The taking of organs for transplants from executed Chinese prisoners may be considerably worse than most of the world has recognized, researchers have suggested. Not only are organs being removed without the consent of what might loosely be called the donor, but a new study alleges that in some cases they're not even dead when vital parts of their body are taken to be given to others. Perhaps most shockingly of all, some of the doctors responsible have written about it in scientific journals, rather than keeping it secret.

There is a desperate shortage of organs for transplantation worldwide. Eventually, this may be solved through the creation of artificial hearts and lungs, or by genetically engineering pigs to produce transplantable body parts. Both, however, are years away from widespread adoption at best.

In the meantime, most governments have worked on trying to nudge people towards donating their organs in the event of premature death.

For decades, China allowed the taking of organs from executed criminals, a practice widely condemned by the rest of the world, before it was supposedly banned in China in 2015. However, a paper in the American Journal of Transplantation presents evidence that in some cases the situation is considerably worse, with the organs removed from people who were still alive – at least when the operation started.

It might sound like the kidney removal scene from Monty Python's Meaning Of Life, but Australian National University PhD student Matthew Robertson is anything but joking. Robertson's thesis is on using statistical analysis to seek evidence for falsification of organ donor data in the official Chinese register. In the process, however, he stumbled on something even worse.

In Chinese language scientific journals, papers were found where doctors matter-of-factly describe taking organs from patients whose brain death had not been established. “The surgeons wrote that the donor was brain dead, but according to everything we know about medical science, they could not possibly have been brain dead because there was no apnea test performed,” Robertson told Medscape Medical News. 

As the paper notes, this violates the essential rule of transplant ethics that states that procurement of organs must not cause the death of the donor. However, with transplantation – particularly of hearts and lungs – being more likely to succeed the better condition the donor was in beforehand, some doctors may not see it that way.

Along with Professor Jacob Lavee of Tel Aviv University, Robertson kept digging and found 71 such papers, in each case identifying “incriminating sentences” demonstrating patients were not intubated before the operation began, a requirement for the performance of the apnea test. This may only be the tip of the iceberg, because many doctors would either not write about such behavior, or do a better job of covering their tracks.

“We have shown for the first time that the transplant surgeons are the executioners – that the mode of execution is organ procurement. These are self-admissions of executing the patient,” Lavee told Medscape. Levee added he was initially so disbelieving he insisted on getting a second translation from Chinese to back up Robertson's work.

Worse still, this is not the result of some rogue institution, but reported from 56 hospitals in 15 provinces. The earliest paper the pair found dates from 1980, and the most recent from 2015.

Robertson and Levee fear the lack of more recent examples reflects growing awareness of how such reports would be perceived, rather than a halt to the practice. It appears it has not been reported previously because the journals the papers were published in are so little read outside China. Moreover, it would be easy for someone reading quickly to skip over the crucial part. The paper notes the clues are usually “A phrase of a few characters in a paper several pages long.”

People who defend harvesting organs from executed prisoners argue that committing a capital crime erases a person's right (or that of their family) to dictate what happens to their organs after death. Critics have pointed out that the value of the organs creates an incentive to sentence people to death whose guilt may be disputable, or circumstances warranting mercy under other circumstances.

There are widespread allegations some of those executed were targeted for being followers of suppressed religions.

Anyone planning on using this study as a justification for anti-Chinese racism should consider that many of the recipients of these organs are international visitors who don't care to look too closely into the source of their new body part. The fact these transplant tourists always seem to be met with a suitable organ within weeks is one of the things that alerted Robertson to the likelihood the organs were coming from prisoners. It appears executions are frequently timed to meet the demands of wealthy non-citizens.