Call for retraction of 400 scientific papers amid fears organs came from Chinese prisoners

Study finds failure of English language medical journals to comply with international ethical standards
By Melissa Davey

A world-first study says journals, researchers and clinicians who used the research on organ transplantation were complicit in ‘barbaric’ methods of organ procurement.

A world-first study has called for the mass retraction of more than 400 scientific papers on organ transplantation, amid fears the organs were obtained unethically from Chinese prisoners.
The Australian-led study exposes a mass failure of English language medical journals to comply with international ethical standards in place to ensure organ donors provide consent for transplantation.
The study was published on Wednesday in the medical journal BMJ Open. 

Its author, the professor of clinical ethics Wendy Rogers, said journals, researchers and clinicians who used the research were complicit in “barbaric” methods of organ procurement.

Medical journal to retract paper after concerns organs came from executed prisoners.

“There’s no real pressure from research leaders on China to be more transparent,” Rogers, from Macquarie University in Sydney, said. 

“Everyone seems to say, ‘It’s not our job’. The world’s silence on this barbaric issue must stop.”
A report published in 2016 found a large discrepancy between official transplant figures from the Chinese government and the number of transplants reported by hospitals. 

While the government says 10,000 transplants occur each year, hospital data shows between 60,000 to 100,000 organs are transplanted each year. 

The report provides evidence that this gap is being made up by executed prisoners of conscience.
In 2017 the European parliament passed a declaration condemning organ harvesting from prisoners of conscience, and called on Chinese officials to end it.
Rogers and her team obtained all research papers reporting on Chinese transplant recipients published in English-language medical journals between January 2000 and April 2017. 

The 445 studies they identified involved 85,477 transplants. 

But 99% of those studies failed to report whether organ donors had given consent for transplantation. 

The 19 studies which claimed no organs from executed prisoners were used took place prior to 2010, when there was no volunteer donor program in China.
It is the first time a study has tracked the progress of the transplant community in blocking unethical research.
In 2017 the prestigious medical journal Liver International was forced to retract a scientific paper by Chinese surgeons who examined the outcomes of 564 liver transplantations over four years. 

But experts pointed out that it was impossible for one hospital to have obtained so many useable livers given the small numbers of volunteer donors in China at the time, especially given most livers came from donors after cardiac death, or “donation after circulatory death (DCD) donors”. 

Livers from these patients are only viable for transplantation in about one third of cases, meaning the numbers of livers obtained in the study did not stack up with the number of deceased patients in China.
Rogers’s research found even the Journal of American Transplantation and the official journal of the The Transplantation Society [TTS], which have policies barring unethical research involving executed prisoners, had published questionable papers. 

This was despite the TTS in 2016 declaring it would not accept papers where organs had been sourced from prisoners.

China is still using executed prisoners' organs, official admits.

The paper concludes: “The transplant community has failed to implement ethical standards banning publication of research using material from executed prisoners.
“As a result, a large body of unethical published research now exists, raising questions of complicity to the extent that the transplant community uses and benefits from the results of this research.
“We call for immediate retraction of all papers reporting research based on use of organs from executed prisoners, and an international summit to develop future policy for handling Chinese transplant research.”
Guardian Australia has contacted the International Committee of Medical Journal Editors for comment.
“It’s not good enough to just have ethical guidelines without implementing them,” Rogers said.
While China vowed to stop using organs from executed prisoners in 2015, no new law or regulation has been passed banning the practice. 

Humanitarian groups including Amnesty International have voiced concerns that the practice is continuing.
In December, the Independent Tribunal into Forced Organ Harvesting from Prisoners of Conscience in China issued its interim report, finding: “The tribunal’s members are all certain – unanimously, and sure beyond reasonable doubt – that in China forced organ harvesting from prisoners of conscience has been practised for a substantial period of time involving a very substantial number of victims.”
The tribunal’s full report is due in 2019.

