A. Introduction

The Coalition to Investigate the Persecution of the Falun Gong in China (CIPFG), has asked us to investigate allegations of organ harvesting of Falun Gong practitioners in China. The coalition is a non‑governmental organization registered in Washington, D.C., U.S.A. with a branch in Ottawa, Canada.  The request came formally by letter dated May 24, 2006 attached as an appendix to this report.

The request was to investigate allegations that state institutions and employees of the government of the People's Republic of China have been harvesting organs from live Falun Gong practitioners, killing the practitioners in the process.  In light of the seriousness of the allegations as well as our own commitment to respect for human rights, we accepted the request.

David Matas is an immigration, refugee and international human rights lawyer in private practice in Winnipeg.  He is actively involved in the promotion of respect for human rights as an author, speaker and participant in several human rights non‑governmental organizations. 

David Kilgour is a former member of Parliament and a former Secretary of State of the Government of Canada for the Asia Pacific region.  Before he became a parliamentarian, he was a Crown prosecutor.  The biographies of both authors are attached as appendices to this report.

B. The Allegation

It is alleged that Falun Gong practitioners are victims of live organ harvesting throughout China.  The allegation is that organ harvesting is inflicted on unwilling Falun Gong practitioners at a wide variety of locations, pursuant to a systematic policy, in large numbers. 

Organ harvesting is a step in organ transplants.  The purpose of organ harvesting is to provide organs for transplants.  Transplants do not necessarily have to take place in the same place as the location of the organ harvesting. The two locations are often different; organs harvested in one place are shipped to another place for transplanting. 

The allegation is further that the organs are harvested from the practitioners while they are still alive. The practitioners are killed in the course of the organ harvesting operations or immediately thereafter.  These operations are a form of murder. 

Finally, we are told that the practitioners killed in this way are then cremated.  There is no corpse left to examine to identify as the source of an organ transplant.

C. Working Methods

We conducted our investigation independently from the Coalition to Investigate the Persecution of the Falun Gong in China, the Falun Dafa Association, any other organization, and any government. We sought to go to China unsuccessfully, but would be willing to go even subsequently to pursue the investigation. 

When we began our work, we had no views whether the allegations were true or untrue.  The allegations were so shocking that they are almost impossible to believe.  We would have much rather found the allegations to be untrue than to be true.  The allegations, if true, represent a disgusting form of evil which, despite all the depravities humanity has seen, are new to this planet.  The very horror made us reel back in disbelief.  But that disbelief does not mean that the allegations are untrue.

We were well aware of the statement of U.S. Supreme Court Justice Felix Frankfurter 1943 to a Polish diplomat in reaction to being told by Jan Karski about the Holocaust.  Frankfurter said:

          "I did not say that this young man was lying. I said that I was unable to believe what he told me.  There is a difference."

After the Holocaust, it is impossible to rule out any form of depravity.  Whether an alleged evil has been perpetrated can be determined only by considering the facts.

After the first version of our report was released, on July 7, 2006 in Ottawa, we travelled extensively, publicising the report and promoting its recommendations. In the course of our travels, and as a result of the publicity surrounding the first version, we acquired substantial additional information.  This second version incorporates this new information. 

Nothing we subsequently discovered shook our conviction in our original conclusions.  But much which we later discovered reinforced it.  This version presents, we believe, an even more compelling case for our conclusions than the first version did.

D. Difficulties of Proof

The allegations, by their very nature, are difficult either to prove or disprove.  The best evidence for proving any allegation is eye witness evidence.  Yet for this alleged crime, there is unlikely to be any eye witness evidence.

The people present at the scene of organ harvesting of Falun Gong practitioners, if it does occur, are either perpetrators or victims. There are no bystanders. Because the victims, according to the allegation, are murdered and cremated, there is no body to be found, no autopsy to be conducted. There are no surviving victims to tell what happened to them.  Perpetrators are unlikely to confess to what would be, if they occurred, crimes against humanity.  Nonetheless, though we did not get full scale confessions, we garnered a surprising number of admissions through investigator phone calls.

The scene of the crime, if the crime has occurred, leaves no traces.  Once an organ harvesting is completed, the operating room in which it takes place looks like any other empty operating room.

The clampdown on human rights reporting in China makes assessment of the allegations difficult.  China, regrettably, represses human rights reporters and defenders.  There is no freedom of expression.  Those reporting on human rights violations from within China are often jailed and sometimes charged with communicating state secrets.  In this context, the silence of human rights non‑governmental organizations on organ harvesting of unwilling Falun Gong practitioners tells us nothing.

