Health Europa Quarterly speaks to bioethicist Professor Wendy Rogers about forced organ harvesting and the ethical responsibilities of physicians and academics
Professor Wendy Rogers is the Professor in Clinical Ethics at Macquarie University, Australia; and Chair of the International Advisory Board for the International Coalition to End Transplant Abuse in China, a charitable NGO: a role for which she receives no remuneration.
In 2019 she was presented with the National Health and Medical Research Council’s (NHMRC) Ethics Award and named one of the Nature journal’s top 10 people who matter in science, in recognition of her research-led campaign against forced organ harvesting; as well as appearing in Medscape’s 2019 Physicians of the Year. Rogers tells HEQ about the responsibility of physicians and academics to recognise and act against forced organ harvesting.
What do you know about the current situation regarding forced organ harvesting in China?
My understanding is that China is still performing a large number of transplants – far more than any official figures would indicate – and that vast [quantities of] organs are sourced from prisoners of conscience.
A lot of those prisoners are Falun Gong practitioners, who are still incarcerated in large numbers; but based on evidence that some women gave who have been incarcerated in the Uyghur prisons fairly recently, almost certainly people from the Uyghur community are being harvested as well.
What first drew your attention to the forced organ harvesting of prisoners of conscience in China?
I was watching the film Hard to Believe [a 2016 documentary investigating forced organ harvesting in China], which was produced by Kay Rubacek and directed by Ken Stone. It presents itself as a mystery: all these transplants are happening in China, where could all the organs be coming from? It’s a very compelling documentary, and I saw it and I thought: goodness. I hadn’t really been aware of the nature of the allegations of what was happening in China.
So, then I bought [investigative writer] Ethan Gutmann’s book [The slaughter: mass killings, organ harvesting, and China’s secret solution to its dissident problem] and the 2006 book by David Matas and David Kilgour [Bloody Harvest]; and I read those books.
The more I looked into it, the more I found that there was a lot of evidence that organ harvesting from prisoners of conscience does occur and the Chinese provided no evidence that would reassure you that things are happening ethically there.
The China Tribunal determined that what’s going on right now is a crime against humanity against Falun Gong practitioners and Uyghur Muslims; but that the requirement for intent had not been sufficiently proven to officially declare genocide. Do you think that genocide has been or is being committed?
I think there’s a distinction between the technical definition of genocide in the [United Nations Convention on the Prevention and Punishment of the Crime of Genocide] and people’s lay understanding. I think there is no doubt that when the persecution of the Falun Gong started in 1999, there was an absolute determination to destroy the practice of Falun Gong; and given that many of the practitioners wouldn’t give it up, it meant destroying them. I think that was the primary intent of the persecution when it first started, and then they realised how valuable the organs were inside these prisoners.
If we think about genocide, there has to be the intent to wipe out the victim group. I think that at a government level in China that intent does exist, because they set up the 610 Office [a government security agency], which was basically charged with stamping out the practice of Falun Gong, including killing the practitioners if necessary.
That was the overarching policy which sanctioned all the actions against Falun Gong practitioners; but if you get down to the level of killing individuals, the people actually doing the killing do not necessarily have the intent to exterminate Falun Gong practitioners; they want to make money [from their organs]. I don’t know if the legal definition of genocide can incorporate both the level of ‘we need to exterminate them all’ and the motive behind each individual killing.
You helped to develop the National Health and Medical Research Council’s guidelines for organ and tissue donation: how are organ recipients slipping through the cracks in international law and ethical guidelines? Do you think that surgeons are aware of this happening?
The National Health and Medical Research Council only has jurisdiction within Australia, so the ethical guidelines [only cover] the donation of organs by people living in Australia at the time they donate and the transplantation of those organs into other people living in Australia at the time.
Those guidelines can’t cover what happens outside Australia; but what we do know, from anecdotal evidence and the odd media report and surgeons that have contacted me off the record, is that patients are going overseas to transplant [a report published in October 2019 indicated that more than two thirds of the 540 physicians surveyed had travelled overseas to support patients undergoing transplants at least once].
Have the physicians who oversee the aftercare of these patients ever come across cases where they have questioned the source of the organ?
