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Sunday, 5 January 2020

Hakikat Pindah Organ di China


Organ harvesting from Falun Gong practitioners in China




Reports of organ harvesting from Falun Gong practitioners and other political prisoners in China have raised increasing concern by some groups within the international community. According to the reports,[1] political prisoners, mainly Falun Gong practitioners, are being executed "on demand" in order to provide organs for transplant to recipients. The organ harvesting is said to be taking place both as a result of the Chinese Communist Party's persecution of Falun Gong and because of the financial incentives available to the institutions and individuals involved in the trade. 

Reports on systematic organ harvesting from Falun Gong prisoners first emerged in 2006, though the practice is thought by some to have started six years earlier. Several researchers—most notably Canadian human rights lawyer David Matas, former parliamentarian David Kilgour and investigative journalist Ethan Gutmann—estimate that tens of thousands of Falun Gong prisoners of conscience have been killed to supply a lucrative trade in human organs and cadavers and that these abuses may be ongoing.[2] These conclusions are based on a combination of statistical analysis; interviews with former prisoners, medical authorities and public security agents; and circumstantial evidence, such as the large number of Falun Gong practitioners detained extrajudicially in China and the profits to be made from selling organs. 

The Chinese government has consistently denied the allegations. However, the perceived failure of Chinese authorities to effectively address or refute the charges has drawn attention and public condemnation from some governments, international organizations and medical societies. The parliaments of Canada and the European Union, as well as the Foreign Affairs Committee of the U.S. House of Representatives, have adopted resolutions condemning organ harvesting from Falun Gong prisoners of conscience. United Nations Special Rapporteurs have called on the Chinese government to account for the sources of organs used in transplant practices, and the World Medical Association, the American Society of Transplantation and the Transplantation Society have called for sanctions on Chinese medical authorities. Several countries have also taken or considered measures to deter their citizens from travelling to China for the purpose of obtaining organs. A documentary on organ harvesting from Falun Gong practitioners, Human Harvest, received a 2014 Peabody Award recognizing excellence in broadcast journalism.[3]
 
China has one of the largest organ transplant programs in the world. Although China does not keep nationwide statistics on transplant volume, Chinese officials estimated that as many as 20,000 organ transplants were performed in 2006[4], and approximately 9,000 of these were kidney and liver transplants[5]. Some sources say the actual number of transplants is significantly higher, based on detailed analysis of hospital records.[6] As a matter of culture and custom, however, China has extremely low rates of voluntary organ donation. Between 2003 and 2009, for instance, only 130 people volunteered to be organ donors.[7] In 2010 the Chinese Red Cross launched a nationwide initiative to attract voluntary organ donors, but only 37 people signed up.[8] Due to low levels of voluntary organ donation, most organs used in transplants are sourced from prisoners. The Chinese government approved a regulation in 1984 to allow the removal of organs from executed criminals, provided they give prior consent or if no one claims the body.[9]
 
Despite the absence of an organized system of organ donation or allocation, wait times for obtaining vital organs in China are among the shortest in the world—often just weeks for organs such as kidneys, livers, and hearts. This has made it a destination for international transplant tourism[10] and a major venue for tests of pharmaceutical anti-rejection drugs.[11][12][13] The commercial trade in human organs has also been a lucrative source of revenue for the Chinese medical, military and public security establishments.[14][15] Because there is no effective nationwide organ donation or allocation system, hospitals source organs from local brokers, including through their connections to courts, detention centers and prisons.[16]
 
Organ transplant recipients in China are generally not told the identity of the organ donor, nor are they provided with evidence of written consent. In some cases even the identity of the medical staff and surgeons may be withheld from patients. The problem of transparency is compounded by the lack of any ethical guidelines for the transplant profession or system of discipline for surgeons who violate ethical standards.[15]
 
By the 1990s, growing concerns about possible abuses arising from coerced consent and corruption led medical groups and human rights organizations to start condemning China's use of prisoner organs. These concerns resurfaced in 2001, when a Chinese military doctor testified before U.S. Congress that he had taken part in organ extraction operations from executed prisoners, some of whom were not yet dead.[17] In December 2005, China's Deputy Health Minister Huang Jiefu acknowledged that up to 95% of transplant organs from deceased donors, which make up 65% of all transplantations, came from executed prisoners and promised steps to prevent abuse.[18][19] Huang reiterated these claims in 2008 and 2010, stating that over 90% of organ transplants from deceased donors are sourced from prisoners.[20][21][22] In 2006 the World Medical Association demanded that China cease harvesting organs from prisoners, who are not deemed able to properly consent.[23] In 2014, Huang Jiefu said that reliance on organ harvesting from death row inmates was declining, while simultaneously defending the practice of using prisoners’ organs in the transplantation system.[24][25]
 
In addition to sourcing organs from death-row inmates, international observers and researchers have also expressed concern that prisoners of conscience are killed to supply the organ transplant industry.[26] These individuals were not convicted of capital crimes, and in many cases were imprisoned extrajudicially on the basis of their political or religious beliefs.

