From this article (summarized below):
Somebody should send the Chinese some Larry Niven.
The article doesn’t present any evidence per se; it refers to papers that have procedural information indicating that organ harvesting from living prisoners has occurred, and given the general secretiveness and propensity of contempt toward human rights not unlikely, but there is no ‘evidence’ to evaluate in the article itself, and it should be noted that all of the images of simulated organ harvesting are Falun Gong protests.
It is more of a question about the medical ethics of a physician being actively involved in the process of executing a prisoner. Although this certainly makes sense in strictly technical terms of maximizing successful harvesting of the organs, it is contrary to accepted physician responsibility to not do harm to a patient regardless of their legal status or transgressions. The incentive to find legitimate rationale to harvest organs from heathy ‘donors’ via the penal process is an ethical conundrum, but most methods of execution (electrocution, poison, shooting) would essentially preclude harvesting many organs.
Can we convince them to try to build a Ringworld? (Don’t tell them about the dynamic stability and fundamental material strength problems.)
Stranger
Okay, let’s take a look…
A core value in medical ethics is the principle of ‘do no harm,’ famously captured in the Hippocratic Oath. This principle motivates two widespread professional medical prohibitions: the dead donor rule (DDR), which forbids the procurement of vital transplant organs from living donors, and the injunction against physician participation in executions.
[…]
[W]e developed a criterion for problematic Brain Death Declaration (BDD) […] We define as problematic any BDD in which the report states that the donor was intubated after the declaration of brain death, and/or the donor was intubated immediately before organ procurement, as part of the procurement operation, or the donor was ventilated by face mask only.
[…]
We have documented 71 descriptions of problematic brain death declaration prior to heart and lung procurement […] The 71 papers we identify almost certainly involved breaches of the DDR because in each case the surgery, as described, precluded a legitimate determination of brain death, an essential part of which is the performance of the apnea test, which in turn necessitates an intubated and ventilated patient. In the cases where a face mask was used instead of intubation—or a rapid tracheotomy was followed immediately by intubation, or where intubation took place after sternal incision as surgeons examined the beating heart—the lack of prior determination of brain death is even more apparent.
I’m only a layman, but I attempted to identify the hypothesis of this paper in bold. They hypothesized that China was harvesting hearts and lungs before the patient was declared dead, then they went and searched a ton of Chinese academic papers for descriptions of heart and lung harvest surgery. They sussed out descriptions where the determination of brain death preceded intubation and ventilation, on the basis that a legitimate determination of brain death requires intubation for an apnea test. The result, apparently, is that they found at least 71 descriptions of heart/lung harvest surgery precluding a legitimate determination of brain death.
The apnea test measures brain function by seeing if the patient attempts to breathe when removed from life support. From what I have read, the apnea test is a “condition ‘sine qua non’ for determining brain death”, meaning without the test, you cannot declare brain death.
My understanding of the theory is that when you exhale your body releases carbon dioxide, so if you aren’t breathing you will build up carbon dioxide. Your brain is supposed to react to a buildup of carbon dioxide in the blood by attempting to breathe. This is a reflex even when you are unconscious or in a coma. If you have more than so much carbon dioxide in your blood, and you don’t make any attempt to breathe, it follows that your brain isn’t performing this vital function.
For the test a comatose patient is disconnected from artificial ventilation. After the patient’s carbon dioxide levels cross a threshold the doctors observe whether the patient makes any effort to breathe. If breathing effort is observed, the patient is still alive.
Ventilation means movement of air. Your lungs, by expanding and contracting, either suck in or expulse air. A comatose patient who is not breathing properly will hopefully be on a form of life support called artificial ventilation, which is any artificial method of moving air into and out of the patient’s lungs. The most simple form is to press your mouth to the patient’s and blow air into their lungs, but there are handbags you can use like bellows and various machines that do the mechanical work automatically.