Medical journal to retract paper after concerns organs came from executed prisoners of conscience

Study published in Liver International examined the outcomes of 564 transplantations at Zhejiang University’s First Affiliated hospital in China
By Melissa DaveyDoctors during a liver transplant. Liver International will retract a scientific paper after concerns were raised that organs used in the study came from executed prisoners of conscience.

A prestigious medical journal will retract a scientific paper from Chinese surgeons about liver transplantation after serious concerns were raised that the organs used in the study had come from executed prisoners of conscience.
The study was published last year in Liver International. 

It examined the outcomes of 564 liver transplantations performed consecutively at Zhejiang University’s First Affiliated hospital between April 2010 and October 2014.
According to the study authors, “all organs were procured from donors after cardiac death and no allografts [organs and tissue] obtained from executed prisoners were used”.
But Wendy Rogers, a professor of clinical ethics at Macquarie University in Sydney, said it was impossible for one hospital to have obtained so many useable livers in a four-year period from cardiac deaths alone given the small numbers of volunteer donors in China.
Donors after cardiac death, or “DCD donors”, are those people with injuries so severe that it is futile to keep them alive, even though they are not braindead. 

A decision is made by doctors and family members to withdraw care, leading to cardiac death.
But livers from these patients are only viable for transplantation in a third of cases, because the time it takes to die once drugs and ventilation are withdrawn varies and can jeopardise the quality of the liver.
Livers are extremely sensitive and need to be removed quickly, and are often unsuitable for transplantation by the time the patient dies.
In a letter to Liver International’s editor, Prof Mario Mondelli, Rogers wrote that this was one of the reasons the numbers in the Chinese paper did not stack up. 

She called on him to retract the paper.
“International programs report relatively low rates of procurement of livers from DCD donors,” she wrote. 

“In the USA, rates of liver transplant from DCD donors in the years 2012-14 were 32%, 28% and 27% respectively. If retrieval rates are similar in China, this would require 1,880 DCD donors, assuming a retrieval rate of 30%, to transplant the 564 livers reported in this paper.
“Given that there were only 2,326 reported voluntary donations in the whole of China during 2011–2014, it is implausible that this small pool could have resulted in 564 livers successfully retrieved … unless the surgeons there had exclusive access to at least 80% of all voluntary donors across the whole of China in this period.”
Rogers told the Guardian that China also lacked a coordinated nationwide system of transporting organs within the time frame required for successful liver transplantations.
The only plausible explanation was that the livers were coming from executed prisoners.

These were not just prisoners sentenced to death but people jailed for beliefs outlawed by the Chinese government, including Falun Gong practitioners. 

There is comprehensive evidence that prisoners of conscience are being killed on demand for their organs in China, with profits going to the government and military.
Mondelli told the Guardian: “The authors’ institution was given until last Friday 3 February to provide evidence against allegations supported by data that organ procurement for liver transplantation was not from executed prisoners. However, there was no answer.”
Mondelli will issue a formal retraction notice and a full transcript of his interactions with the surgeons in the journal’s next edition, along with the letter from Rogers.
A report published last year found a large discrepancy between official transplant figures from the Chinese government and the number of transplants reported by hospitals. 

While the government says 10,000 transplants occur each year, hospital data shows between 60,000 to 100,000 organs are transplanted each year. 

The report provides evidence that this gap is being made up by executed prisoners of conscience.
In July the European parliament passed a declaration condemning organ harvesting from prisoners of conscience and called on Chinese officials to end it.
In an editorial published in the British Medical Journal on Tuesday, Rogers wrote that while China vowed to stop using organs from executed prisoners in 2015, no new law or regulation had been passed banning the practice. 

“Nor have existing regulations permitting the use of prisoners’ organs been rescinded,” she wrote.
“Prisoners remain a legal source of organs if they are deemed to have consented before execution, thus permitting ongoing retrieval of organs from prisoners executed with or without due process.”
The transplant registries were not open to public scrutiny or independent verification, she said, and an “inexplicably high” volumes of transplantation continued to take place in China.
A former surgeon from the western Chinese region of Xinjiang, Enver Tothi, was instructed in 1995 to operate on a political prisoner who had just been shot. 

