By Martina Keller, Die ZEIT
March 13, 2013
In China body organs are taken from executed prisoners, and for a fee, are then implanted in patients from the West.
When Beijing attorney Han Bing published his latest blog on December 6, 2012, he must have known he was placing himself at serious risk. His report spread like wildfire via the Chinese wire service Sina Weibo. “On this very morning,” Han reported, “a frightful execution took place.” A prisoner sentenced to death was reportedly executed although the highest Chinese court, a few days before, had ordered the case to be reexamined. Apparently, for the responsible parties, this was too long a wait. The prisoner’s body organs were needed and had to be in the best possible condition. There was no other explanation for why the execution took place in a clinic, according to the attorney’s report. “These unscrupulous judges and doctors are transforming a hospital into a place of execution – a marketplace for the organ trade,” Han wrote.
The attorney reports that the condemned man was forced to sign a document affirming his “voluntary” consent of the organ harvesting. His family members were not allowed to see him for a final visit although it was their right to do so. “We plan to appeal,” the attorney announced on behalf of the surviving dependents.
Han’s account was forwarded more than 18,000 times within a single day, and more than 5,600 people posted comments. Then the blog was erased.
This example of an anonymous execution victim is not an isolated case. Statistically China is second worldwide, just behind the USA, for numbers of organ transplants. It is an accomplishment that fills the regime with pride. Every year more than 10,000 kidneys, livers, hearts and lungs are transplanted in China, as reported last year by Vice Minister of Health Huang Jiefu – himself a transplant specialist – in the medical journal The Lancet. His statistics indicate that more than 60 percent of these organs are taken from executed prisoners. The frankness of the report is astonishing. Until a few years ago, the government rejected all foreign reports on China’s questionable transplant practices as propaganda.
A person dies just in time to permit another person to continue living. This is possible in the Chinese transplant system. In the name of progress, in the name of money – including Western money, as will be seen.
The number of persons executed in China is a state secret. It is estimated that approximately 4,000 executions of prisoners take place in China per year. Those convicted are killed by a bullet to the head or by lethal injection. Insiders report that transplant clinics cooperate with prisons and send out their own teams for the organ removal. It is quite possible that physicians take part in executions.
Intensive research is conducted in China on ways to perform lethal injection without damaging the organs. Wang Lijun, the former chief of police of Jinzhou, received a long prison sentence last year following a political scandal. Wang headed a psychological-forensic research institute for several years. In 2006 Wang’s studies of execution methods brought him the country’s prestigious Guanghua Innovation Special Contribution Award. The award is the equivalent of about 200,000 Euros. The citation stated that he had developed a “brand-new protective fluid” for organs, ensuring successful transplants from executed prisoners despite lethal injection. In his acceptance remarks, Wang said he had conducted his execution experiments “on several thousand persons.” He called the experience “heart-wrenching.”
Elsewhere in the world, such reports trigger outrage. But there is one thing that scarcely anyone knows: The west is deeply implicated in the unethical Chinese system. Patients in western countries have to thank Chinese execution victims for their new kidneys, livers and hearts. Pharmaceutical firms supply the Chinese market with anti-rejection drugs, and conduct research on transplantation practices that in all likelihood have come from the use of organs from executed prisoners. Western clinics and doctors support China’s transplant centers, no questions asked. Western consultants to the Chinese government claim to be encouraging change in transplant practices, while at the same time they pursue business interests in China. Vehicles from the West are converted into mobile medical execution units. A Chinese car dealer, for example, offers a European-brand vehicle with medical monitoring equipment and infusion devices for sale on the Internet – a grisly symbol for the hand-in-hand work between executioners and doctors.
The various participants of China’s transplant industry and the physicians who violate the most basic ethical principles of their profession and prefer to stay silent, and cross the moral line between cooperation and complicity, make up the basis for this story. The question is: What is the impact of deteriorating medical ethics, the impact of ambitious research for personal gain and the impact of financial profit? And where must the West draw the line to avoid complicity, to avoid the guilt?
Attorney Han Bing and his clients do not know who received the organs from the man who was executed in December, but there are patients who do come forward and speak of their transplant surgery in China. Mordechai Shtiglits lives with his wife in Petach Tikwa, near Tel Aviv. At age 63, despite his 120 kilos, he is a healthy man who loves steaks and is the happiest when spending time with his family. While his wife serves coffee in the living room, he pulls a photograph album out of a drawer. It documents his trip to China, one that for Shtiglits could have been his last.