When doctors remove a comatose patient from artificial ventilation for the apnea test, they have to ensure the patient is still getting oxygen to the brain. So they will run a tube from an oxygen machine to the patient’s windpipe. The process of attaching this tube is called intubation.
Because carbon dioxide buildup is thought to drive the breathing reflex, providing the patient with pure oxygen shouldn’t interfere with the test.
All the data is given in Appendix 2. Here are a few examples which you can read for yourself that they documented brain death before intubation.
供心为一脑外伤患者,取心时呼吸巳停,施行气管内插管,人工呼吸,心脏跳动良好。供心取出至复跳共冷灌注保存3小时30分,心脏移植时间69分,循环开放后供心除
Translation: The heart donor was a brain trauma patient. By the time of heart procurement, breathing had ceased. Endotracheal intubation was performed and artificial respiration [established]. The heart beat well. The donor heart was procured …
供心摘取:全麻气管插管下,维持循环呼吸.前胸正中纵切口入路,建立经升主动脉灌注冷心肌保护液系统,放置上、下腔静脉结扎线。全身
Translation: Donor heart extraction: under general anesthesia tracheal intubation, maintain circulatory ventilation.
术前1h给供体静脉注射肝素3mg/kg。自第4肋间横断胸骨进胸,剪开心包,见心脏跳动微弱,心肌紫给,经气管插管辅助呼吸后,心肌转红,心脏搏动转为有力。自升主动脉根部插针灌注4℃的冷停跳液1000ml。。。5.1关于供心保护供心的保护直接关系到移植心脏的成败。对于脑死亡的供者,自主呼吸丧失,心肌缺氧,在这紧急情况下,必须在紧急开胸的同时,进行紧急气管插管及辅助呼吸,以维持心脏的血液循环和氧供,缩短心脏的热缺血时间。本文供体开胸时,胸壁切口已苍白无血迹,心脏己紫给,跳动微弱,但于气管插管供氧后心脏搏动迅即转为有力。取供心时自第4肋间切断胸骨进胸,速度快,显露良好,在野外操作无电源不能进行胸骨锯开的情况下采用此切口不失为一良好选择。本文从开胸到供心取出,耗时仅3min。
The donor was intravenously injected with heparin 3mg/kg 1h before the operation. The sternum was transected from the 4th intercostal space into the chest, and the pericardium cut open. The heartbeat was weak and the myocardium was purple. After assisted ventilation through tracheal intubation, the myocardium turned red and the heartbeat turned strong. A needle at the root of the ascending aorta was used to perfuse with 1000ml of cold cardioplegic solution at 4c°… 5.1 About donor heart protection. The protection of the donor heart is directly related to the success or failure of the transplanted heart. For brain-dead donors with loss of autonomic respiration and myocardial hypoxia, emergency tracheal intubation and assisted respiration must be performed in this emergency situation while opening the chest to maintain the circulation and oxygen supply to the heart and shorten the thermal ischemia time of the heart. When the chest of the donor in this paper 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, which is fast and well exposed. This incision is a good choice for field operation where the sternum cannot be sawed open without power. In this paper, it took only 3 min from the opening of the chest to the removal of the donor heart.
供体脑死亡后,尽快气管插管人工呼吸并迅速开胸,速作升主动脉、肺动脉灌注冷停搏液,压力分别为11kPa(83mmHg)、6.67kPa(50mmH
Translation: After donor brain death, tracheal intubation was performed as soon as possible for artificial ventilation. The chest was opened quickly, and the ascending aorta and pulmonary artery were infused with cold cardioplegia …
于1994年9月27日获20岁男性供体心肺(脑死亡)。其心肺保护过程为:确认脑死亡,气管插管,人工呼吸,吸氧。常规消毒依次解剖,暴露心脏,心跳良好。放置升主动脉冠状灌注管,阻断升主动脉
Translation: Received a 20-year-old male donor heart and lung (brain death) on September 27, 1994. The cardiopulmonary protection process: confirmation of brain death, tracheal intubation, artificial respiration, and oxygen inhalation. Routine disinfection followed by dissection to expose the heart; heartbeat was good. Place the ascending aorta coronary perfusion tube to clamp the ascending aorta.