The International Committee of the Red Cross is not allowed to visit prisoners in China.  Nor is any other organization concerned with human rights of prisoners.  That also cuts off a potential avenue of evidence.

China has no access to information legislation.  It is impossible to get from the Government of China basic information about organ transplants ‑ how many transplants there are, what is the source of the organs, how much is paid for transplants or where that money is spent.

We did seek to visit China for this report.  Our efforts went nowhere.  We asked in writing for a meeting with the embassy to discuss terms of entry.  Our letter is attached as an appendix to this report.  Our request for a meeting was accepted.  But the person who met with David Kilgour was interested only in denying the allegations and not in arranging for our visit.

E. Methods of Proof

We have had to look at a number of factors, to determine whether they present a picture, all together, which make the allegations either true or untrue.  None of these elements on its own either establishes or disproves the allegations.  Together, they paint a picture.

Many of the pieces of evidence we considered, in themselves, do not constitute ironclad proof of the allegation.  But their non‑existence might well have constituted disproof.  The combination of these factors, particularly when there are so many of them, has the effect of making the allegations believable, even when any one of them in isolation might not do so.  Where every possible element of disproof we could identify fails to disprove the allegations, the likelihood of the allegations being true becomes substantial.

Proof can be either inductive or deductive.  Criminal investigation normally works deductively, stringing together individual pieces of evidence into a coherent whole.  The limitations our investigation faced placed severe constraints in this deductive method.  Some elements from which we could deduce what was happening were, nonetheless, available, in particular, the investigator phone calls.

We also used inductive reasoning, working backwards as well as forwards.  If the allegations were not true, how would we know it was not true?  If the allegations were true, what facts would be consistent with those allegations?  What would explain the reality of the allegations, if the allegations were real?  Answers to those sorts of questions helped us to form our conclusions.

We also considered prevention.  What are the safeguards that would prevent this sort of activity from happening?  If precautions are in place, we could conclude that it is less likely that the activity is happening.  If they are not in place, then the possibility that the activity is happening increases.

F. Elements of Proof and Disproof

a) General considerations

1) Human rights violations

China violates human rights in a variety of ways.  These violations are chronic and serious.  Besides Falun Gong, other prime targets of human rights violations are Tibetans, Christians, Uighurs, democracy activists and human rights defenders.  Rule of Law mechanisms in place to prevent human rights violations, such as an independent judiciary, access to counsel on detention, habeas corpus, the right to public trial, are absent in China. China, according to its constitution, is ruled by the Communist Party. It is not ruled by law. 

Communist China has had a history of massive, jaw dropping cruelty towards its own citizens.  The Communist regime has killed more innocents than Nazi Germany and Stalinist Russia combined^[1].  Girl children are killed, abandoned and neglected in massive numbers.  Torture is widespread.  The death penalty is both extensive and arbitrary.  China executes more people than all other countries combined. Religious belief is suppressed^[2].

This pattern of human rights violations, like many other factors, does not in itself prove the allegations.  But it removes an element of disproof.  It is impossible to say of these allegations that it is out of step with an overall pattern of respect for human rights in China.  While the allegations, in themselves, are surprising, they are less surprising with a country that has the human rights record China does than they would be for many other countries.

When there are so many violations of human rights in China, it is invidious to point to only one victim.  We nonetheless draw the attention to the victimization of human rights lawyer Gao Zhisheng as an example or a case study.  It was Gao who wrote to us last summer, inviting us to come to China to investigate the stealing of vital organs from Falun Gong prisoners of conscience. No visa was subsequently issued by its embassy in Ottawa to do so; he was detained not long afterwards.

Gao wrote three open letters to President Hu and other leaders, protesting a range of abuses against the Falun Gong, including specific cases of torture and murder.  Gao also wrote about and condemned the extraction and sale of organs from Falun Gong practitioners. He expressed his willingness to join the Coalition to Investigate Organ Harvesting from Still Alive People^[3].

He was convicted of inciting subversion and on December 2, 2006 given a three-year prison sentence. His removal to custody, however, was suspended for five years; his political rights were removed for a year by the Beijing court.  This repression of someone whose only concern is respect for human rights in general and the persecution of Falun Gong practitioners in particular in itself reinforces his concerns and ours. 

