- Three years ago, Dr. Thomas Diflo's moral nightmare walked
into his examination room: a patient freshly implanted with a kidney bought
from China's death row, where prisoners are killed - sometimes for minor
offenses - and their organs harvested.
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- Since then, Dr. Diflo, director of the renal transplant
program at the New York University Medical Center, has seen half a dozen
such people, typically young Chinese American women. The surgeon says his
patients weren't distressed about snatching organs from the condemned,
but he was overwhelmed by the implications.
-
- Unable to shoulder the burden alone, on January 11, Diflo
took his "horror at a real ethical quagmire" to the medical center's
Ethics Committee.
-
- Diflo is the first American doctor to talk publicly about
this experience, and he did so only after being drawn out by the Voice.
The gruesome practice has been documented among ethnic Chinese communities
throughout Asia, but so far every attempt to prove that people were leaving
U.S. soil to buy organs from China's massive death row has failed.
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- "To tell you the truth, the original rationale
for bringing this situation to the Ethics Committee was my own discomfort
in taking care of these patients.""Dr. Thomas Diflo
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- "To tell you the truth, the original rationale for
bringing this situation to the Ethics Committee was my own discomfort in
taking care of these patients. I was outraged at the way in which they
obtained their organs, and I had a great deal of difficulty separating
that fact from the care of the patient," Diflo told the Voice.
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- "Several patients were very up-front and candid
about it, that they bought an organ taken from an executed convict for
about $10,000," Diflo recalls. "Most of the patients are ecstatic
to be off of dialysis, and none has seemed particularly perturbed regarding
the source of the organs."
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- There's no telling how many kidney buyers returning to
the U.S. have gone for follow-up care at a less elite institution or stayed
within secretive medical channels recommended by their brokers. Diflo gets
his patients on referral from recognized hospitals. "Patients sort
of arrive on their doorstep and they don't know what to do. Not everybody
who's had a transplant is cared for by a transplant specialist. I tend
to see the more complicated ones," Diflo says.
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- Of all medical disciplines, organ transplantation is
perhaps the most bittersweet. Transplants are gifts that coax life from
death, that close the door for one person while opening the future for
another. But the outright sale of organs is abhorrent to nearly all surgeons
in the field. Selling organs is a felony under a 1984 federal law that
was spearheaded by then senator Al Gore, and is punishable by up to five
years in prison and a fine of up to $50,000. Live or executed prisoners
in the U.S. are forbidden to donate an organ, even for free, except to
family members under special circumstances.
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- In China, human rights groups say, citizens have been
executed for nonviolent offenses like taking bribes, credit card theft,
small-scale tax evasion, and stealing truckloads of vegetables. Political
dissidents have also been sentenced to death. Chinese embassy officials
did not respond to requests for comment, but in the past the government
has denied promoting the for-profit organ trade.
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- Diflo says he and his colleagues wrestled with the issue
in a debate that was "quite lively and revealing, but the bottom line
was that we take care of patients who come to us, regardless of their situation"moral,
ethical, financial, orsocial. Although I might find what they had done
reprehensible, I was still nonetheless obligated to care for them in the
best way that I knew how, and that is what I do."
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- But Diflo refuses to let it end at that. "Because
it is not really appropriate for me to take my outrage out on the patients
who come to me, I began to think that I would be better off addressing
the root problem, the pilfering of organs from prisoners in China. That
is what pushed me to pursue this further," he says. And so he's going
public.
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- America-based human rights activists have sought this
break for years.
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- The trafficking of human organs from Chinese executions
to American residents is "something we've always known was going on
but something we've never been able to document," says an American
investigator working for the Laogai Research Foundation, a group founded
by renowned human rights crusader Harry Wu and named for the gulags of
China.
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- The Federal Bureau of Investigation partnered with Wu
in 1998 in a sting operation aimed at netting two suspected organ brokers
who resided in Queens. Wu posed as a board member of a renal clinic in
Aruba and got the men, Wang Cheng Yong and Fu Xingqi, to not only arrange
for patients to fly to China for kidneys but to also smuggle corneas, which
can keep for weeks when frozen, for sale abroad. The case was dismissed
when a key witness fled the U.S. and refused to return to testify. The
Laogai Research Foundation also discovered a doctor advertising himself
as an organ broker in a Chinese-language newspaper published in the U.S.