2讨论 2.1关于供肺保护 供肺的保护直接关系到肺移植的成败。本例供体开胸时心脏呈紫给,但仍有跳动,行气管插管辅助呼吸后心脏变红,跳动迅速转为有力,因而缩短了肺的热缺血时间。第4肋间横断胸骨进胸,速度快,显露好。供肺采取低温肺动脉灌洗加低
Translation: 2. Discussion. 2.1 About donor lung protection… In this case, the heart of the donor was purple when the chest was opened, but still beating. After tracheal intubation and assisted breathing, the heart turned red and the beating quickly became forceful, thus shortening the warm ischemic time of the lungs…
1.3手术配合过程 1.3.1供者准备 取平仰卧位,胸腹背部垫一硬枕。巡回护士选用带加药壶16号静脉留置针迅速建立静脉通道。同时协助麻醉师气管内插管维持呼吸和循环。1.3.2灌注连接管准备巡回护士在无菌技术操作下将肺动脉灌注液连接管接上冷Collins灌注液瓶(第一瓶soomL
Translation: 1.3 Surgical cooperation process. 1.3.1 Donor preparation [Donor] takes the supine position, with a hard pillow on the chest, abdomen and back. Roving nurse selects a No. 16 intravenous needle to quickly establish an intravenous channel. At the same time, [she] assists the anaesthetist with endotracheal intubation to maintain breathing and circulation.
1.4供体手术气管插管通气胸骨正中开胸纵行切开心包并悬于切口两侧探查心脏外观正常后于
Translation: 1.4. Donor surgery. Tracheal intubation for ventilation, sternal opening, longitudinal incision of the pericardium and mobilization of both sides of the incision to explore the normal appearance of the heart.
供体心肺功能正常,但胸廓小于受体10%。于脑死亡 后立即气管插管接简易呼吸囊行控制呼吸，FiO尸0 2。迅 速开胸,肝素化,分离心肺组织,阻断升主动脉后,从主动脉 根部灌注冷晶体停搏液10
Translation: The donor’s cardiopulmonary function is normal, but the thorax is 10% smaller than that of the recipient. Immediately after brain death the trachea was intubated and a simple breathing balloon was used to control breathing… Open the chest quickly, heparinize, separate the heart and lung tissues, block the ascending aorta, and infuse cold crystalloid cardioplegia …
HOWEVER, I read on PubMed that there is an alternative procedure to the apnea test which does not involve intubation.
In the second procedure the patient is not disconnected from the respirator but the minute volume is decreased to a very low level (0.5–2 l/min), with the respirator in the synchronized intermittent mandatory volume ventilation mode and with pure oxygen provided for inspiration. In this procedure, the patient is not disconnected until the required PaCO2 is achieved. Lang and coworkers prefer this method as it prevents tracheopulmonary complications and allows the examiner to detect any spontaneous respiratory effort. Al Jumah et al, have proposed a third procedure of biphasic intermittent positive airway pressure (BIPAP), a method known as ‘bulk diffusion’.
As I am a layman I would appreciate if someone more knowledgeable could read some of the above descriptions, and opine as to whether it is possible the Chinese surgeons determined brain death with this alternate test procedure.
~Max
I’m against capital punishment as a general rule, so this may color my viewpoint, but my moral objection to the harvesting organs from executed prisoners is that it provides an incentive for exectutions. "This guy is scum so we should kill him "is a different moral calculus from “this guy is scum and if we kill him we can take two people off of dialysis, give a heart attack victim a new lease on life, give sight to the blind, …”
The article also notes that elites in Chinese government are always at the top of the list for receiving an implant, if someone in their family needs one, and I saw another article this morning on The Wire saying that, “Hospitals continue to advertise organs to transplant tourists with websites in English, Russian, and Arabic”.
