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Execution by organ procurement: Breaching the dead donor rule in China

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  • Execution by organ procurement: Breaching the dead donor rule in China


    Execution by organ procurement: Breaching the dead donor rule in China
    Matthew P. Robertson, Jacob Lavee
    First published: 04 April 2022

    Funding information:
    This work was supported by the Google Cloud Research Credits program (award GCP19980904), the Australian Government Research Training Program Scholarship, and the Victims of Communism Memorial Foundation.


    The dead donor rule is fundamental to transplant ethics. The rule states that organ procurement must not commence until the donor is both dead and formally pronounced so, and by the same token, that procurement of organs must not cause the death of the donor. In a separate area of medical practice, there has been intense controversy around the participation of physicians in the execution of capital prisoners. These two apparently disparate topics converge in a unique case: the intimate involvement of transplant surgeons in China in the execution of prisoners via the procurement of organs. We use computational text analysis to conduct a forensic review of 2838 papers drawn from a dataset of 124 770 Chinese-language transplant publications. Our algorithm searched for evidence of problematic declarations of brain death during organ procurement. We find evidence in 71 of these reports, spread nationwide, that brain death could not have properly been declared. In these cases, the removal of the heart during organ procurement must have been the proximate cause of the donor's death. Because these organ donors could only have been prisoners, our findings strongly suggest that physicians in the People's Republic of China have participated in executions by organ removal...

  • #2

    In China, New Evidence That Surgeons Became Executioners
    Clinical reports recount scores of cases in which organ donors were alive when operations began.
    By Jacob Lavee and
    Matthew P. Robertson
    May 31, 2022 4:20 pm ET

    Eight doctors at the Tongji Medical College hospital in Wuhan, China, traveled 40 miles on March 18, 1994, to procure a heart from a death-row prisoner. But rather than wait until the judicial authorities had executed the prisoner, the doctors carried out the execution themselves—by heart extraction.

    In a large-scale review we conducted of nearly 3,000 Chinese-language clinical reports and published in the American Journal of Transplantation, we find surgeons acknowledging such actions again and again.

    The Wuhan doctors write: “When the chest of the donor was opened, the chest wall incision was pale and bloodless, and the heart was purple and beating weakly. But the heartbeat became strong immediately after tracheal intubation and oxygenation. The donor heart was extracted with an incision from the 4th intercostal sternum into the chest. . . . This incision is a good choice for field operation where the sternum cannot be sawed open without power.”

    By casually noting that the donor was connected to a ventilator (“tracheal intubation”) only at midsurgery, the physicians inadvertently reveal that the donor was alive when the operation began.

    For a declaration of brain death to be legitimate, the organ donor must have lost the ability to breathe spontaneously and have already been intubated. This is a well-established medical principle associated with a basic rule of transplant ethics: Donors must be deceased before vital organs are removed.

    Yet our research finds scores of reports—over a three-decade period, at 56 Chinese hospitals, involving more than 300 medical workers—in which brain death was described as having been declared before the donor was intubated. They were often intubated immediately before surgery. In the 1994 Wuhan case, intubation took place after the surgery began. In other cases, there was no intubation at all...