Study published in Liver International examined the outcomes of 564 transplantations at Zhejiang University’s First Affiliated hospital in China
A prestigious medical journal will retract a scientific paper from Chinese surgeons about liver transplantation after serious concerns were raised that the organs used in the study had come from executed prisoners of conscience.
The study was published last year in Liver International. It examined the outcomes of 564 liver transplantations performed consecutively at Zhejiang University’s First Affiliated hospital between April 2010 and October 2014.
According to the study authors, “all organs were procured from donors after cardiac death and no allografts [organs and tissue] obtained from executed prisoners were used”.
But Wendy Rogers, a professor of clinical ethics at Macquarie University in Sydney, said it was impossible for one hospital to have obtained so many useable livers in a four-year period from cardiac deaths alone given the small numbers of volunteer donors in China at the time.
Donors after cardiac death, or “DCD donors”, are those people with injuries so severe that it is futile to keep them alive, even though they are not braindead. A decision is made by doctors and family members to withdraw care, leading to cardiac death.
But livers from these patients are only viable for transplantation in a third of cases, because the time it takes to die once drugs and ventilation are withdrawn varies and can jeopardise the quality of the liver.
Livers are extremely sensitive and need to be removed quickly, and are often unsuitable for transplantation by the time the patient dies.
In a letter to Liver International’s editor, Prof Mario Mondelli, Rogers wrote that this was one of the reasons the numbers in the Chinese paper did not stack up. She called on him to retract the paper.
“International programs report relatively low rates of procurement of livers from DCD donors,” she wrote. “In the USA, rates of liver transplant from DCD donors in the years 2012-14 were 32%, 28% and 27% respectively. If retrieval rates are similar in China, this would require 1,880 DCD donors, assuming a retrieval rate of 30%, to transplant the 564 livers reported in this paper.
“Given that there were only 2,326 reported voluntary donations in the whole of China during 2011–2014, it is implausible that this small pool could have resulted in 564 livers successfully retrieved … unless the surgeons there had exclusive access to at least 80% of all voluntary donors across the whole of China in this period.”
Rogers told the Guardian that China also lacked a coordinated nationwide system of transporting organs within the time frame required for successful liver transplantations.
The only plausible explanation was that the livers were coming from executed prisoners, she said. These were not just prisoners sentenced to death but people jailed for beliefs outlawed by the Chinese government, including Falun Gong practitioners. There is comprehensive evidence that prisoners of conscience are being killed on demand for their organs in China, with profits going to the government and military.
Mondelli told the Guardian: “The authors’ institution was given until last Friday 3 February to provide evidence against allegations supported by data that organ procurement for liver transplantation was not from executed prisoners. However, there was no answer.”
Mondelli will issue a formal retraction notice and a full transcript of his interactions with the surgeons in the journal’s next edition, along with the letter from Rogers.
A report published last year found a large discrepancy between official transplant figures from the Chinese government and the number of transplants reported by hospitals. While the government says 10,000 transplants occur each year, hospital data shows between 60,000 to 100,000 organs are transplanted each year. The report provides evidence that this gap is being made up by executed prisoners of conscience.
In July the European parliament passed a declaration condemning organ harvesting from prisoners of conscience and called on Chinese officials to end it.
In an editorial published in the British Medical Journal on Tuesday, Rogers wrote that while China vowed to stop using organs from executed prisoners in 2015, no new law or regulation had been passed banning the practice. “Nor have existing regulations permitting the use of prisoners’ organs been rescinded,” she wrote.
“Prisoners remain a legal source of organs if they are deemed to have consented before execution, thus permitting ongoing retrieval of organs from prisoners executed with or without due process.”
The transplant registries were not open to public scrutiny or independent verification, she said, and an “inexplicably high” volumes of transplantation continued to take place in China.
A former surgeon from the western Chinese region of Xinjiang, Enver Tothi, was instructed in 1995 to operate on a political prisoner who had just been shot. The prisoner was unconscious but not yet dead but Tothi was ordered to remove his organs regardless, without the use of anesthesia.
Tothi says that, technically, it was he and not the gunshot that killed the prisoner. He left China in 1999 and was granted political asylum in Britain but said that being a part of the system of killing political prisoners still haunted him. He is unable to return to China for fear of repercussions for speaking out about organ donation.
“I was ordered to do it, but guilt haunted me for a long time,” Tothi told the Guardian. “It is duty of the humanity to stop this tragedy getting worse.”
He called on people to stop travelling to China and buying organ transplants. Today he lobbies around the world for an end to organ harvesting.
Last year Rogers and her colleagues called for the retraction of another paper on Chinese organ donation published in the Journal of Medical Ethics. Rogers said the paper presented a sanitised account of organ procurement in China and failed to highlight that many organs were being harvested from prisoners of conscience. The journal subsequently published a lengthy correction.