In November 2005, when he was pushed on board an airplane in a wheelchair, Shtiglits could scarcely put one foot in front of the other. His wife and elder daughter accompanied him to Shanghai. On the day they arrived, Shtiglits was brought to Zhongshan Hospital, one of the largest transplant centers in China. He was given a room in the modern wing, reserved for foreigners and wealthy Chinese patients. There, Shtiglits met patients from Canada, Australia and Hong Kong. Like him, they were waiting for a life-saving operation.
Shtiglits’s own heart was failing, and he was facing the end of his life with just 10 percent functional capacity. With luck, that was just enough to keep him alive. Shtiglits suffered from frequent near fatal cardiac arrests, but each time he was able to be revived. He spent some nights sitting in an upright position in an effort just to breathe.
For a year and a half he lay in the Sheba Medical Center near Tel Aviv awaiting a new heart. But in Israel, organs are donated even less often than anywhere else in the world. So his family members took matters into their own hands. Shtiglits’s son went on the Internet in search of a new heart for his father. Everywhere he heard the same response, “Yes, you can come, but for a heart you have to reckon with waiting several months.”
But that, the family believed, was time that Shtiglits did not have. Therefore the choice fell on China. Since the state has drastically curtailed its subsidies to hospitals in China, many of them shore up their budgets with organ sales. In China you can receive a new heart within two or three weeks. If you are lucky, like Mordechai Shtiglits, the process can go even faster.
A week after his arrival in Shanghai, his Chinese surgeon informed him that he would receive his new heart on the following day. Shtiglits learned that the donor was 22 years old. He did not ask what had happened to the man. “I was ill, I was at death’s gate,” he says today. “They indicated that he was the victim of a traffic accident.”
That is extremely unlikely. It’s true that more than 60,000 persons die in road accidents each year in China. But even Chinese doctors do not know in advance when someone will die in an accident. And so far there is no central distribution system in the country for quick organ distribution.
Organ harvesting from executed persons is universally frowned upon. Transplants are based on the principle of voluntary organ donation, while prisoners have no freedom of choice. This is the view of the World Medical Association as well as that of The Transplantation Society. But that is not the end of the moral problem with China’s practice. If wealthy patients are to be supplied quickly with an organ, it is not sufficient to wait until a suitable donor happens by chance to be executed or die at the right moment. “Prison officials have to target potential donors on the basis of health, blood and tissue type, and execute them while the tourist is in China,” writes the renowned New York bioethicist Arthur Caplan in the 2012 book State Organs: Transplant Abuse in China: “This is nothing else but killing on demand.”
The history of this gruesome practice is thought to have started in the 1980s. At that time the Chinese transplant system was still in its infancy. But then a marked uptick began. Vice Minister of Health, Huang Jiefu, documented this trend in a presentation he made in Madrid in 2010, stating that the number of transplanted kidneys rose between 1997 and 2005 from 3,000 to 8,500 annually, while the figure for livers increased from 2,000 to about 3,000 a year. The prerequisite for this boom was new and improved anti rejection medications. These are medications that came from the West.
Cyclosporin A, a product of the Swiss Sandoz Corporation, is essential to the survival of transplant patients and has been supplied to China since the mid-1980s. Later, other Swiss firms, Roche and Novartis began to supply life sustaining transplant drugs. Today the owners of Sandoz, as well as the Japanese Astellas Corporation, sell their anti-rejection drugs in the People’s Republic of China. Since 1994, at the latest, these firms would have known about these accusations against China. At that time, the non-governmental organization Human Rights Watch had published a detailed report.
In late 2005, Roche even began producing the anti rejection drug Cellcept inside China. At the opening ceremony for the production center in Shanghai, Roche CEO Franz Humer, according to a report in the Handelsblatt, justified the decision to begin production specifically in China. “Unlike Japan,” he said, “the country has no ethical or cultural barriers to transplantation medicine.”
The Chinese government has no such inhibitions. Citizens, on the other hand, are anxious. They show scarcely any willingness to donate organs voluntarily. Between 2003 and 2009 only 130 organ donors were registered in the entire country. Many Chinese distrust the health care system. They are afraid of being declared dead too early or of being abused by the organ business by donating their organs.