The International Olympic Committee, in 2001, awarded Beijing the 2008 Olympics.  Liu Jingmin, Vice President of the Beijing Olympic Bid, in April 2001, said: "By allowing Beijing to host the Games you will help the development of human rights."

Yet, the result has been just the opposite.  Amnesty International, in a statement released September 21, 2006 said:

          "In its latest assessment of the Chinese government's performance in four benchmark areas of human rights ahead of the Olympics, Amnesty International found that its overall record remained poor.  There has been some progress in reforming the death penalty system, but in other crucial areas the government's human rights record has deteriorated."

The international community, by carrying on with the Olympics in Beijing despite the deterioration of human rights in China in crucial areas, sends to China a message of impunity.  The impression China must get is that it does not matter how much it violates human rights; the international community seems not to care.

2) Health financing

When China moved from a socialist to a market economy, the health system was 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.  Since 1980, government spending dropped from 36% of all health care expenditure to 17%, while patients' out‑of‑pocket spending rocketed up from 20% to 59%.^[4] A World Bank study reports that reductions in public health coverage were worsened by increases in cost by the private sector^[5].

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 reports: "Rural hospitals [have had] to invent ways to make money to generate sufficient revenue".^[6]

The sale of organs became for hospitals a source of funding, a way to keep their doors open, and a means by which other health services could be provided to the community.

One could see how this dire need for funds might lead first to a rationalization that harvesting organs from prisoners who would be executed anyways was acceptable and second to a desire not to question too closely whether the donors wheeled in by the authorities really were prisoners sentenced to death.

3) Army financing

The military, like the health system, has gone from public financing to private enterprise.  The military in China is a conglomerate business.  This business is not corruption, a deviation from state policy.  It is state sanctioned, an approved means of raising money for military activities.  In 1985, then President Deng Xiaoping issued a directive allowing the People's Liberation Army units to earn money to make up the shortfall in their declining budgets.

Many of the transplant centres and general hospitals in China are military institutions, financed by organ transplant recipients.  Military hospitals operate independently from the Ministry of Health.  The financing they earn from organ transplants does more than pay the costs of these facilities.  The money is used to finance the overall military budget. 

There is, for instance, the Organ Transplant Center of the Armed Police General Hospital in Beijing.  This hospital boldly states:
 

          "Our Organ Transplant Center is our main department for making money. Its gross income in 2003 was 16,070,000 Yuan. From January to June of 2004 income was 13,570,000 Yuan.  This year (2004) there is a chance to break through 30,000,000 Yuan."^[7]

Military involvement in organ harvesting extends into civilian hospitals.  Recipients often tell us that, even when they receive transplants in civilian hospitals, those conducting the operation are military personnel.

Here is one example.  When we were in Asia promoting our report, we met a man who in 2003 flew to Shanghai to obtain a new kidney for the $20,000 USD price negotiated before his departure. He was admitted to the No 1 Peoples' Hospital‑a civilian facility‑and during the ensuing two weeks four kidneys were brought for testing against his blood and other factors.  None proved compatible because of his anti‑bodies; all were taken away.

He subsequently went to his home country, returning to the hospital about two months later. Another four kidneys were similarly tested; when the eighth proved compatible, the transplant operation was successfully completed.  His eight days of convalescence was done at No 85 hospital of the Peoples' Liberation Army.  His surgeon was Dr. Tan Jianming of the Nanjing military region, who wore his army uniform at times in the civilian hospital.

Tan carried sheets of paper containing lists of prospective "donors”, based on various tissue and blood characteristics, from which he would select names.  The doctor was observed at various times to leave the hospital in uniform and return 2‑3 hours later with containers bearing kidneys.  Dr. Tan told the recipient that the eighth kidney came from an executed prisoner.

The military have access to prisons and prisoners.  Their operations are even more secretive than those of the civilian government.  They are impervious to the rule of law.

4) Corruption

Corruption is a major problem across China.  State institutions are sometimes run for the benefit of those in charge of them rather than for the benefit of the people. Occasionally, China engages in "Strike Hard" against corruption. 

But, in the absence of rule of law and democracy, where secrecy holds sway and public accounting of public funds is absent, these anti-corruption campaigns seem to be more power struggles than true anti-corruption drives.  They are attempts to placate public concern about corruption, politicized public relations drives.

The sale of organs is a money driven problem.  But that is different from saying that it is a corruption problem.  The sale of organs from unwilling donors combines hatred with greed.   A state policy of persecution is acted out in a financially profitable way.