Falun Gong is a Chinese qigong discipline involving meditation and a moral philosophy rooted in Buddhist tradition. The practice rose to popularity in the 1990s in China, and by 1998, Chinese government sources estimated that as many as 70 million people had taken up the practice.[27][28] Perceiving that Falun Gong was a potential threat to the Party's authority and ideology, Communist Party leader Jiang Zemin initiated a nationwide campaign to eradicate the group in July 1999.[29]
 
An extra-constitutional body called the 6-10 Office was created to lead the persecution of Falun Gong,[30][31] and authorities mobilized the state media apparatus, judiciary, police force, army, education system, families, and workplaces to “struggle” against the group.[32][33]
 
Since 1999, Falun Gong practitioners have been the targets of systematic torture, mass imprisonment, forced labour, and psychiatric abuse, all with the aim of forcing them to recant their beliefs.[34][35] As of 2009, the New York Times reported that at least 2,000 Falun Gong practitioners had been killed amid the persecution campaign;[36] Falun Gong sources documented over 3,700 named death cases by 2013. Due to the difficulty in accessing and relaying information from China, however, this may represent only a portion of actual deaths.[34]
 
The first allegations of large-scale organ harvesting from Falun Gong practitioners were made in March 2006 by three individuals claiming knowledge of involuntary organ extractions at the Sujiatun Thrombosis Hospital in Shenyang, Liaoning province. One of the whistleblowers, the wife of a surgeon at the hospital, claimed her husband had performed numerous operations to remove the corneas of Falun Gong practitioners for transplant.[15][37]
 
Representatives of the U.S. State Department were dispatched to the Sujiatun hospital to investigate the claims. They were given a tour of the facilities and found no evidence to prove the allegations were true, but said they remained concerned over China's treatment of Falun Gong and the reports of organ harvesting.[38] Soon thereafter, in May 2006, the Coalition to Investigate the Persecution of Falun Gong asked former Canadian parliamentarian David Kilgour and human rights lawyer David Matas to investigate the broader allegations of organ harvesting from Falun Gong practitioners in China. Kilgour and Matas agreed to conduct an investigation as volunteers.[39]

 

Kilgour-Matas report

Main article: Kilgour-Matas report
David Kilgour and David Matas released the results of their preliminary investigation on 20 July 2006, in a report titled "Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China".[40] Although the pair were denied visas to travel to China, they nonetheless compiled over 30 distinct strands of evidence which were consistent with allegations of organ harvesting from Falun Gong practitioners. These included an analysis of statistics on organ transplantation in China, interviews with former Falun Gong prisoners, and recorded admissions from Chinese hospitals and law enforcement offices about the availability of Falun Gong practitioners’ organs.[15]
 

David Matas, senior legal counsel of B'nai Brith Canada, international human rights lawyer, coauthor of Bloody Harvest.

In the absence of evidence that would invalidate the organ harvesting allegations—such as a Chinese government registry showing the source of transplant organs— Kilgour and Matas concluded that the Chinese government and its agencies “have put to death a large but unknown number of Falun Gong prisoners of conscience. Their vital organs, including kidneys, livers, corneas and hearts, were seized involuntarily for sale at high prices, sometimes to foreigners, who normally face long waits for voluntary donations of such organs in their home countries.” They estimated that from 2000 to 2005, the source for 41,500 organ transplants was unexplained, and that Falun Gong prisoners were the most plausible source for these organs.[15][41][42] The authors qualified their report by noting the inherent difficulties in verifying the alleged crimes: no independent organizations are allowed to investigate conditions in China, eyewitness evidence is difficult to obtain, and official information about both organ transplantation and executions is often withheld or is contradictory.[15]
 
In 2007, Kilgour and Matas presented an updated report under the title "Bloody Harvest: Revised Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China". The findings were subsequently rewritten as a book released in October 2009.[43] The reports received international media coverage, and the authors travelled internationally to present their findings to governments and other concerned organizations. 