I have no particular good will for Falun Gong, given their political activities in the USA, but I don’t believe that I can support an argument for a profit motive for executing them.
I question that article’s assertion and assumption that “brain dead” is the only version of “dead” that matters. Life and death are far harder to define than those people seem to want to accept.
The Hippocratic Oath? That’s Eurocentrism, maybe even Western Imperialism attempting to impose foreign values on Chinese culture.
A discussion on the topic:
In all cases where we might say that it’s ethical to take a person apart for their organs, though, I think we can assume that a person should be in some sort of irreversible something where the person would fairly quickly reach permanent death if left unattended for a few days, and that’s never going to get better. And, that that something doesn’t allow them to perceive the world nor interact with it. I.e., some form of coma, not just being quadriplegic or whatever.
But so that gives us the questions of how many people end up in an irreversible coma/vegetative state (coma, for short), on average? How many of those tend to be prisoners? And how many people need an organ transplant on average?
The best source that I can find would be Spain, giving us about 46,778 patients who are in some form of coma (including reversible). Even though that number will be higher than just irreversible, let’s run with it since we might assume that China and Chinese prisons are just a more dangerous life style than everyday Spain, with more head injuries and a less healthy environment.
Spain has 47.35m people and, if we only want to take organs from people between 15 and 65 then we get 9708/47350000 as a likelihood of a person of harvestable age in poor living conditions, to go into a coma.
The Wikipedia believes that there are about 1.7m people in prison, in China. And now, if we say that about 97% of prisoners are between 15 and 65, then that would say that we expect a total of 338 comatose prisoners to be in Chinese prisons, at any given moment - if we assume that they’re not being harvested for organs, since that would remove them from the pool. At any rate, this gives us a number to compare to versus the pool of all people needing a transplant.
In Japan - a country with a better lifespan than China - the total number of people in need of an organ transplant is probably around 18,550. If we take that same rate over to China then we have about 206,733 people in need of a transplant.
I think it’s safe to say that naturally occurring comatose prisoners are not the source of organs.
And, of course, that’s assuming that 100% of comatose patients were deemed worthy of execution. (Which, granted, they are a money sink if they’re in an irreversible state - so it might be.)
In 2018, they were performing about 20,000 transplants per year but it looks like China is also only admitting to about 1,000 executions per year, total. So even if we assume that they’re harvesting 100% of them, that would still be far less than they need.
Of course, that’s all based on public/official numbers.
The article suggests an organized, secret, genocidal movement against Falun Gong and the Uighurs. If that’s real then public numbers aren’t a good indicator.
But, of course, you could also get to 20,000 transplants a year by doing better at getting the equipment and training into hospitals to deal with car accident victims, and etc. Genocidal murder really isn’t the only option here.
And we might note that with Falun Gong, involved, and their strength at propaganda in the USA, this could, largely, be false news. At this moment in time, I don’t know where Mr. Guttman got his information from.
It does seem to be that the Dead Donor Rule is a popular convention among Western Doctors. There is no official statute. China has not signed anything.
That said, saying one thing and doing another is still makes you a deceitful person, undeserving of trust, even if what you’re hiding isn’t worth hiding. If they’re saying that they follow the Dead Donor Rule and, then, not doing that then that would be a negative.
China doesn’t need to bow to Western norms.
Some of the more official information on the Uyghur Situation:
It basically amounts to saying that people are being put into prison, punished if they don’t speak Chinese and accept Chinese law, and forced to work at places that they don’t want to work.
Mike Pompeo has said “genocide” and the governments of the US, Canada, and Netherlands have hinted at it, but I don’t see anything from any of them providing support for the argument. The best would seem to be a Twitter post by the Chinese embassy saying that Uyghur women weren’t going to make babies any more.
That would point to extreme medical intervention, but not of the kind that we’re looking at here.