Former Chinese president Deng Xiaoping said: "To get rich is glorious".  He did not say that some ways of getting rich are shameful.

Profiteering hospitals take advantage of a defenceless captive prison population in their regions.  The people are in prison without rights, at the disposition of the authorities.   The incitement to hatred against prisoners and their dehumanization means that they can be butchered and killed without qualms by those who buy into this official hate propaganda.

b) Considerations specific to organ harvesting

5) Technological development                  

Albert Einstein wrote:

          "The release of atom power has changed everything except our way of thinking...the solution to this problem lies in the heart of mankind. If only I had known, I should have become a watchmaker."

Technological developments do not change human nature.  But they do change the ability to inflict harm.

The development of transplant surgery has done much to improve the ability of humanity to cope with failing organs.  But these developments in transplant surgery have not changed our way of thinking.

There is a tendency to think of any new medical development as a benefit to humanity.  That is certainly the intent of its developers.  But medical research, no matter how far advanced, comes face to face with the same old capacity for good and evil.

More advanced techniques in transplant surgery do not mean a more advanced Chinese political system.  The Chinese Communist system remains.  Developments in transplant surgery in China fall prey to the cruelty, the corruption, the repression which pervades China.  Advances in transplant surgery provide new means for old cadres to act out their venality and ideology.

We do not suggest that those who developed transplant surgery should instead have become watchmakers.  We do suggest that we should not be so naive as to think that just because transplant surgery was developed to do good, it can do no harm. 

On the contrary, the allegation made against the development of transplant surgery in China, that it is being used to harvest organs from unwilling Falun Gong practitioners, would be just the acting out, in a new context, of the lesson Albert Einstein was teaching.  We have seen before that modern technologies developed for the benefit of humanity have been perverted to inflict harm.  We should not be surprised if this has also happened to transplant surgery.               

6) Treatment of prisoners sentenced to death

Deputy Health Minister Huang Jiefu, speaking at a conference of surgeons in the southern city of Guangzhou in mid November 2006 acknowledged that executed prisoners sentenced to death are a source of organ transplants.  He said: "Apart from a small portion of traffic victims, most of the organs from cadavers are from executed prisoners."  Asia News wrote:

          "'Under‑the‑table business must be banned,' Mr Huang said cognizant that too often organs come from non consenting parties and are sold for high fees to foreigners."

China has the death penalty for a large number of offences including strictly political and economic crimes where there is no suggestion that the accused has committed a violent act.  To go from executing no one to killing Falun Gong practitioners for their organs without their consent is a large step.  To go from executing prisoners sentenced to death for political or economic crimes and harvesting their organs without their consent to killing Falun Gong practitioners for their organs without their consent is a good deal smaller step.

It would be difficult to believe that a state which killed no one, which had no death penalty, which harvested the organs of no one else without their consent, would harvest the organs of Falun Gong practitioners without their consent.  It is a good deal easier to believe that a state which executes prisoners sentenced to death for economic or political crimes and harvests their organs without their consent would also kill Falun Gong practitioners for their organs without their consent.

The Falun Gong constitutes a prison population who the Chinese authorities vilify, dehumanize, depersonalize, marginalize even more than executed prisoners sentenced to death for criminal offences.  Indeed, if one considers only the official rhetoric directed against the two populations, it would seem that the Falun Gong would be a target for organ harvesting even before prisoners sentenced to death.                   

7) Organ donations

China has no organized system of organ donations.[8] [9] In this it is unlike every other country engaged in organ transplant surgery. Donations from living donors are allowed for family members. 

We are told that there is a Chinese cultural aversion to organ donation.  Yet, Hong Kong and Taiwan, with essentially the same culture, have active organ donation programs.

The absence of an organ donation system in China tells us two things.  One is that organ donations are not a plausible source for organ transplants in China.

Because of the culture aversion to organ donation in China, even an active organ donation system would have difficult supplying the volume of transplants now occurring in China.   But the problem is compounded when there is not even an active effort to encourage donations.

Donations matter in other countries because donations are the primary source of organs for transplants.  We can conclude that from the absence of a serious effort to encourage donations in China that, for China, donations do not even matter. China has such a plethora of organs available for transplants without donations that encouraging organ donations becomes superfluous.

The absence of a serious effort to encourage organ donations in combination with short waiting times for transplant surgery in China and the large volume of transplants tells us that China is awash in living organs for transplant; people the authorities have ready on hand to be killed for their organs for transplants.  That reality does nothing to dispel the allegation of organ harvesting of unwilling Falun Gong practitioners. 