State Organs: Transplant Abuse in China

In 2012, State Organs: Transplant Abuse in China, edited by Matas and Dr. Torsten Trey, was published with essays from Dr. Gabriel Danovitch, Professor of Medicine,[44] Arthur Caplan, Professor of Bioethics,[45] Dr. Jacob Lavee, cardiothoracic surgeon,[46] Dr. Ghazali Ahmad,[47] Professor Maria Fiatarone Singh,[48] Dr. Torsten Trey,[49] Ethan Gutmann and Matas.[50][51][52][53][54]

 

 

Ethan Gutmann

Ethan Gutmann with Edward McMillan-Scott at Foreign Press Association press conference, 2009


Ethan Gutmann, an investigative journalist and author specializing in China, initiated his own investigation into the allegations of organ harvesting from Falun Gong practitioners in 2006. Over the span of several years, he conducted interviews with over 100 refugees from China's labor camp and prison system, as well as with Chinese law enforcement personnel and medical professionals.[55] Based on his research, Gutmann concluded that organ harvesting from prisoners of conscience became prevalent in the northwestern province of Xinjiang during the 1990s, when members of the Uyghur ethnic group were targeted in security crackdowns and “strike hard campaigns.”[56][57] Enver Tohti, an exiled pro-Uyghur independence activist, claims to have carried out the first live organ transplant on a Uyghur Muslim prisoner in 1995. He said that the first time he performed the transplant procedure, he was taken to a room near the execution ground in Urumqi to remove the liver and kidneys of an executed prisoner. He claimed that the man's heart was still beating as he removed the liver and kidneys.[58]
 
By 1999, Gutmann says that organ harvesting in Xinjiang began to decline precipitously, just as overall rates of organ transplantation nationwide were rising. The same year, the Chinese government launched a nationwide suppression of the Falun Gong spiritual group. Gutmann suggests that the new Falun Gong prisoner population overtook Uyghurs as a major source of organs.[2] He estimated that approximately 65,000 Falun Gong practitioners had been killed for their organs between 2000 and 2008, and notes that this figure is similar to that produced by Kilgour and Matas when adjusted to cover the same time period.[2][59]
 
These findings have been published in a variety of journals and periodicals, including the World Affairs Journal, the Weekly Standard, the Toronto Star, and the National Review, among others. Gutmann has also provided testimony on his findings before U.S. Congress and European Parliament, and in August 2014 published his investigation as a book titled “The Slaughter: Mass Killings, Organ Harvesting and China’s Secret Solution to Its Dissident Problem.”[60]

 

Verdict by the China Tribunal

On June 17, 2019, China Tribunal, an independent People's Tribunal located at London, had pronounced its verdict on Organ Harvesting in China, and the Chinese government was found guilty[61][62].

 

 

Evidence

Several distinct strands of evidence have been presented to support allegations that Falun Gong practitioners have been killed for their organs in China. Researchers, human rights advocates and medical advocacy groups have focused in particular on the volume of organ transplants performed in China; the disparity between the number of transplants and known sources of organs; the significant growth in the transplant industry coinciding with the mass imprisonment of Falun Gong practitioners; short wait times that suggest an “on demand” execution schedule; and reports that Falun Gong prisoners are given medical exams in custody to assess their candidacy as organ suppliers.



Increase in nationwide organ transplants after 1999

The number of organ transplants performed in China grew rapidly beginning in 2000. This timeframe corresponds with the onset of the persecution of Falun Gong, when tens of thousands of Falun Gong practitioners were being sent to Chinese labor camps, detention centers and prisons.[63][64]
In 1998, the country reported 3,596 kidney transplants annually. By 2005, that number had risen to approximately 10,000.[15] The number of facilities performing kidney transplants increased from 106 to 368 between 2001 and 2005. Similarly, from 1999 to 2006, the number of liver transplantation centers in China rose from 22 to over 500.[4] The volume of transplants performed in these centers also increased substantially in this period. One hospital reported on its website that it performed 9 liver transplants in 1998, but completed 647 liver transplants in four months in 2005. The Jiaotong University Hospital in Shanghai recorded seven liver transplants in 2001, 53 in 2002, 105 in 2003, 144 in 2004, and 147 in 2005.[15]
 
Kilgour and Matas write that the increase in organ transplants cannot be entirely attributed to improvements in transplant technology: “kidney transplant technology was fully developed in China long before the persecution of Falun Gong began. Yet kidney transplants shot up, more than doubling once the persecution of Falun Gong started...Nowhere have transplants jumped so significantly with the same number of donors simply because of a change in technology.”[15]
 
Furthermore, they note that during this period of rapid expansion in China's organ transplant industry, there were no significant improvements to the voluntary organ donation or allocation system, and the supply of death row inmates as donors also did not increase.[15][26] Although it does not prove the allegations, the parallel between rapid growth in organ transplants and the mass imprisonment of Falun Gong practitioners is consistent with the hypothesis that Falun Gong practitioners in custody were having their organs harvested.