But no physical evidence was ever uncovered. In 1998, the FBI raided the
Los Angeles offices of a man the feds said had presented himself as an
organ broker, but it's unclear whether the scheme led to any transplants.
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- When told that an American doctor was revealing his experiences,
the laogai investigator, who asked that she not be identified because it
would make her work in China impossible, pointed out that the opening comes
at a critical time. Executions in China have surged to 400 in April alone
as the Communist government conducts another of its periodic "strike
hard" crackdowns on crime. During the most recent campaign, in 1996,
more than 4000 prisoners were killed, she said.
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- Even in a normal year China executes more inmates than
in all other nations combined, reports Amnesty International. In 1999,
the confirmed toll reached 1263, according to the organization, which gathers
its statistics from tallies published, for propaganda purposes, in government-run
newspapers.
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- "It's for scaring criminals and scaring" controlling"society,"
the investigator says. The approach is known as "killing the chicken
to scare the monkey."
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- Executions often come in floods, usually around the holidays,
according to the investigator. This week, with the Labor Day celebrations
that started May 1, is viewed by Chinese doctors as a particularly good
time to get an organ, but there's no better time than the Lunar New Year,
she added. Most"perhaps 70 percent"of the hospitals performing
the procedures are run by the military, which has the best connections
to the penal system and can be present at executions, she explains. Money
from patients purchasing organs is dispersed among those who provide access
to the prisoner's body. Hospitals even pay judges to tip them off when
they sentence a suitable donor to death. "The money goes to officials
all of the way up the line," she says. "It goes to the courts,
the people in charge of the prisons. It goes to the doctors, the hospitals,
everything."
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- The Laogai Research Foundation reports that sometimes
tens of operations are done at the same hospital on the same day for patients
who are essentially walk-ins. China says it has performed about 25,000
transplants in 20 years, but makes no distinction between organs culled
from executions and those garnered through accidents and live donors.
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- Forced labor from China's laogai has always been a source
of cash for the country's rapidly advancing economy. And punishment doesn't
necessarily end at the point of death, usually a single shot to the back
of the head. Families are often forced to pay for the bullet used. But
the laogai turned into Execution, Inc. less than 20 years ago after the
introduction of Cyclosporine, an immunosuppressant drug that prevents rejection
of organs by the recipient's body.
-
- Wei Jingsheng, an agitator at Columbia University's Human
Rights Center, testified before the International Relations Committee and
Government Reform & Oversight Committee of the U.S. House of Representatives
on June 4, 1998, that while he was on death row a guard confided that often
organ removal is the means of execution in and of itself. Wei, who now
heads his own foundation in Washington, D.C., stated that the guard told
him, "There are almost no exceptions. They first are given ansthesia.
Just the same as killing a pig. . . . We use cloth to wrap them up and
bring them to the execution ground. No one cares if they are alive or dead."
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- Further, Wei said he had confirmed, through a plan hatched
with a 20-year-old cellmate, that executed prisoners were being harvested
against their will. The young man, whom he called Zhang, was to cry out,
"I'm not sick, I don't need a doctor," if he saw a medical team
equipped to harvest his organs waiting at his execution. If there was no
evidence of this, Zhang was to scream as the condemned normally would.
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- After a long stretch of silence, Zhang sent the message.
"My first feeling was of satisfaction, knowing that this evidence
finally proved this practice. But this feeling was quickly replaced by
another," Wei told the congressional committees. "My second feeling
was of heaviness, knowing that this young man used his life to record an
unbelievable crime. If I did not have the opportunity to tell others of
this evil, if I did not have the opportunity to try and stop this evil
from continuing, then I would have to apologize to this young man. All
this time, I have deeply felt this responsibility. We must stop this practice."