8) Waiting times

Hospital web sites in China advertise short waiting times for organ transplants. Transplants of long dead donors are not viable because of organ deterioration after death.  If we take these hospital's self‑promotions at face value, they tell us that there are a large number of people now alive who are available on demand as sources of organs. 

The waiting times for organ transplants for organ recipients in China are much lower than anywhere else. The China International Transplantation Assistant Centre website says, "It may take only one week to find out the suitable (kidney) donor, the maximum time being one month...”[10]. It goes 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." [11] The site of the Oriental Organ Transplant Centre in early April, 2006, claimed that "the average waiting time (for a suitable liver) is 2 weeks." [12] The website of the Changzheng Hospital in Shanghai says: "...the average waiting time for a liver supply is one week among all the patients". [13]

In contrast, the median waiting time in Canada for a kidney was 32.5 months in 2003 and in British Columbia it was even longer at 52.5 months.[14]  The survival period for a kidney is between 24-48 hours and a liver about 12 hours.[15]  The presence of a large bank of living kidney-liver "donors" must be the only way China's transplant centres can assure such short waits to customers.  The astonishingly short waiting times advertised for perfectly-matched organs would suggest the existence of a large bank of live prospective 'donors'.    

9) Incriminating Information on Websites

Some of the material available on the websites of various transplant centres in China before March 9, 2006 (when allegations about large‑scale organ seizures resurfaced in Canadian and other world media) is also inculpatory. Understandably, a good deal of it has since been removed. So these comments will refer only to sites that can still be found at archived locations, with the site locations being identified either in the comments or as footnotes. A surprising amount of self‑accusatory material was still available as of the final week of June, 2006 to web browsers. We list here only four examples:

(1) China International Transplantation Network Assistance Centre Website

(http://en.zoukiishoku.com/)

(Shenyang City)

This website as of May 17, 2006 indicated in the English version (the Mandarin one evidently disappeared after March 9) that the centre was established in 2003 at the First Affiliated Hospital of China Medical University "...specifically for foreign friends. Most of the patients are from all over the world." The opening sentence of the site [16]introduction declares that "Viscera (one dictionary definition: "soft interior organs...including the brain, lungs, heart etc") providers can be found immediately!"  On another page[17] on the same site is this statement: "...the number of kidney transplant operations is at least 5,000 every year all over the country. So many transplantation operations are owing to the support of the Chinese government. The supreme demotic court, supreme demotic law - officer, police, judiciary, department of health and civil administration have enacted a law together to make sure that organ donations are supported by the government. This is unique in the world."

In the 'question and answer' section of the site are found:

"Before the living kidney transplantation, we will ensure the donor's renal function...So it is more safe than in other countries, where the organ is not from a living donor." [18]

   . "Q: Are the organs for the pancreas transplant(ed) from brain death (sic) (dead) patients?"

     "A: Our organs do not come from brain death victims because the state of the organ may not be good." [19]

(2)Orient Organ Transplant Centre Website

(http://www.ootc.net)

(Tianjin City)

On a page we were informed was removed in mid-April (but can still be located as an archive 12) is the claim that from "January 2005 to now, we have done 647 liver transplants - 12 of them done this week; the average waiting time is 2 weeks." A chart also removed about the same time (but archive still available[20]) indicates that from virtually a standing start in 1998 (when it managed only 9 liver transplants) by 2005 it had completed fully 2248[21].
 

In contrast, according to the Canadian Organ Replacement Register 14, the total in Canada for all kinds of organ transplants in 2004 was 1773.

(3) Jiaotong University Hospital Liver Transplant Centre Website

(http://www.firsthospital.cn/hospital/index.asp)

(Shanghai ‑ This is #5 in the list of telephoned centres)

In a posting on April 26, 2006, [22]

(http://www.health.sohu.com/20060426/n243015842.shtml), the website says in part: "The liver transplant cases (here) are seven in 2001, 53 cases in 2002, 105 cases in 2003, 144 cases in 2004, 147 cases in 2005 and 17 cases in January, 2006," .

(4) Website of Changzheng Hospital Organ Transplant Centre, affiliated with No. 2 Military Medical University

(http://www.transorgan.com/)

(Shanghai)

A page was removed after March 9, 2006. (Internet Archive page is available.[23])  It contains the following graph depicting the number of liver transplant each year by this Centre:

In the "Liver Transplant Application" form [24], it states on the top, "...Currently, for the liver transplant, the operation fee and the hospitalization expense together is about 200,000 Yuan ($66,667 CND), and the average waiting time for a liver supply is one week among all the patients in our hospital...."

