Examining China’s Organ Transplantation System: The Nexus of Security, Medicine, and Predation / Part 1: The Growth of China’s Transplantation System Since 2000


In late February and early March this year, in the midst of the COVID-19 pandemic, official Chinese media reported two impressive medical feats: the Wuxi People’s Hospital near Shanghai, and the Zhejiang Medical University’s First Affiliated Hospital, both performed dual lung transplants for coronavirus patients. This was indeed a “World First!”, as one headline put it (Beijing Daily, March 1). While the news itself was noteworthy, so were the extremely short waiting times for the organs: Dr. Chen Jingyu, China’s most well-known lung transplant surgeon at the Wuxi People’s Hospital, managed to acquire compatible lungs from a healthy donor in Guizhou Province within five days of the patient being transferred to his hospital (China News, March 1). Similarly, surgeons at Zhejiang Medical University’s First Affiliated Hospital acquired lungs within three weeks for a March 2 transplant, after “scouring the country for a donor” (Beijing News, March 2).

These extremely short waiting times for procuring organs are unusual when compared to other countries, where waiting times are often measured in months or years. They speak either to an extremely efficient matching system from hospital-based, voluntary donors in the People’s Republic of China (PRC)—something that countries with advanced organ donor systems are often unable to achieve, let alone achieve in the midst of a pandemic—or else they indicate a captive population able to be executed on demand to provide organs. Based on the information at present, it is impossible to tell which explanation is true for these two cases. However, there are many reasons to find the rapid nature of such organ procurements suspicious.

For most of the last two decades, China’s transplantation system has been tightly linked with its security apparatus: nearly a quarter of authorized transplant hospitals are military or paramilitary (NHFPC, February 11, 2018). China is also the only country to systematically source organs almost solely from prisoners (Human Rights Watch, August 1994; Lancet, March 3, 2012). In 2015, the PRC claimed that it had reformed its transplant system, and officials promised that prisoners would never be used again (New York Times, December 4, 2014). Prior to that, it was clear that prisoners were being killed on demand: waiting times for transplants were only weeks, days, and sometimes even hours, meaning that execution and transplantation were being closely choreographed. There has been intense controversy about the identity of those prisoners—whether death row prisoners only (as claimed by China since 2006), or prisoners of conscience also.

Given that an organ transplant surgery can cost tens of thousands of dollars (TV Chosun, July 16, 2018), there is an obvious incentive for transplant hospitals and surgeons to perform transplants. The use of prisoners as an organ source involves only minimal expenditure for medical examinations. Thus, while some prisoners may be funneled to labor camps and in-prison sweatshops, a smaller number can be directly monetized via the procurement and trafficking of their organs. Furthermore, access to organ transplants appears to be one of the medical benefits available to officials in the ranks of the Chinese Communist Party (CCP)’s nomenklatura.

The central questions when examining China’s organ transplantation system at present include: Is the trade in human organs in China still continuing? At what scale? How successful has the PRC been at reforming its abusive practices? How strong is the evidence that prisoners of conscience have been, and continue to be, exploited as an organ source? And how deeply involved in these activities is the CCP itself—including its armed components of the People’s Liberation Army (PLA) and the People’s Armed Police (PAP)?

Read in The China Brief