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Originally published: March 10, 2020

Beginning in the year 2000, the People’s Republic of China began a singular feat of medical advancement and mobilization, constructing one of the largest systems of organ transplantation in the world in a matter of years. Unlike other countries, however, China did this without the use of voluntary deceased donors as an organ source.

China’s organ-sourcing practices have been controversial since the inception of the field. Yet for the most part, key global constituencies — including medical associations, human rights organizations, scholars, major media organizations, and the relevant executive agencies of most Western governments — have not devoted resources to a close examination of the case. Without the commitment of resources, the public stance defaults to a largely uncritical adoption of the Chinese Communist Party’s official explanation as to the source of organs. This explanation has changed three times. Pre-2006, the official stance was that the source of organs was primarily voluntary donors. From 2006 to 2015, China claimed the source of organs had been death-row prisoners all along. Post-2015, China has claimed the source of organs to be solely voluntary, non-prisoner deceased donors.

A review of the evidence, however, indicates that the official explanations of organ sourcing in China require reexamination. China’s organ transplantation machine has rapidly accelerated since 2000, yet the country’s death penalty cases have declined. This contradiction demands an explanation. Recent evidence further belies China’s claim that organ transplant system reform is underway; it indicates Chinese medical administrators systematically falsified their voluntary deceased donation numbers from 2010 onwards.

These contradictions between the facts and China’s claims about its human organ transplantation program are the focus of this report. The paper makes three arguments. First, China’s official explanation (since 2006) of voluntary donors as the main source of organs fails to account for phenomena observed in the development of its transplantation industry since 2000. Second, an undisclosed population has therefore been China’s main source of organs for two decades. Third, this undisclosed source is political prisoners. Given recent evidence of ongoing organ trafficking in China, the evidence and argumentation in this report are not only relevant: they are urgent.

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