10) Donor recipient interviews

For the first version of our report, we did not have time to engage in donor recipient interviews, people who went to China from abroad for transplants.  For this version, we engaged in extensive interviews of a number of these recipients and their family members.  Summaries of their experience are attached as an appendix to this report.

Organ transplant surgery, as described by the recipients and their relatives, is conducted in almost total secrecy, as if it were a crime which needed cover up.  As much information as possible is withheld from the recipients and their families.  They are not told the identity of the donors.  They are never shown written consents from the donors or their families.  The identity of the operating doctor and support staff are often not disclosed, despite requests for this information.  Recipients and their families are commonly told the time of the operation only shortly before it occurs.  Operations sometimes occur in the middle of the night.  The whole procedure is done on a "don't ask, don't tell" basis.

When people act as if they have something to hide, it is reasonable to conclude that they have something to hide.  Since organ sourcing from prisoners sentenced to death is widely known and even acknowledged by the Government of China, Chinese transplant hospitals can not be trying to hide that.  It must be something else.  What is it?

11) The money to be made

In China, organ transplanting is a very profitable business.  We can trace the money of the people who pay for organ transplants to specific hospitals which do organ transplants, but we can not go further than that.  We do not know who gets the money the hospitals receive.  Are doctors and nurses engaged in criminal organ harvesting paid exorbitant sums for their crimes?  That was a question it was impossible for us to answer, since we had no way of knowing where the money went.

China International Transplantation Network Assistance Centre Website

(http://en.zoukiishoku.com/)

(Shenyang City)

Before its indicated removal from the site [25] in April, 2006, the size of the profits for transplants was suggested in the following price list:

Kidney US$62,000

Liver US$98,000-130,000

Liver-kidney US$160,000-180,000

Kidney-pancreas US$150,000

Lung US$150,000-170,000

Heart US$130,000-160,000

Cornea US$30,000

A standard way of investigating any crime allegation where money changes hands is to follow the money trail.  But for China, its closed doors mean that following the money trail is impossible.  Not knowing where the money goes proves nothing.  But it also disproves nothing, including these allegations.

12) Chinese transplant ethics

Chinese transplant professionals are not subject to any ethical strictures separate from the laws which govern their work.  Many other countries have self governing transplant professions with their own disciplinary systems.  Transplant professionals who violate ethical guidelines can be ejected from their profession by their colleagues without any state intervention.

For transplant professionals in China, we found nothing of the sort.  When it comes to transplant surgery, as long as the state does not intervene, anything goes.  There is no independent supervisory body exercising disciplinary control over transplant professionals independent of the state.

The Wild West system of transplant surgery in China makes it easier for abusive practices to occur.  State involvement and criminal prosecution are inevitably less systematic than professional discipline.   Because the penalties for criminal prosecution are greater than the penalties for professional discipline - potential jail time rather than just barring someone from the profession - prosecution cases are more rare than discipline cases.

The absence of a functioning transplant professional discipline system does not mean that abuses are occurring.  But it certainly makes it more likely that they will occur.

13) Foreign transplant ethics

There are huge gaps in foreign transplant ethics.  In many of the countries from which transplant tourism to China originates, transplant professionals have organized ethical and disciplinary systems.  But it is rare for these systems to deal specifically with either transplant tourism or contact with Chinese transplant professionals or transplants from executed prisoners.   The watch words here seem to be "out of sight, out of mind".

On transplant tourism, the Professional Code of Conduct of the Medical Council of Hong Kong has two principles, in particular, worth emphasizing.  One is that, "if there is doubt" as to whether the consent is given freely or voluntarily by the donor, the profession should have nothing to do with the donation.  And, the very least one can say about China, in light of the fact that "almost all" transplants come from prisoners, is that there is doubt in almost every case whether the consent is given freely or voluntarily by the donor.

The second is that the onus is on the foreign professionals to ascertain the status of the Chinese donor.  The foreign professional is not acting ethically as long as he or she makes no inquiries or only cursory ones.  The foreign professional, after investigation, has to be satisfied beyond any doubt before referring a patient to China that consent was given freely or voluntarily by the donor.