The prisoner was unconscious but not yet dead but Tothi was ordered to remove his organs regardless, without the use of anesthesia.
Tothi says that, technically, it was he and not the gunshot that killed the prisoner. 

He left China in 1999 and was granted political asylum in Britain but said that being a part of the system of killing political prisoners still haunted him. 

He is unable to return to China for fear of repercussions for speaking out about organ donation.
“I was ordered to do it, but guilt haunted me for a long time,” Tothi told the Guardian. 

“It is duty of the humanity to stop this tragedy getting worse.”
He called on people to stop travelling to China and buying organ transplants. 

Today he lobbies around the world for an end to organ harvesting.
Last year Rogers and her colleagues called for the retraction of another paper on Chinese organ donation published in the Journal of Medical Ethics. 

Rogers said the paper presented a sanitised account of organ procurement in China and failed to highlight that organs were being harvested from prisoners of conscience. 

The journal subsequently published a lengthy correction.

Butcher's Pope

Debate Flares Over China’s Forced Organ Harvesting
By DIDI KIRSTEN TATLOW

BEIJING — A politely worded but testy debate has flared over a Vatican conference on human organ trafficking, with a group of ethicists warning that China will use the participation of its most senior transplant official to convince the world that it has overhauled its organ procurement system.

In a letter to the Pontifical Academy of Sciences in Rome, where the two-day Summit on Organ Trafficking and Transplant Tourism began on Tuesday, 11 ethicists wrote: “Our concern is with the harvesting and trafficking of organs from executed prisoners in China.”
China has admitted that it extracted organs from death row prisoners for decades, in what critics have called a serious violation of the rights of inmates who cannot give genuine consent. 

Since Jan. 1, 2015, Chinese officials have said they no longer use prisoners’ organs, though doubts persist.
“We urge the summit to consider the plight of incarcerated prisoners in China who are treated as expendable human organ banks,” wrote the 11 signatories, who included Wendy Rogers of Macquarie University in Australia; Arthur Caplan of the New York University Langone Medical Center; David Matas and David Kilgour, both Canadian human rights lawyers; and Enver Tohti, a former surgeon from the western Chinese region of Xinjiang.

The Chinese official attending the meeting, Huang Jiefu, a liver transplant specialist, is co-chairman of the National Organ Donation and Transplantation Committee of China, which is charged with remaking the country’s organ donation system to ensure transparency in sourcing and distributing organs in line with international standards.
Reached in Rome, Huang did not comment immediately, writing in a WeChat message that he was at the meeting and would reply soon.
An article co-written by another member of the national committee, Zheng Shusen, also a liver transplant specialist, was recently withdrawn after publication by the journal Liver International over concerns it relied on data from executed prisoners, Science magazine reported on Monday.
In their letter, the ethicists also argued that there was no evidence that China had ended the practice of taking organs from executed prisoners, which they said included prisoners of conscience.
“On the contrary, there is evidence that it continues,” they wrote. 

“Officials from China should not be given the prestigious platform of the Pontifical Academy of Sciences to spread misinformation about reform in China.”
In a response to the letter, addressed to Dr. Rogers, who is also chairwoman of the advisory committee of the International Coalition to End Organ Pillaging in China, Bishop Marcelo Sánchez Sorondo, chancellor of the Pontifical Academy of Science, warned against promoting political agendas.
“The organizer intends for the summit to be an academic exercise and not a reprise of contentious political assertions,” Bishop Sorondo wrote.
In an interview, Dr. Rogers said she disagreed with the bishop’s response. 

“I thought that was outrageous, really, to try and hedge off any discussion by saying it’s political,” she said. 

“The weight of evidence is such that it’s up to the Chinese to prove that they’re not doing this, and not the other way round.”
Last year, 4,080 Chinese donated a total of 11,296 organs, according to an article published on Monday in the Chinese journal Health News and republished in People’s Daily, the Communist Party’s main newspaper. 

That number is a small fraction of the total needed. 

