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Michael Nguyen has a double major in neuroscience and music, with a minor in biology and is a 2023-24 health care ethics intern with the Markkula Center for Applied Ethics at Santa Clara University. Views are his own.
Allegations surfaced in 2006 that Falun Gong practitioners were being forced to undergo live organ harvesting in China, effectively being murdered in the process of organ procurement. David Matas and David Kilgour, both Canadian attorneys and human rights activists, led an investigation that uncovered 41,500 unaccounted for organ transplants from 2000 to 2005.
These transplants did not have identifiable donor sources, such as willing family members or brain-dead donors, suggesting that transplanted organs could have come from prisoners of conscience. This discovery, in addition to witness testimonies, led Matas & Kilgour to verify these allegations: imprisoned Falun Gong practitioners were executed and their organs involuntarily harvested. 18 years later, these concerns remain unchanged.
Although organ trafficking is known to occur in other countries such as India and Egypt, I focused on this issue in China specifically because of its long and concerning history. Forced organ harvesting is a clear social justice issue and a severe violation of patient autonomy, because these individuals are viewed as a vessel of organs, rather than human beings with inherent dignity. I aim to demonstrate the atrocities of forced organ harvesting and highlight how citizens, political leaders, and international committees all play an essential role in ending this practice.
History of China’s organ transplant industry
Organ transplantation in China began with a kidney transplant in 1960. During this time, organs were primarily sourced from executed prisoners. Chinese transplant surgeons traveled abroad to receive training, and very little regulation existed. At a World Health Organization (WHO) meeting in 2005, the Chinese government pledged to reform its organ transplantation system, which previously included few deceased donor organ transplants, and transition to a voluntary, citizen-based organ donation program. In 2015, the China Human Organ Donation and Transplantation Committee officially announced the discontinuation of organ donation from executed prisoners: voluntary organ donation by citizens after death was now the only legal source of deceased organ transplantation in China. Despite these optimistic reforms, concerns of forced organ harvesting from prisoners of conscience persist.
A lack of transparency continues despite supposed reforms
First, the 2015 announcement did not address the discontinuation of organ procurement from prisoners of conscience, demonstrating the lack of concern regarding the persecution of minority groups. Additionally, the 1984 regulations allowing organ procurement from executed prisoners were not replaced by new legislation, which raises the question: are these barbaric procedures truly outlawed? Furthermore, the China Organ Transplant Response System (COTRS), developed in 2011 for organ allocation, does not disclose where organs are sourced from. The lack of transparency causes difficulty in verifying that all organ donations are ethically sourced from volunteers.
Secondly, the rapid expansion of China’s transplant industry is also questionable, according to Robertson et al. China is currently believed to have the second-largest number of transplants globally, but before the organ donation system was established in 2013, China had few voluntary donors. Within a two-year period, China reported donations from 2766 individuals, with 7785 transplants performed in 2015. These dramatic increases in donors and transplantations seem implausible given the low rate of deceased organ donation (3.9 deceased donors per million people) and a low willingness to donate (47.45% of the general public). These findings prompted suspicions that unethical organ procurement continues to supply the ever-growing demand for organs.
Response from the international community
Many countries are aware of the transgressions occurring in China. The Independent Tribunal Into Forced Organ Harvesting from Prisoners of Conscience in China (the China Tribunal), released their final judgment in 2019 concluding that the Chinese government had committed crimes against humanity by targeting minorities for organ harvesting. Although they did not have legal authority to pursue further action, the tribunal aimed to provide a resolution for victims’ families.
In the United States, Rep. Christopher Smith (R-New Jersey) introduced the Stop Forced Organ Harvesting Act of 2023 with the goal of imposing sanctions and allowing the State Department to revoke the passports of those convicted of organ trafficking-related crimes. Sen. Tom Cotton (R-Arkansas) introduced a similar bill in the Senate, which mandates annual reporting by the State Department on forced organ harvesting in foreign countries. Finally, Rep. Michelle Steel (R-California) and Neal Dunn (R-Florida) urged the Secretary of State to prevent individuals potentially participating in organ harvesting, such as physicians-in-training, from entering the United States.
It is promising that several U.S. politicians have introduced legislative changes, but these bills will not take effect immediately. Therefore, it is essential that citizens and activists, as well as professional organizations and committees, also play a part in ending forced organ harvesting.
What more needs to be done?
Forced organ harvesting in China may seem like an isolated problem irrelevant to the American general public. However, U.S. citizens are complicit in organ trafficking, such as China’s $1 billion organ harvesting industry, if they choose to purchase organs overseas. Known as transplant tourism, this phenomenon occurs because shorter waiting times advertised by Chinese hospitals offer an attractive alternative for desperate patients.
Though understandable that vulnerable patients want a quick cure, transplant tourism only contributes to greater injustice in exchange for individual benefit. Instead, it is vital that we close the gap between organ supply and demand. Investing in educational programs can raise awareness and reduce existing stigmas about organ donation. New approaches to organ recovery, such as controlled donation after circulatory determination of death, can increase organ availability and reduce waiting times, eliminating the need for transplant tourism.
This two step-approach asks families to first authorize organ preservation and allow organs to be harvested after unexpected deaths outside of a clinical setting. At a later time, the family will be asked to authorize organ donation. Currently, the Biden administration seeks to modernize the system to shorten waiting times and address racial inequities in patient referrals.
The United Network for Organ Sharing, responsible for coordinating transplantations, was the sole network for organ transplants in the United States for nearly 40 years. Now, the Health Resources and Services Administration (HRSA) is offering multiple contracts to increase competition between bidders and ensure that patients benefit from highly qualified vendors.
The responsibility of ending forced organ harvesting also falls on physicians. When individuals return from their overseas procedures, physicians can decide whether to treat or turn patients away; either decision is ethically valid. However, physicians must also discuss and actively discourage transplant tourism. They can point to the medical risks (organs abroad may be obtained from non-ideal donors with few safety measures in place, leading to surgical complications and/or serious risks of infection) or the moral dilemmas (transplant tourism funds illegal organ trafficking, which is believed to generate $840 million to $1.7 billion annually) to explain why patients should avoid traveling abroad for transplants.
Ultimately, the lack of accountability and standardization across countries allowed forced organ harvesting to persist for far too long. International organizations and committees must consistently apply pressure on China to demand the immediate cessation of forced organ harvesting and greater transparency regarding organ donation statistics.
Following the China Tribunal’s recommendations, this issue should be escalated to the International Court of Justice for an advisory opinion or the United Nations Human Rights Council for an investigation mandate. Countries must also establish a standard set of regulations to prohibit forced organ harvesting and transplant tourism worldwide. The organ black market can easily move across borders and resurface in other countries because national policies have limited jurisdiction. Similarly, transplant tourism is difficult to regulate because only some countries have regulations in place for proper oversight. Therefore, impactful change in response to these horrors requires international coordination and standardized top-down regulation.
Forced organ harvesting cannot be ignored. This is an undeniably heinous practice that plagues our society, but little has been done to right these wrongs. To address such a significant ethical issue, collaborative efforts are required from citizens, physicians, activists, politicians, and international committees. Everyone has a responsibility to take action; how will you help end forced organ harvesting?