The organ harvesting market in China, in order to thrive, requires both a supply and a demand.  The supply comes from China, from prisoners.  But the demand, in large part, in big bucks, comes from abroad. 

In an appendix, we present a critical analysis of the ethics of contact with China on transplants.  The Hong Kong principles are the exception rather than the rule.  Global professional ethics do little or nothing to staunch the foreign demand for organs from China.

14) Chinese transplant laws

Until July 1st, 2006, the practice of selling organs in China was legal.  A law banning their sale came into effect on that date. 

In China there is a huge gap between enacting legislation and enforcing it. To take one example, the preamble of the Constitution of China promises for China a "high level" of democracy.  But, as the Tiananmen square massacre demonstrated, China is not democratic.

Indeed from what we can tell, the law on organ transplants is not now being enforced.  Belgian Senator Patrik Vankrunkelsven, in late November 2006, called two different hospitals in Beijing pretending to be a customer for a kidney transplant.  Both hospitals offered him a kidney on the spot for 50,000 euros.

As noted earlier, Deputy Health Minister Huang Jiefu in November 2006 decried the selling of organs from executed prisoners sentenced to death saying "Under‑the‑table business must be banned".  Yet, it was already banned, on July 1.   His speech must be taken as an official acknowledgment that the ban is not working. 

15) Foreign transplant laws

The sort of transplants in which the Chinese medical system engages is illegal everywhere else in the world.  But it is not illegal for a foreigner in any country to go to China, benefit from a transplant which would be illegal back home, and then return home.  Foreign transplant legislation everywhere is territorial.  It does not have extraterritorial reach.

Many other laws are global in their sweep.  For instance, child sex tourists can be prosecuted not just in the country where they have sex with children, but, in many countries, back home as well.  This sort of legislation does not exist for transplant tourists who pay for organ transplants without bothering to determine whether the organ donor has consented.

There have been some legislative initiatives. For instance, Belgian Senator Patrik Vankrunkelsven is proposing an extraterritorial criminal law which would penalize transplant tourists who purchase organs abroad where the donors are prisoners or missing persons.   But these legislative proposals are still in an early stage.

16) Travel Advisories

Many states have travel advisories, warning their citizens of the perils in travel to one country to another.  The advisories often warn of political violence, or even weather related problems.  But no government has posted a travel advisory about organ transplants in China, warning its citizens that, in the words of The Transplantation Society, "almost all" organs in China come from prisoners.

Some, and we would hope, many would-be recipients of organ transplants would hesitate to go to China for transplants if they knew that their organs were coming from people who were non-consenting prisoners.  But right now there is no systematic communication to would be recipients of the source of organs in China, either through governments or the medical profession

For instance, the Canadian travel advisory for China, posted on the Foreign Affairs web site gives extensive information, almost 2,600 words, and has a section about health.  But organ transplants are not mentioned.

17) Pharmaceuticals

Organ transplantation surgery relies on anti-rejection drugs.  China imports these drugs from the major pharmaceutical companies.

Transplant surgery used to require both tissue and blood type matching for the transplant to succeed.  The development of transplant anti-rejection drugs has allowed for transplant surgery to circumvent tissue matching.  It is possible, with heavy use of anti-rejection drugs, to transplant from a donor to a recipient whose tissues do not match.  Only blood type matching is essential.  Tissue matching is preferable, to avoid heavy reliance on anti-rejection drugs, but no longer essential.  The Chinese medical system relies heavily on anti-rejection drugs.

International pharmaceutical companies behave towards the Chinese transplantation system the same way everyone else does.  They ask no questions.  They have no knowledge whether their drugs are being used in recipients who received organs from involuntary donor prisoners or not.

Many countries have export control acts, forbidding the export of some products altogether and requiring state permission for the export of other products.  But no state, to our knowledge, prohibits export to China of anti-rejection drugs used for organ transplant patients.

For instance, the Canadian Export and Import Permits Act provides:

          "No person shall export or attempt to export any goods included in an Export Control List or any goods to any country included in an Area Control List except under the authority of and in accordance with an export permit issued under this Act."^[26]

But anti-rejection drugs for transplants are not included in the Area Control list for China.

18) Foreign state funding for care

Some state administered health plans pay for health care abroad in the amount that would be paid if the care were administered in the home country.  Where that happens, there is not, to our knowledge, in any country a prohibition of payment where the patient obtains an organ transplant in China.