Anecdotally, I know of one [doctor] who was not happy to look after a patient who came back because she felt that the patient had engaged in organ trafficking to get a transplant; and the doctor just withdrew from that patient’s care and handed her on to someone else.
There’s a strong feeling in the medical profession that you can’t withhold care from a person that needs it, no matter what they’ve done; so even if they come back and you know that they’ve bought a trafficked organ, or even worse, an organ that someone was killed for, they’re still a patient. They still need medical care, so the doctors say ‘it’s not our business, we’re not police. It’s not up to us to do anything about where people got their organs, we just have to look after our patient.’
The surgeons conducting the transplants must know to some degree that the organs they using are not ethically sourced. Do they only know the source is somehow questionable, or do they know exactly where the organ is from and choose to turn a blind eye?
It is completely normalised. There has been such a programme of brutalisation against the Falun Gong practitioners, and now against the Uyghurs, that they’re not really considered human, they’re considered enemies of the state. [The prevailing sentiment is that] this is the best thing that could happen, that they’re actually doing some good by being killed and giving their liver to someone else. So [the surgeons] know where they come from, but they don’t think it’s wrong.
In terms of the patients that are going to China from other countries to receive these harvested organs, do you think that they know?
I think some of them would know. There was an article in the media in Australia a couple of years ago now where a [patient] said: ‘I’m going to China, they’re shooting my donor next week’. She clearly knew what was going on [but] she was convinced that the donor was a mass murderer or something, so they deserved the death penalty.
Whether they know that it’s innocent people being killed, I don’t know; but from what people have said, from the interviews that have been reported in the Matas and Kilgour book, the way that transplants happen in China you feel like you are involved in something pretty underhand. I don’t think it feels ethically robust, or like you’re doing a good thing.
You had a paper published in the BMJ Open criticising the degree to which the transplant research community fails to examine thoroughly the provenance of organs used in Chinese transplants. Do you think that wider and more investigative academic reporting could act as a deterrent?
I think so. In that paper we listed 445 papers that we felt should be retracted; and I just found out that PLOS ONE, which is quite a major general medical journal, has retracted five papers which we identified, so I’m really pleased about that [since this interview was conducted PLOS ONE and the Transplantation journal have retracted a total 27 papers].
The transplant community has been a bit asleep behind the wheel on this, there wasn’t enough scrutiny of papers being published. The problem is that at least some of the Chinese [academic paper] authors lie. We have been able to catch them out: they’ve written in one paper that no organs from executed prisoners were used, but this was a time when there was no volunteer donor scheme; so that clearly couldn’t be true.
In general, we expect scientists to be truthful and honest, so when it’s written in a Chinese paper that the organs came from volunteers, reviewers just think that sounds right without actually doing the checking to [be able to] say they didn’t have any volunteers at the time this research was done; so it couldn’t be ethical.
What do you think academic reporters could do better?
[They should] be more aware of how organs are being procured in China and be more willing to challenge the authors: for each of the 26 retractions so far by journals, they’ve written [an update] about contacting the authors and the authors not responding or protesting. Once the journals start pushing back against the authors, the authors can’t actually defend the claims that they’ve made; and so then it’s easy to reject the paper.
Is there anything else that you think our readers should know?
It’s so horrendous that it’s really hard to take it in: it’s easier to say it couldn’t possibly be happening, but readers just need to come to it with an open mind and read some of the materials. There’s a lot of material on the China Tribunal website; there’s a lot of materials on the End Transplant Abuse in China website; there’s a lot of materials on the Doctors Against Forced Organ Harvesting website.
If people actually look at that material then they can understand what’s actually happening, and they should know that it is not at all safe to go to China for a transplant because it is absolutely likely that the organ you get will come from someone [who has been] killed to give you that organ. So, they certainly shouldn’t think about doing that at all.
Professor Wendy Rogers
Department of Clinical Medicine and Department of Philosophy
Macquarie University, Australia
International Coalition to End Transplant Abuse in China
Please note, this article will appear in issue 12 of Health Europa Quarterly, which will be available to read in February 2020.