Thread by @mpr0010

Doctors in China have been executing prisoners by extracting their hearts for transplantation, according to a new paper by myself and co-author Dr. Jacob Lavee in the American Journal of Transplantation.

we do a little thread about it.

onlinelibrary.wiley.com/doi/full/10.11…

Many know that China has long used organs from prisoners. The model here is: execution ground -> firing squad -> organ procurement.

But for hearts and lungs, it's not so simple. One does not simply execute the donor at a field site with a bullet to the head. If the donor suffers cardiac arrest, the heart will not be viable for transplant.

Heart donors must generally be brain dead, meaning the heart is still beating. In voluntary systems, this is typically from accidents (car crashes, suffocation, strokes, other head trauma). A very small number of hospital patients become brain dead.

Diagnosing brain death requires that the donor be on a ventilator. Doctors then turn off the ventilator and monitor carbon dioxide in the blood; if it increases past a threshold, the patient is diagnosed as brain dead: legally and medically dead.

But in China, the security apparatus & medical system faced a challenge: How to reliably inflict brain death on prisoners in a controlled manner? Shooting them in the head might accidentally lead to circulatory death, wasting the heart.

Our study argues that the execution is actually taking place in the operating room, and is performed by doctors themselves through the removal of the heart. A form of medicalized execution for profit.

How did we come to this conclusion?

Remember that brain death can only be determined if the patient is already on a ventilator. But in our review of Chinese clinical reports, we found that surgeons are declaring the donor brain dead, *but only then putting them on a ventilator.*

See this schematic.

Sometimes they do not put them on a ventilator at all. In one case, they only ventilated the prisoner mid-surgery.

We found 71 cases like this at 56 hospitals (12 of them military/paramilitary) in 33 cities, 15 provinces, over 35 years; 348 medical professionals were involved.

Our methods. First we scraped over 120,000 Chinese language medical publications. Then we filtered them for heart and lung transplants. Then we wrote a 'fuzzy string matching' algorithm that searched through these reports for sentences and phrases indicating unethical conduct.

This is the core of the code. only 20 lines, but it took months to learn how to do that; first it was 200 lines (nested for loops!) and took hours, by the end it was functionalized and took only minutes to run through 3k txt files.

This is what the raw data looked like:

Once we found the incriminating papers we translated them, manually reviewed them, and shared them extensively with other transplant experts and researchers. (From appendix 2 onlinelibrary.wiley.com/doi/full/10.11…)

Our discovery surprised us. This is the only instance we are aware of where the medical profession in a country has collaborated closely, for decades, with the security apparatus to source and medically execute prisoners in order to traffic their organs.

Who are these prisoners? The clinical reports we examine do not say. They do not even identify them as prisoners. Death row prisoners certainly, but possibly also political prisoners like Falun Gong and others. (more info on that chinatribunal.com among other places)

Is this ongoing? China says it stopped using prisoners for organs in 2015 -- the last year we found these violations. So maybe they did stop. But these claims were first exposed in Sept 2014. Chinese journals may simply have been told to stop publishing these details after that.

We write that we cannot conclude one way or the other. If use of prisoners stopped, then naturally the abuse would stop. But if prisoners *are* still being used, the abuse would likely continue. We think there's good evidence that prisoners continue to be used as an organ source.

Finally(?), there's a question of scale. We found 71 clinical reports, but were there only that many? These papers appear at the end of a very large funnel: There is the total number of transplants- some portion of those get written up into clinical reports (we don't know the %)

Some portion of *those* are about heart and lung transplants (%?). Some portion of *those* have a description of the methods. Finally, some portion of THOSE include this incriminating data. Our surprise was not that this was happening, but that we found so much evidence for it.

So this is/was probably taking place at a much larger scale. We suspect that execution by procurement became the default method for solving the clinical and logistical challenges in heart transplants from prisoners - otherwise quite tricky to solve for optimal transplant outcomes