The Western pharmaceutical industry shares responsibility for scientific research in China. Research records list nine clinical studies in China with about 1,200 transplant patients, with whom Wyeth and Pfizer from the USA, Novartis and Roche from Switzerland, and Astellas from Japan have all tested their transplant drugs. Altogether the corporations have cooperated with 20 hospitals in China for these studies.
Die ZEIT asked the pharmaceutical companies how they ensured that no organs from executed persons were included in these studies. A few companies did not respond at all, while others avoided the concrete question. Roche and Pfizer only affirmed that the standards of the World Health Organization (WHO) had been met.
The WHO requires that organization and performance of transplant operations must be “transparent and accessible to scrutiny.” Human rights organizations have often complained that China consistently violates these rules.
It has been seven years since Mordechai Shtiglits received his new heart. Seven years of the gift of life. Shtiglits has to take a quantity of tablets daily, and not just to prevent rejection of his new heart. “My whole body gives me trouble, my kidneys, my legs, my head…But my heart is fine, it works 100 percent.” He laughs. “I have a young heart and an old body.”
Shtiglits spends his afternoons in a small shop at a tennis center where he and his wife sell drinks and sports equipment. While Shtiglits talks about his illness, his 2 1/2-year-old grandson romps around on a toy horse.
Shtiglits says: “Since the transplant operation, my children have married, I’ve experienced the birth of several grandchildren, and more grandchildren are on the way. I thank God – I can’t complain.” If organs of executed prisoners in China were transplanted, it’s all right with him. “The Chinese kill prisoners. That means that a person dies, no matter whether he gives away his heart or not.”
Mordechai Shtiglits’s old heart was removed on November 22, 2005, as is stated in the skimp discharge document issued to him by the doctors of Zhongshan Hospital. It contains only Shtiglits’s clinical condition upon his admission, a few laboratory figures along with data on the administered and recommended medications. Not a word about the donor or the transplanted organ, as is customary in such documents. By the year 2011, 300 hearts had been transplanted at Zhongshan Hospital. In an inquiry from Die ZEIT asking what institutions the hospital collaborated with in organ transplants the clinical leaders did not reply. This is not medical practice that is “transparent and accessible to scrutiny,” as required by the WHO.
The family commemorated the day of the transplant operation with a photograph: Shtiglits in his yarmulke, in prayer with a close friend who lives in Shanghai. At about two o’clock in the afternoon, Shtiglits was moved into the operating room. Shtiglits’s wife Ida and his daughter Osnat waited in the lobby. “In the middle of the operation, the doctor came out and handed me a plastic glove with something bloody in it,” Osnat recalls. “He said: Here’s your father’s pacemaker.”
By the next day, mother and daughter were already able to wave to Shtiglits through a window. He felt better with each passing day. “You could see the color returning to his face,” Osnat says. Her father had a nurse who looked after him around the clock. “The staff was always available. We got the best possible treatment.”
In fact, a few of the large Chinese transplant centers have medical outcomes today that are comparable to those of Western hospitals. But, as Vice Minister of Health Huang stated in the journal Liver Transplantation, “success was not quick and not easy.” Huang, who expresses himself willingly and often in professional circles, left questions from Die ZEIT unanswered. He specializes in transplant surgery in the complex field of liver transplantation. “Entire transplant teams from the People’s Republic have been trained abroad,” he writes. He burnished his skills in Australia.
Huang would probably not be allowed to take part in a transplant operation in Australia today. Medical centers there now impose regulations during the training of Chinese surgeons. Stephen Lynch, chief physician at Princess Alexandra Hospital in Brisbane, requires that applicants submit a written confirmation from their clinical director, or a responsible person in the provincial government, “that the capabilities acquired from us shall not be applied in transplant programs that use executed prisoners as donors.”
German doctors are less scrupulous. At the German Heart Center in Berlin nearly 2,300 hearts have been transplanted since its founding in 1986. The Center cooperates with more than 30 hospitals in the People’s Republic, including transplant centers. As early as 2005, the personal assistant to medical director Roland Hetzer proudly reported on the Radio China International network that the Center had “nine ongoing collaborations with a cooperative agreement or a sign on the door.” This collaboration was initiated by Hetzer’s representative of many years standing, Weng Yuguo, a cardiac surgeon from Sichuan Province who held a German passport. Hetzer stated in May 2012, at a heart surgery conference in Shanghai that, “more than 500 physicians…from China have taken part in our work in Berlin over the years. A few of the surgeons have completed a full training program lasting five years. All of them have done good work after returning to their home country.”
