The purpose of a groundbreaking analysis published in BMC Medical Ethics on November 14th was to determine whether the Chinese government has in fact fulfilled its promises to reform the nation’s organ donation system.
Instead, the analysis suggests that the Chinese government has been using human-directed data manufacturing and manipulation to inflate its claimed voluntary organ donation numbers. The authors, Matthew Robertson, a doctoral student at the Australian National University (ANU), Raymond Hinde, a statistician from Australia and Jacob Lavee, MD, professor of cardiovascular transplant surgery at Tel Aviv University, used forensic statistical methods to examine three key datasets from 2010-2018 and found “unusual and anomalous features.”
Robertson and his colleagues derived data from the government’s voluntary donation program, including published information from the China Organ Transplant Response System (COTRS) and the Chinese Central Red Cross. The data was mathematically analyzed to determine whether the COTRS and Central Red Cross datasets had internal integrity and consistency, and then compared to one another for congruence. In addition, five provinces were examined with provincial Red Cross data for internal integrity and then compared to reported transplant activity at hospitals in the respective province for congruence. The researchers also compared the figures with data from 50 other countries in the Global Observatory on Donation and Transplantation, a database managed by a collaboration between the World Health Organization and the Spanish Transplant Organization.
COTRS is a national computerized organ allocation and registration infrastructure that forms the basis of China’s voluntary organ donation system. Every organ donation is meant to be allocated solely through COTRS. The Red Cross Society of China is required to verify and witness every organ donation. COTRS was created in response to international calls for China to reform its unethical transplantation system, which government officials acknowledged was heavily dependent on executed prisoners for organs. However, studies over the last 13 years into China’s transplantation infrastructure, including a 2016 investigation and a 2019 People’s Tribunal, have revealed that China has been sourcing organs not just from executed prisoners, but primarily from living prisoners of conscience, including the Falun Gong, Tibetans, House Christians and Uyghurs, to supply a vast organ transplantation system that is larger than any other country outside of the United States. The on-demand nature for transplants in China, with short wait times of approximately two weeks, can be explained by forced organ harvesting of readily accessible living prisoners of conscience.
In addition to the creation of COTRS, Robertson et al. note that China set in motion several other key changes to comply with international ethical standards, including revising what had been a vague definition of diagnostic criteria for both circulatory and neurological death, establishing a network of hospital-based organ procurement organizations (OPOs), and the implementation of transplant coordinators affiliated with both local hospitals and branches of the Red Cross Society of China. The government is also purported to have implemented a policy of “humanitarian aid” for families of deceased donors.
The authors found that the COTRS data conformed almost precisely to a mathematical formula, a one-parameter quadratic that is familiar to most high school students, with the Central Red Cross data mirroring the former. The data, the researchers observed, showed a steady upward swing when plotted on a chart and matches the equation so precisely, with 99.7 percent variation, that suggests it was manufactured. The researchers found that total donors in China, as well as the number of available kidneys and livers “comply almost perfectly” to three separate quadratic equations. “The quadratic formula expresses a relationship between three known quantities – A, B, and C – and an unknown quantity, X. It is most often written as AX2 + BX + C = 0.”
The researchers also found outliers in China’s Red Cross dataset, including a medically impossible 21.3 number of transplants per donor over a 10-day period in March 2016, data inputs that matched an apparent pattern of “correction” for a consistent rate of 2.75 transplants per donor, and other changes suggesting manipulation. Robertson et al. stated that the COTRS data was “falsified through a top-down process,” and the Red Cross data was manipulated to match and “maintain a semblance of congruence.” The data appeared to have been “handed down as quotas – albeit quotas that were imperfectly implemented across a fractured bureaucratic and administrative apparatus, thus exposing the discrepancies identified.”
Asked why Chinese officials would be so careless in publishing these kinds of numbers, Robertson et al. stated that it was very difficult to falsify an entire data series with “some semblance of internal coherence among competing bureaucracies”, and it seemed China had made a mistake. “If they had added 10 percent more random variation we wouldn’t have such strong findings,” he said. “The fact that it was so clean is simply a mistake. It’s a monumental error on their part.”
The study’s results were reviewed by a well-respected statistician in Britain, Professor Sir David Spiegelhalter of Cambridge, who concurred with the findings. While there are almost always recording errors and delays in government data, the anomalies found by Robertson et al., he said, “follow a systematic and surprising pattern… The close agreement of the numbers of donors and transplants with a quadratic function is remarkable, and is in sharp contrast to other countries… This could, of course, just be coincidence, although it is difficult to quantify how surprising such a pattern is without a model for the “natural” development of a transplant program. But I cannot think of any good reason for such a quadratic trend arising naturally.”
The authors wrote in their conclusion that “one of the most troubling consequences of the apparent data falsification and apparent continued use of nonvoluntary organs in the official allocation mechanisms is that it impugns the reputations of Chinese surgeons dedicated to the highest standards in ethical transplant medicine, and undermines their efforts at establishing a trustworthy, transparent, and ethical system.”
The BMC Medical Ethics paper was widely reported by media around the world including The Guardian, The Epoch Times, The Sidney Morning Herald, The Japan Times, Health Europa, Medical News and the Daily Wire.