its share of the global demand for immunosuppressants is roughly in line with the proportion of the world’s transplants they say they carry out. Yet their statistical claims for use of immunosuppressants is as unverifiable as the transplant volumes they say they carry out.
Sean O’Connor, Policy Analyst, Economics and Trade for the U.S.‑China Economic and Security Review Commission wrote in a report dated and titled February 1, 2017 “Fentanyl: China’s Deadly Export to the United States” that “the country’s vast chemical and pharmaceutical industries are weakly regulated and poorly monitored. Chinese law enforcement officials have struggled to adequately regulate the thousands of chemical and pharmaceutical facilities operating legally and illegally in the country”.
25) In addition to the abuse of statistics, the hard data and verifiable research we have accumulated is met with bafflegab, nonsensical blathering. Researchers are called anti‑China. Yet, a person truly anti-China would be indifferent to some Chinese killing other Chinese.
Researchers are accused of being political. Yet, human rights are universal and do not represent any one political ideology.
The Communist Party claims that researchers are being manipulated by practitioners of Falun Gong. Yet, the researchers are doing their own research work. And so on.
26) There has been active attempts to intimidate researchers on this file, to shut us up and shut us down, me and my colleagues working on the file. In our published works, we give many such examples. For the purpose of this event, let me just give one.
When I spoke at a forum in Broadbeach, Gold Coast, Australia August 4, 2008, the forum was connected through the internet to participants in China, over 150 in total. The local as well as the internet participants asked questions after the formal presentation was over. One of the internet participants was a Chinese government police official. This is the question, in translation, he asked me:
“Are you afraid of death? You are brutally interfering in our Party’s internal policies. Are you afraid of our revenge? Our revenge against you, we’ll take revenge against you, are you not afraid of that?”
My answer at the time was: don’t shoot the messenger. I said that the official, if he did not like what I was writing, should work to end organ transplant abuse in China.
I want to conclude with three quotes. The first is from the Scottish poet, Sir Walter Scott, published in 1808: “Oh what a tangled web we weave when first we practice to deceive.”
Chinese Communist Party misrepresentation about organ harvesting is far from its first exercise in dishonesty. However, there is a form of dishonesty with organ harvesting which is new to the Party.
The Party does not care what I think and is quite happy to say nonsense in response. That is its typical reaction to claims of human rights abuse.
However, the Party cares very much what the global transplantation profession thinks. The reason is that they care what their own transplantation profession thinks, and their own transplantation profession does not want to be ostracized by the global transplantation community.
To beguile the global transplantation profession, the Party engages in much more convoluted deception than they have done for other forms of human rights abuse. One can trace the many changes in the Chinese transplantation scene to this charm offensive.
27) a 2006 switch from attributing sourcing to donors to attributing sourcing from prisoners sentenced to death and then executed;
28) a 2007 law banning sourcing of organs without consent, as noted, without repealing the 1984 law which allows that sourcing;
29) a 2007 registration system for transplant hospitals or transplant wings of hospitals, without any explanation of the mismatch between the national claimed transplant totals and totals of minimum bed requirements for registration;
30) a 2007 priority given to local patients needing transplants;
31) the establishment of a donor system, starting with a pilot project in 2010, again without explanation for the dysfunction of a system which investigation shows to be generating statistically insignificant numbers;
32) the China Organ Transplant Response System established in September 2013;
33) a second switch in January 2015 from attributing sourcing from prisoners sentenced to death and then executed to attributing sourcing from donors;
34) attending international events, including The Transplantation Society Congress in Hong Kong in 2016 and the Pontifical Academy of Sciences summit on organ trafficking and transplant tourism at the Vatican in 2017, to convey the Party message; and
35) hosting visits from transplant professionals, including a visit from P. J. O’Connell N. Ascher F. L. Delmonico, two former presidents and the then current president of The Transplantation Society in August 2017, with Potemkin village displays.
Grigory Potemkin was governor of Crimea after Russia annexed the territory from the Ottoman empire. He arranged for fake portable villages to be built along the Dnieper River to hide the devastation of Crimea from Empress Catherine II and her entourage when they visited Crimea in 1787.
These charm offensives to a large extent have worked. There has developed a split in the transplantation profession, the majority arguing for engagement and a minority, with whom I agree, continuing to promote ostracization as peer pressure.
Generally violators approach concerns about human rights violations in one of two ways. The first way is denial, counter accusations, nationalism, and assertions of national sovereignty. This has been the typical Party response to claims of human rights abuse in China.
The other way is for the violators to say, you are right, we will change, show us how, come help us. This has been for China a novel response, but nonetheless the response they have given to the easily charmed transplantation professionals.
Whether the response is rude or polite, the underlying problems remain. The violations continue. There is no transparency. There is no accountability. For the victims, nothing changes. The only substantive change is the end or lessening of the ostracization of the Chinese transplantation profession.
The protests China raises to the evidence about the killing of prisoners of conscience for their organs are so extreme that they reek of insincerity. A far better response would be evidence based. It would involve providing access to records, allowing unannounced visits to hospitals, prisons and detention centres and cooperating with an independent international investigation.
The second quote I have comes from William Shakespeare, and his play Hamlet, “The lady doth protest too much methinks.” When none of that is done, but, in its place, we get over the top protests, these protests themselves lead one to wonder what the Chinese Communists are attempting to hide.
David Matas is an international human rights lawyer based in Winnipeg, Manitoba, Canada
 “Organ procurement and judicial execution in China” Appendices: Three Documents on the Disposition of Corpses in the prc, Document 2 “Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Criminals (October 9, 1984)” Human Rights Watch August 1994
 See Bloody Harvest: The Killing of Falun Gong for their Organs with David Kilgour, Seraphim Editions 2009; State Organs: Transplant Abuse in China co‑edited with Torsten Trey, Seraphim Editions, 2012; Ethan Gutmann, The Slaughter: Mass Killings, Organ Harvesting, and China’s Secret Solution to Its Dissident Problem 2014; David Matas, David Kilgour, Ethan Gutmann, An Update to Bloody Harvest and the Slaughter, 2016 at https://endtransplantabuse.org/
 “The high price of illness in China”, Louisa Lim, BBC News, Beijing, 2006/03/02 http://news.bbc.co.uk/2/hi/asia‑pacific/4763312.stm