This could be expressed differently. In Germany, Chinese doctors are receiving the skills that allow them to transplant organs from executed prisoners in China. Skills used for human rights violations.
Surgeon Liu Zhongmin is among the physicians who have worked for several years in Berlin. Today he is executive director of the Chinese-German Heart Institute in Shanghai, which was founded in 2000 by the German Heart Center and Shanghai East Hospital. The hospital is the closest cooperative partner of Germans in China. Liu’s qualifications can be found on the Heart Institute’s website. He is said to be responsible for clinical research for heart transplants, artificial hearts and combined heart-lung transplantation.
How many hearts in total have been transplanted at the Chinese-German Heart Institute? Where do these organs come from? To these questions submitted in writing by Die ZEIT, Liu has given no response.
Weng, who has represented Hetzer for many years and is senior chief physician at the German Heart Center, is, like the surgeon Liu, an executive director of the Chinese-German Heart Institute. He travels to China several times a year. He directed the operation in which China’s first artificial heart was implanted in 2001. Like Hetzer, Weng failed to respond to Die ZEIT.
In the summer of 2012, in conjunction with a medical congress, we questioned Hetzer about removal of organs from executed prisoners in China. He stated, “Of course I don’t support that, but it’s not the case that anyone can simply say that it’s wrong. Someone is executed and takes his organs with him to the grave. How would you decide, if you knew you were going to be beheaded tomorrow?”
Jacob Lavee, who is Mordechai Shtiglits’s physician, considers it unethical even to raise this question. It is a question, he believes, that a doctor may not want to ask himself. But then, one day in the autumn of 2005, Lavee opened the door to a hospital room at the Sheba Medical Center that was occupied by his critically ill patient.
Shtiglits had been treated by Lavee for years. Lavee, director of the Heart Transplant Department at the hospital, had long since stopped holding out any hope for him. But on that day he found Shtiglits in good spirits. He announced that he was flying to China and would have a heart transplant operation in two weeks. “I smiled at him and said that was impossible,” Lavee recalls, “but he was in dead earnest.” A kidney or part of a liver can be removed from live donors. Lavee had heard of patients who went to China for a kidney, but this was a new dimension. “If you receive a heart, it means that someone else has to die.”
Shtiglits was the first, but not the last, of Lavee’s patients who traveled to China for a heart. The transplant specialist is aware of a dozen cases. One or two patients died, while others like Shtiglits, returned home in stable condition. As a doctor, Lavee wants the best for his patients, but not at any price. “Even for myself,” he says, with conviction, “I would not go to China. Even if I had to die.” But Lavee also says,“I don’t blame the patients. When your life is in danger, you grasp at any straw.”
After Shtiglits returned from China, Lavee continued to treat him as a patient. The heart specialist is happy about the progress Shtiglits is making. At the same time he is beginning to campaign politically against other patients receiving heart transplants from China.
An unusual situation in Israeli precipitated Shtiglits’s journey to China. The costs of all foreign transplant operations were, at the time, assumed by medical insurance up to the customary rates in Israel. Shtiglits said that in his case the entire package had cost about $170,000 in U.S. dollars including the first-class flight with his wife and daughter, hotel costs in Shanghai, an interpreter and a personal guide for the duration of the six-week stay, the medical treatment and medication.
$170,000 is not a great amount in the organ market line – and China is among the cheapest suppliers in the field. But Shtiglits alone could scarcely have raised such a sum. Even the $65,000 for a kidney would not have been affordable for most of the 250 Israelis treated in China. Lavee decided that the reimbursements must come to an end.
He published articles in medical journals that were picked up by the Israeli press. He took part in televised discussions with Shtiglits, always on friendly terms as patient and physician, but irreconcilable on this subject. He organized a conference under the auspices of the Israeli Transplant Society. And Lavee succeeded. The Israeli transplant law, which took effect in 2008, forbids cost reimbursement for foreign transplant operations if organ purchases are involved. At the same time, the law includes provisions to help increase Israeli citizens’ chances for getting an organ in their own country. Anyone possessing an organ donation pass receives preferential treatment from now on if he or she should need a transplant.