Health officials estimate that each year about 300,000 people in China need a transplant.
To help change the system, officials have issued public appeals and deployed organ donation coordinators at hospitals. 

But many Chinese are unwilling, fearing that it is unfilial to one’s ancestors be buried with organs missing.
The meeting in Rome comes amid warming ties between China and the Vatican. 

Francis is eager to visit China, home to millions of Catholics who are members of either the state-sponsored church or the underground church that is loyal to Rome. 

Some consider themselves members of both.
The Chinese state does not recognize the jurisdiction of Rome over Chinese Catholics, though Catholicism is one of China’s five official religions along with Buddhism, Islam, Protestantism and Taoism. 

Organizers of the Vatican meeting said they hoped it would help generate remedies to the problem of organ trafficking and transplant tourism, which they called a “form of human slavery” afflicting many parts of the world.
“We hope this summit will create a top-down and bottom-up movement in society, to raise awareness of the extension and seriousness of this modern challenge and lay the groundwork for moral and appropriate solutions based on human dignity, freedom, justice and peace,” the academy’s website said.
In a Twitter post last year, Francis made clear his objections to organ trafficking:
The Vatican knows about the problem surrounding organ sourcing in China and wants to help change it, said Francesco Sisci, a specialist in Catholic affairs at Renmin University of China who interviewed the pope last year.
“They are well aware of the situation,” Mr. Sisci said in an email. 

“But the Vatican can only do this: encourage better behavior. It can’t start a trade war or send in the Swiss Guards as paratroopers,” he added, referring to the small force responsible for the pope’s safety.
Condemning the perpetrators “may be good revenge, but that’s the job of the Nuremberg trials, or of God,” Mr. Sisci said. 

China's crimes against humanity

Study retraction reignites concern over China’s use of prisoner organs
By Dalmeet Singh Chawla

A protest in Hong Kong of forced organ harvesting in mainland China.

A journal has decided to retract a 2016 study because of concerns that its data on the safety of liver transplantation involved organs sourced from executed prisoners in China. 

The action, taken despite a denial by the study’s authors that such organs were used, comes after clinical ethicist Wendy Rogers of Macquarie University in Sydney, Australia, and colleagues authored a letter to the editor of Liver International on 30 January, calling for the paper’s retraction in the “absence of credible evidence of ethical sourcing of organs.”
For years, Chinese officials have come under fire for allowing the use of organs from executed prisoner for transplants, including for foreigners coming to the country for so-called medical tourism. 

In January 2015, it set up a volunteer donation system, but doubts persist that much has changed.
The disputed study—published online in October 2016—analyzed 563 consecutive liver transplantations performed before the ban (from April 2010 to October 2014) at a medical center in China. 

Suspicious, Rogers organized the protest letter to the journal. 

“Publication of data from prisoners is ethically inappropriate given that it is not possible to ensure that the prisoners freely agreed either to donate their organs, or to be included a research program,” she tells ScienceInsider.
Mario Mondelli of the University of Pavia in Italy, Liver International’s editor-in-chief, notes that two of the study’s authors tried to reassure him in an email, which he provided to ScienceInsider. 

Shusen Zheng and Sheng Yan of the First Affiliated Hospital of Zhejiang University in Hangzhou, China, wrote that “all organs were recovered from donors after "cardiac" death and no grafts obtained from executed prisoners were used.” (Zheng and Yan have not responded to a request for comment from ScienceInsider.)
After getting no reply to subsequent request for further evidence on the origin of the organs, Mondelli says, the journal asked the authors’ institution for an official document, by 3 February, confirming that organs were not sourced from executed prisoners. 

Again, he says, there was no response.
Mondelli says the original study and its related correspondence will be published together in an upcoming print issue. 

The study will, however, be accompanied with a retraction statement, and the authors, adds Mondelli, will face a “life-long embargo” from submitting their work to Liver International.
Last year, Rogers and colleagues called for the retraction of another paper in the Journal of Medical Ethics that, according to Rogers, presented a “very positive” and “sanitized” account of organ procurement in China. 