Transplant tourists need aftercare in their home country.  They continue to need prescription and administration of anti-rejection drugs.  States which provide government funding for health services typically provide funding for this sort of after care.

Again here, to the funders how the organ recipient got the organ is a matter of indifference.  The fact that the organ may have came from an unconsenting prisoner in China who was killed for the organ is simply not relevant to foreign state funding of aftercare for the recipient.

c) Considerations specific to Falun Gong

19) A perceived threat 

The overwhelming majority of prisoners of conscience in Chinese prisons are Falun Gong.  An estimated two thirds of the torture victims in Chinese prisons are Falun Gong.  The extremes of language the Chinese regime uses against the Falun Gong are unparalleled, unmatched by the comparatively mild criticisms China has of the victims the West is used to defending.  The documented yearly arbitrary killings and disappearances of Falun Gong exceed by far the totals for any other victim group.

Why does the Chinese government denounce so viciously and repress so brutally this one group, more so than any other victim group?  The standard Chinese refrain about the Falun Gong is that it is an evil cult. 

Falun Gong has none of the characteristics of a cult.  It has no memberships, no offices and no officers. 

David Ownby, Director of the Centre of East Asian studies at the University of Montreal and a specialist in modern Chinese history, wrote about the Falun Gong in a paper prepared six years ago for the Canadian Institute of International Affairs.  He stated that unlike cults, Falun Gong has no mandatory financial obligations, isolation of practitioners in communes or withdrawal from the world.  He says:

          "Falun Gong members remain within society. In a vast majority, they live within nuclear families. They go to work; they send their kids to school." [27]

There is no penalty for leaving the Falun Gong, since there is nothing to leave.  Practitioners are free to practice Falun Gong as little or as much as they see fit.  They can start and stop at any time.  They can engage in their exercises in groups or singly.

Li Hongzhi, the author of the books which inspired Falun Gong practitioners, is not worshipped by practitioners.  Nor does he receive funds from practitioners.  He is a private person who meets rarely with practitioners.  His advice to practitioners is publicly available information - conference lectures and published books.

The Chinese government labelling of the Falun Gong as an evil cult is a component of the repression of the Falun Gong, a pretext for that repression as well as a defamation, incitement to hatred, depersonalization, marginalization and dehumanization of the Falun Gong.  But this labelling does not explain why that repression arose.  The "evil cult" label is a manufactured tool of repression, but not its cause.  The cause lies elsewhere.

In order to enforce conformity, Chinese exercise regimes or qigong in all their variations were suppressed in 1949 after the Chinese Communist Party seized office. By the 1990s, the police state environment had become less oppressive for all forms of qigong, including Falun Gong.

Falun Gong includes elements of Confucianism, Buddhism and Taoism. In essence, it teaches methods of meditation through exercises intended to improve physical and spiritual health and fitness. The movement has no political platform; its followers seek to promote truth, tolerance and forbearance across racial, national and cultural boundaries.  Violence is anathema.

Li registered his movement with the government's Qigong Research Association. At a time when the movement was falling into official disfavour but before it was banned, in early 1998, Li moved to the United States.  But Falun Gong continued to flourish.  The Jiang government estimated in 1999 that there were 70 million adherents.  That year, the Communist Party of China membership was an estimated 60 million.

Before Falun Gong was banned in July, 1999, its adherents gathered regularly throughout China to do their exercises.  In Beijing alone there were more than 2000 practice stations.

The Communist Party, in April 1999, published an article in the magazine Science and Technology for Youth, which singled out Falun Gong as a superstition and a health risk because practitioners might refuse conventional medical treatments for serious illnesses. A large number of Falun Gong adherents demonstrated against the contents of the piece outside the Tianjin editor's office. Arrests and police beatings resulted.

To petition the Government Petition Office in Beijing about these arrests, on April 25th, 1999, 10,000‑15,000 Falun Gong practitioners gathered from dawn until late at night outside the Communist Party headquarters at Zhongnanhai next to Beijing's Forbidden City.  The gathering was silent, without posters^[28].  Jiang was alarmed by the presence of these petitioners. The ideological supremacy of the Communist Party was, in his view, in danger.

20) A policy of persecution

If organ harvesting from Falun Gong practitioners were widespread across China, one would expect some governmental policy directive to that effect.  Yet, the secrecy of policy formulation in China prevents us from determining whether such a policy exists.

Nonetheless, we do know that persecution of Falun Gong exists as an official policy.  There are some very strong policy statements, attached as an appendix to this report, by the Governmen