Lavee reports that since the law took effect not one more Israeli patient has traveled to China for a transplant. In such a small country, a specialist such as he can have a good overview of the matter. In Internet forums, Lavee is now attacked as a physician who blocked patients’ access to China.
“It’s an accusation I’m very proud of,” Lavee says.
Yet, his mission is not complete. The international problem of organ tourism continues, even as the Chinese leadership officially strives for reforms, and more needs to be done.
Since 2007, organ trade in China has been forbidden by law. This does not mean that organs can no longer be removed from prisoners – this practice continues to be tolerated. The new laws state that organs, irregardless of origin, can no longer be provided for money, for example to rich Chinese or Europeans. From time to time, publicity
generating actions occur. In August 2012, for instance, in a raid against alleged organ dealers, Chinese police arrested 137 persons including 18 doctors. Yet at the same time, websites like chinahealthtoday.com, placidway.com and novasans.com openly court transplant clients from all over the world, with ads like: “Heart transplantation overseas – Clinic managers and medical tourism facilities in China.” And the government? For the most part, it lets the hospitals that are behind these messages continue their efforts.
Organ trade is tolerated by the Chinese government. Executions supply organs and materials for transplant operations. This is frightful, but it’s not the whole story. There is another suspicion, which is even worse: Forced organ harvesting from spiritual prisoners of conscience. You might dismiss it as a fantasy by an author of thrillers, doing a remake of the shocker known as Spare Parts (Fleisch, Meat, in German), if it weren’t for the Canadian attorney David Matas and Canada’s former Secretary of State, David Kilgour. Both men were nominated for the Nobel Peace Prize in 2010. With painstaking care they have been collecting facts and reports since 2006. The results of their efforts were considered by the U.S. Congress last autumn.
Matas and Kilgour’s material suggests that in China prisoners from labor or reeducation camps are also killed. Their research involved practitioners of Falun Gong, who practice Buddhist meditation techniques – people not sentenced to death but who allegedly must die because their organs are suitable for a patient.
Is this possible? It’s a fact that practitioners of Falun Gong are persecuted in China. It’s also a fact that the Falun Gong movement answers every bit of propaganda from the Chinese government with smart counter-propaganda, especially overseas. This is why the two Canadians, Matas and Kilgour, tried to keep their research independent from statements from Falun Gong practitioners. They not only collected material on Falun Gong prisoners who were subject to medical examinations while in custody, but also those who disappeared without a trace from camps, or whose bodies were found to be missing certain body parts. They also interviewed non-Chinese patients who received a kidney or liver transplant in China. They even succeeded in questioning former co-perpetrators about organ removal from Falun Gong prisoners. They documented telephone calls from investigators who presented themselves as patients or relatives and inquired at Chinese transplant centers about organs from Falun Gong practitioners. Falun Gong practitioners are considered especially suitable donors due to their general good health, while criminal inmates are often infected with hepatitis B.
A telephone call to the Zhongshan Hospital was also tape-recorded in March 2006 – four months after Mordechai Shtiglits received his new heart there. When the caller asked whether organs from Falun Gong practitioners were also transplanted, a doctor answered, “Ours are all of that type.”
The two Canadians’ accusations are “well researched and very decisive,” says Manfred Nowak, Professor of Civil Law at the University of Vienna, and former (2010) United Nations Special Rapporteur on Torture. One important clue is that the strong rise in transplantation figures in China coincides with the dates of the persecution of Falun Gong in particular. In the name of the United Nations, Nowak called upon the Chinese government and in U.N. jargon, “made urgent appeals” for precise data on the sources of all transplanted organs. Novak reports that the People’s Republic of China always dismissed all charges as propaganda, but never rebutted them.
Afterwards the U.S. Congress considered Matas and Kilgour’s research and heard further reports. Almost one-fourth of the members of the House of Representatives signed a letter to then Secretary of State Hillary Clinton. In it they urged the State Department to make public any further information that it might possess on the “unbelievable abuse of organ transplants.”
