China has issued rules targeting the illegal trade in transplant organs, but analysts told Radio Free Asia that members of the political and financial elite procure replacement organs in secret via military hospitals, making the crackdown hard to enforce in practice.
The new rules published Dec. 14 and signed by Premier Li Qiang are intended "to meet the demands of the changing situation," state news agency Xinhua reported, adding that they strengthen penalties for "malpractice" and tighten requirements for medical institutions performing transplants.
They define organ donation as "the voluntary and free provision" of human organs for transplant.
Yet the rules are the latest in a series of moves in recent years claiming to clamp down on the secretive organ trade, including a monitoring system announced in 2014 that was supposed to track organs to prevent "private" allocations of donor organs or the use of executed prisoners' organs without their consent.
Since Jan. 1, 2015, only voluntary public donations or organs from living relatives have been legally permitted for transplant, but demand for transplant organs continues to outstrip supply.
The new rules, once again, ban the trade in human organs, saying organs should be provided free of charge.
Military involvement?
But analysts said the rules, which take effect from May 1, 2024, would do little to stop the rich and powerful in China from procuring organs in secret.
A doctor from mainland China who is currently practicing in North America and gave only the pseudonym Yang for fear of reprisals said that, unlike most countries, half of organ transplants in China are performed in military hospitals.
"We know that anyone supervising [transplants] at provincial or municipal level, or from the Red Cross, will stand aside once the military intervenes," Yang said. "So where do the military get their organs from? Just how transparent can this be?"
He said the military is closely tied up with the provision of transplant organs to the most powerful people in China.
"Organ transplantation in China is not for ordinary people," Yang said. "It is a service specially provided to the [party elite]."
He said he had witnessed the processes through which the highest-ranking people in China and paying customers from overseas come by organs for donation.
"A senior official from Kazakhstan wanted a kidney transplant at the People's Liberation Army General Hospital," he said, adding that the organ transplant ward of the "301" army hospital was known as the "Senior Cadre Ward."
"Within a month, a kidney transplant had been successfully performed, then he went back to Kazakhstan," Yang said.
‘Smokescreen’
Canadian human rights lawyer David Matas described the rules as "a big smokescreen."
"If you look at the principles and the regulations, they look terrific," Matas told Radio Free Asia. "But if you try to see whether or not it's being implemented, you see nothing."
"It's all cover-up: obfuscation, denial of accusations, counter narratives."
Vice Minister of Health Huang Jiefu once publicly admitted that China’s transplant organs mostly come from death row prisoners, although this practice was banned following the setting up of the Human Organ Donation Management Center in 2012.
Yet the center still has very few active donors, and researchers say their data is suspect.
"First of all, it's unverifiable," Matas said. "The number looks as if it was made up using a mathematical calculation formula."
Another issue is that China has no precise definition of what constitutes brain death, meaning that organs harvested when a person is still technically alive could be counted as "donated" organs.
"They used to say that all organs were coming from death penalty prisoners, but they never gave death penalty statistics," Matas said. "
"We've had investigators investigating, and the donation centers are often closed or if they're open, the statistics they have are insignificant," he said.
Investigators have also spoken to families of traffic accident victims who have been paid for their loved ones' organs, Matas said, adding that the global sale of Chinese transplant organs continues "at high prices."
Torsten Trey, founder and executive director of the international organization Doctors Against Forced Organ Harvesting, said the latest rules were unlikely to scratch the surface of the illegal organ trade in China.
“It is a combination of large transplant numbers, implausible, unprecedented short wait times for donor organs, organ donation programs that are too small to yield the amount of organ that are reflected in the annual transplant numbers, and a plethora of witness testimonies that suggest that living prisoners of conscience are killed in operation rooms without any court convictions," he said.
"The new regulations do not address the issue of transparent access to organ donors," Trey said.
Executions
China's former organ transplant chief Huang Jiefu and colleagues reported in the U.K.-based medical journal The Lancet in 2011 that about 65% of transplants in China use organs from deceased donors, more than 90% of whom were executed prisoners.
And a 2022 study in the American Journal of Transplantation found evidence in 71 cases of "executions by organ removal" from prisoners, concluding that "the removal of the heart during organ procurement must have been the proximate cause of the donor's death."
China is believed to be one of the world's top executioners, but the exact number of executions is regarded as a state secret by the ruling Chinese Communist Party.
Matas agreed that the new rules would do little to prevent any of that from happening.
"Simply enacting new regulations without a system of verifiability for its enforcement ... really doesn't amount to a whole lot," he said, calling for a system along World Health Organization guidelines that insist on traceability of individual organs through a transparent donation process that is open to scrutiny, including instant access for inspection teams to carry out spot checks.
"We can't look at what they say and see if it's true," he said.
Translated by Luisetta Mudie. Edited by Malcolm Foster.