Discrepancy in known sources of organs

Chinese officials reported in 2005 that up to 95% of organ transplants are sourced from prisoners.[18] However, China does not perform enough legal executions to account for the large number of transplants that are performed, and voluntary donations are exceedingly rare (only 130 people registered as voluntary organ donors nationwide from 2003 to 2009[7]). 

In 2006, the number of individuals sentenced to death and executed was far fewer than the number of transplants. Based on publicly available reports, Amnesty International documented 1,770 executions in 2006; high-end estimates put the figure closer to 8,000.[65] Because China lacks an organized organ matching and allocation system, and in order to satisfy expectations for very short wait times, it is rare that multiple organs are harvested from the same donor. Moreover, many death row inmates have health conditions such as hepatitis B that would frequently disqualify them as organ donors. This suggests the existence of a secondary source for organs.[16] United Nations Special Rapporteur on Torture Manfred Nowak says “the explanation that most of these organs come from death row inmates is inconclusive...If so, the number of executed felons must then be much higher as so far assumed.”[66]
 
In a statement before the U.S. House of Representatives, Damon Noto said “the prisoners sentenced to death cannot fully account for all the transplantations that are taking place in China [...] Even if they executed 10,000 and transplanted 10,000 a year, there would still be a very large discrepancy. Why is that? It is simply impossible that those 10,000 people executed would match perfectly the 10,000 people that needed the organs.”[67] David Kilgour and David Matas similarly write that traditional sources of transplants such as executed prisoners, donors, and the brain dead "come nowhere near to explaining the total number of transplants across China." Like Noto, they point to the large number of Falun Gong practitioners in the labor camp and prison system as a likely alternative source for organs.[15]


Organ transplant wait times

Wait periods for organ transplants in China are significantly shorter than elsewhere in the world. According to a 2006 post on the China International Transplantation Assistance Center website, "it may take only one month to receive a liver transplantation, the maximum waiting time being two months. As for the kidney transplantation, it may take one week to find a suitable donor, the maximum time being one month...If something wrong with the donor's organ happens, the patient will have the option to be offered another organ donor and have the operation again in one week."[68] Other organ transplant centers similarly advertised average wait times of one or two weeks for liver and kidney transplants.[15][69][70] This is consistent with accounts of organ transplant recipients, who report receiving organs a matter of days or weeks.[10][71][72] By comparison, median wait times for a kidney in developed countries such as the United States, Canada and Great Britain typically range from two years to over four years, despite the fact that these countries have millions of registered organ donors and established systems of organ matching and allocation.[73][74][75]
 
Researchers and medical professionals have expressed concern about the implications of the short organ transplant wait times offered by Chinese hospitals. Specifically, they say these wait times are indicative of a pool of living donors whose organs can be removed on demand.[26] This is because organs must be transplanted immediately after death, or must be taken from a living donor (kidneys must be transplanted within 24–48 hours; livers within 12 hours, and hearts within 8 hours).[76]
 
Kirk C. Allison, Associate Director of the Program in Human Rights and Medicine at the University of Minnesota, wrote that the "short time frame of an on-demand system [as in China] requires a large pool of donors pre-typed for blood group and HLA matching," which is consistent with reports of Falun Gong prisoners having blood and tissue tested in custody. He wrote that China's short organ wait times could not be assured on a “random death” basis, and that physicians he queried about the matter indicated that they were selecting live prisoners to ensure quality and compatibility.[76] Dr. Jacob Lavee, Director of the Heart Transplant Unit at the Sheba Medical Center in Israel, recounts one of his patients traveling to China for a heart transplant. The patient waited two weeks for a heart, and the surgery was scheduled in advance—meaning the organ could not have been procured on the basis of a random death.[77] Franz Immer, chairman of the Swiss National Foundation for organ donation and transplantation, reports that during a visit to Beijing in 2007, he was invited by his Chinese hosts to observe a heart transplantation operation: “The organizer asked us whether we would like to have the transplantation operation in the morning or in the afternoon. This means that the donor would die, or be killed, at a given time, at the convenience of the visitors. I refused to participate.”[2]
 
Editors of the Journal of Clinical Investigation write that “The only way to guarantee transplant of a liver or heart during the relatively short time period that a transplant tourist is in China is to quickly obtain the requisite medical information from prospective recipients, find matches among them, and then execute a person who is a suitable match.”[26] Noto similarly says that China's organ transplant wait times and the ability to schedule transplants in advance can only be achieved by having a large supply of “living donors that are available on demand.” Death row inmates alone are not numerous enough to meet this demand.[67]



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