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- Harry Wu spent 19 years in the laogai, and has also testified
before Congress. His Laogai Research Foundation claims that when bullets
are used, the target reflects the market: a shot to the head when a liver's
wanted, a shot to the chest when corneas are in demand. Amnesty International
also reports that a form of lethal injection gaining acceptance in China
can be used to kill without damaging crucial organs, and can blur the line
between life and death.
-
- Young, nonsmoking prisoners are given blood tests and
medical exams to assess compatibility with arriving patients, the investigator
explains, and courts set execution dates accordingly.
-
- Long before the U.S. and China clashed in the spy plane
incident, the West was wary of the emerging superpower. Wei and Wu have
edged the organ trade into the human rights spotlight on China, an arena
already crowded with accusations of prison and child labor, coerced abortions,
and suppression of religious minorities and Tibetan national aspirations.
The nation's trade surplus with America, chilling of freedoms in Hong Kong,
and occasional saber rattling at Taiwan have done little to soften sentiments
in Washington. Business interests striving to engage China as a strategic
ally, rather than competitor"through most-favored-nation trade status,
membership in the World Trade Organization, and support for its bid to
host the Olympics"may have a tougher row to hoe now that Diflo is
delivering the goods on an explosive Chinese crime that touches on American
soil.
-
- Suddenly, what had existed largely as a kind of urban
legend, a science-fiction horror story from a distant world, has become
very, very real, right here on the streets of New York. Activists say that
if it's happening here, it's likely happening in other large cities of
North America, from Boston and San Francisco to Vancouver and Los Angeles.
-
- The Chinese government published regulations in 1990""On
the Use of Dead Bodies or Organs From Condemned Criminals""stating
that for a prisoner to be a donor, prior consent must be given by that
person or remaining family, unless the body is unclaimed. Human rights
activists scoff at that statement, noting that since prisoners are often
kept from communicating with family members, there is no one to claim the
body, which is harvested and cremated almost immediately. The government
also requires that medical teams involved in the procurement of organs
act stealthily: "Surgical vans must not display hospital logos; surgeons
must not wear hospital uniforms when at the execution site; guards must
be present until the organ is removed; and the corpses should be promptly
cremated following the removal of the organs."
-
- Human rights groups seeking to determine the source of
organs might try matching the dates of operations to dates of executions
in the same city, but the method isn't reliable, especially since the government
has taken to selectively publicizing its tallies. The Laogai Research Foundation
says doctors speaking for the Chinese government claim regulations against
contacting the family of a donor prevent them from revealing to patients
where the organs come from.
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- The harvesting enrages physicians like Dr. Diflo. "I
think it's a gross violation of human rights and very much at odds with
what the transplant community tries to promulgate as the way to go about
things. This does not involve appropriate consent. I don't think prisoners
are given the option of donating or not donating. It's not done from an
altruistic point of view," Diflo says. Even putting aside his reservations
about the death penalty, Diflo says, "The central issue is the nonconsensual
taking of organs and making human body parts a commodity."
-
- The Laogai investigator agrees. "It's very obviously
profit-motivated because if the person can pay extra then they might be
able to move up an execution date, or have it arranged for later,"
she says. "And those who pay more get better treatment." She
cites a case where an ethnic Chinese patient from Malaysia was allowed
to die without anti-rejection medications when his money ran out.
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- The economics of human organtrafficking are powerful.
Patients can live active lives on dialysis"thanks to this technology,
most don't need a kidney to survive"but the inconvenience and discomfort
are considerable. Diflo says his patients were "obviously much more
troubled by being on dialysis than by getting organs this way."
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- For patients, the cost of a transplant is far cheaper
than a lifetime of dialysis, says Dr. André-Jacques Neusy, head
of the dialysis unit at Bellevue and director of the NYU School of Medicine
Center for Global Health. Both Bellevue and NYU Medical Center work with
Gouverneur hospital in Chinatown.
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- Bellevue is a public hospital, so it takes all comers.
Many of the city's sick immigrants end up here. "We call it the 'Bellevue
Express,' " because patients head there directly from the airport,
remarks Neusy. In addition to being the designated facility for the president
and visiting dignitaries, the hospital offers extensive translation services.