Michael Millis, Chief of Transplantation Services at a renowned Medical School in Chicago, does not appear particularly curious about the Chinese transplant system. He says that he “deliberately did not enter into details on the prisoner donor system.” This is remarkable, since Millis has been advising the Chinese government for more than a decade on transplantation matters. He is even a friend of Vice Minister of Health Huang. According to his own words, Millis knew from the beginning that in China organs are removed from executed prisoners, although the government officially denied this during the early years of his consulting activity. However, he stated that he has never done a transplant in China. Millis emphasizes that he restricted himself to giving only speeches and lectures there. In China he wants “to develop an internationally accepted and ethically irreproachable transplantation program.” He says that he foresees a “voluntary system,” one “that eliminates incriminations.”
In Millis’ waiting room, photo albums testify to the chief’s enthusiasm for China: Son Andrew diving in China, father and son at a Chinese hospital, the whole family in a group photo with the Vice Minister of Health. Millis, his son and Huang have co-published articles together in the medical journal The Lancet.
Asked about the alleged removal of organs from incarcerated Falun Gong practitioners, Millis says: “That is not my sphere of influence. There are many things in the world that are not my focus or interest.”
Millis believes that important steps have already been taken. Since organ sales are forbidden in China, transplantation centers require a license from the Ministry of Health. However, military hospitals go their own way and are subject to scarcely any controls even by the party and the government. Meanwhile, Vice Minister of Health, Huang, calls the removal of organs from executed prisoners an “ethical problem.” It is not clear whether he is speaking here simply from conviction or if international pressure has grown too big. In any case, he does not want to completely ban the use of organs from executed prisoners. The Chinese government merely wants to reduce the dependency on donations from prisoners – in fact, the number of executions has been decreasing for the past few years. Therefore, a pilot project was started with the Chinese Red Cross to encourage voluntary organ donations.
And chief transplanter Millis? He has business interests in China. Millis is a member of the board of directors of Vital Therapies Inc. He wants to see the company put an artificial liver on the market. The so-called ELAD System is supposed to stabilize people with liver failure until their organ has regained function, or a new one can be transplanted. A pilot study for ELAD began seven years ago in China with 49 patients, and the year after that Vital Therapies applied for licensing in China. The potential market there is huge: 300,000 patients in the final stages of liver disease.
In July 2012 Michael Millis paid a visit to Berlin. The 24th Congress of The Transplantation Society was taking place there. More than 5,000 visitors from all over the world exchanged information on the latest developments in transplantation medicine. Roland Hetzer, medical director of the German Heart Center, was also present. Falun Gong practitioners were also there and had set up a stand in front of the International Congress Center. An attractive Asian woman offered flyers to visitors. Her name was Liu Wei. Flyers, she recalled, were also what caused her much trouble back in September 2001 in China. Then it was leaflets of her Falun Gong group, which she had forgotten to conceal that led to her arrest. She spent 16 months in custody. Liu states she was beaten and tortured by sleep deprivation in the prison camp. Now, at age 40, she had been employed at the Company for Technical Cooperation (CTC) in Beijing.
One day during her time in custody Liu Wei tells of how a team of ten doctors and ten policemen entered the prison to examine her and other prisoners. “Only Falun Gong practitioners were called up,” she says. They took a blood sample from her and her internal organs were subject to ultrasound scanning. The doctors asked about previous illnesses in her family. Such examinations occurred, she says, five or six times. She never heard anything about the results.
The continuous pressure in the prison camp was too much for Liu. She made a show of starting to separate herself from Falun Gong. “I felt as if I had died,” she says. “But I was still young, and wanted to live.”
When Liu was released from detention at the end of January 2003, the CTC hired her back. A year later she moved to Germany. Today she says: “I had great luck that at that time apparently none of my organs were needed by a patient.”
While Liu distributed leaflets outside, the Congress president, Peter Neuhaus of the Charité University Clinic, opened the press conference.
He was especially pleased that 160 Chinese colleagues have found their way to Berlin. Asked by a journalist about organ removal from executed prisoners in China, Neuhaus replied, “There is no question that this was the case.” However, he said that China’s Vice Minister of Health had assured him two or three years earlier that the state wanted nothing of this kind to occur again.
The Chinese government is “seeing to” many things – including the disappearance from the Internet of reports like the one by Beijing attorney Han Bing.
Contributor: Arne Schwarz