In that case, instead of retracting the article, the journal published a lengthy correction.
The new dispute has flared just before a summit on organ trafficking and transplant tourism, to be held in Vatican City, Italy on February 7 and 8, by The Pontifical Academy of Sciences.

The Butcher's Pope

• Vatican defends inviting Chinese ex-minister to organ trafficking talks
• Huang Jiefu’s inclusion at summit confers legitimacy on Beijing’s forced organ harvesting

By Stephanie Kirchgaessner in Rome

Vatican officials have defended their decision to invite a Chinese former deputy health minister to a conference on organ trafficking despite concerns that China still relies on the organs of executed prisoners in its transplant programme.
Medical ethics experts and human rights activists have decried the move by the Pontifical Academy of Sciences to invite Huang Jiefu to a two-day conference starting on Tuesday that aims to expose organ trafficking and seeks to find “moral and appropriate solutions” to the issue.
Wendy Rogers, a medical ethics expert at Macquarie University in Australia, said Huang’s inclusion in the conference, where there could be a meeting with Francis, risked giving a propaganda boost to China and an “air of legitimacy” to its transplantation programme.
“The Pontifical Academy of Sciences should be aware of how the endorsements – even indirect – of prestigious foreign bodies are used by China’s propaganda apparatus to burnish the reputation of its unethical transplant system,” Rogers wrote in a protest letter to a Vatican official.
“We urge the summit to consider the plight of incarcerated prisoners in China who are treated as expendable human organ banks. There is no evidence that this practice has ceased in China,” she wrote.
At the heart of the controversy lies a daunting question for the Vatican at a time when it is desperately seeking to re-establish ties to China: whether dialogue with Communist party officials could help spur reform on issues such as human rights and religious freedom, or whether such interactions offer legitimacy to practices that are deeply at odds with Catholic teaching, including the church’s objection to capital punishment.
In an address last year, Francis said he considered illicit organ trafficking to be a “new form of slavery”.
In his response to Rogers’ letter, which was obtained by the Guardian, Marcelo Sánchez Sorondo, an Argentine bishop and chancellor of the Pontifical Academy of Sciences, said the conference was meant to be an “academic exercise and not a reprise of contentious political assertions”.
Huang, who has led an effort to overhaul China’s transplantation processes, has been under fire before. 

China’s use of prisoners’ organs was debated at an international conference last year after two doctors said it was premature to declare China an “ethical partner” in the international transplant community.
In 2015, Huang claimed China would no longer use organs from executed prisoners to meet the country’s high demand.
Nicholas Bequelin, regional director for East Asia for Amnesty International, said it was known at the time that the vast majority of organ transplants in China came from executed prisoners. 

The number of prisoners China executes every year is a state secret, but Bequelin said estimates ranged from 3,000 to 7,000 people annually.
Bequelin said experts had cast doubt on Huang’s claims that China had outlawed the practice, in large part because the country is yet to develop an effective national donor programme of willing participants.
“They haven’t stopped the practice and won’t stop. They have a need for organ transplants that far outpace the availability of organs,” Bequelin said.
Details of the process are grim. 

Bequelin said China did not adhere to World Health Organization recommendations on how doctors determine whether a person is legally dead. 

In China, organs have been removed before the prisoner would be considered medically dead by international standards.
“The timing of the execution is dependent on the need of a particular transplant surgery. You will execute this person at this time on this day, because that is when the patient has to be ready,” Bequelin said. 

“It is very secret and there is not a lot of reliable information.”
In testimony before a US congressional committee examining the issue last year, Francis Delmonico, a professor of surgery at Harvard Medical School who was appointed to the Pontifical Academy of Sciences by Francis, acknowledged that he could not assure the committee that the practice had been completely eradicated.

Amnesty’s Bequelin said: “It is a very optimistic view of the lay of the land in China if you think that conversations and dialogue can be on its own a significant factor. China is a system. There is a risk of naiveté about what can be achieved through rapprochement and meetings.”