-
- Affiliated with the NYU Medical Center, Bellevue is Dr.
Diflo's chief source of referral patients who have Chinese prisoners' organs.
People who receive a transplant must remain under a doctor's care for an
extended period. Thus, patients who buy a kidney from China's death row
end up seeking treatment in American hospitals, where the cost can be supported
by public funding. Diflo says his patients pay for their anti-rejection
drugs with Medicaid and Medicare.
-
- Though no patient would be denied treatment at Bellevue
when arriving with an organ of mysterious origin, candidates for domestic
transplants must be legal American residents. Even for those eligible candidates
the wait for an organ can be extraordinary. There are now more than 75,000
people on waiting lists for organs in the U.S., according to the United
Network for Organ Sharing, which maintains the national Organ Procurement
and Transplantation Network under contract with the U.S. Department of
Health and Human Services.
-
- Fewer than a third of those people are likely to get
their organs this year, the group said in March. Immigrants, both legal
and illegal, will sometimes visit home rather than relocate, naturalize,
or wait, Neusy says. "We've had patients disappear from the dialysis
unit and reappear with a kidney," he notes. He was unaware of any
who'd gone specifically for kidneys from executed prisoners in China. "It's
disturbing to think we have professional colleagues on the other side that
would condone this kind of thing," he says.
-
- Dr. Nathan Thompson, also of Bellevue, concurs. "We
have had patients who have gone against our advice and come back with transplants.
Where they've gotten them I have no idea," Thompson says.
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- "I guess we,ve all heard about things like this,
but it kind of gets you when, for the first time, you see it.""Dr.
Gerald Villanueva
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- Another Bellevue physician, Dr. Gerald Villanueva, sent
Diflo a Chinese American woman who had appeared at the hospital, implanted
with a death row kidney. Suffering from hepatitis, the patient became one
of the complicated cases referred to NYU. Only after talking to Diflo did
Villanueva realize the source of her transplant. "I guess we've all
heard about things like this, but it kind of gets you when, for the first
time, you see it," he says. "There are things we read about,
but when you see it, it's still surprising. I guess it shouldn't be, huh?"
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- Diflo says that doctors seeing scores of patients daily
simply don't have time to probe more deeply into their patients' histories,
especially when language is a barrier. And they're not paid to argue with
their charges. "I don't really see that confronting them about the
ethics involved will really serve any useful function. In addition, we
see them during our office hours, in which we can see as many as 50 patients
in three hours"not really time for prolonged ethical discussions,"
he says.
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- Most doctors interviewed for this article agreed that
the majority of those organs aren't coming from China. There's a thriving
black market in organs sold by live, willing donors in poorer nations with
medical know-how, like India. "I believe that both are morally and
ethically reprehensible," Diflo says. "If there are degrees of
reprehensibility, however, China wins hands down" because the organs
are coming from the executed, who are deprived the right of refusal, for
profits. Unlike with desperately poor live donors, that's cash that neither
the victims nor their survivors will ever see.
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- Nearly every country touched by the orgaqw de rose.
In the United States, the practice of flying to China for organs becomes
a crime if arrangements were made for a fee on American soil. Buqwt as
with the war on drugs, many experts argue that the only real solution to
fighting the organ trade is by addressing the demand. People need organs
quickly, through humane means. Doctors interviewed floated several ideas.
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- The most ready cure is for more people to make provisions
that their organs be donated at the time of death. Belgium achieves this
by presuming organ donation, requiring that people opt out. The doctors
noted that while organ donor cards (like those on drivers' licenses) might
help tip the balance in discussions with family, the form isn't a binding
agreement. Families can still have the final say. And even with that acceptance,
families"parents"must be willing to say goodbye at times when
they might falsely believe there's a shred of hope.
-
- "Brain death is a hard concept to get across. Japan
only recently accepted it as a legal definition," explains Dr. Dale
Distant of the SUNY Downstate Medical Center. "How does a person take
this action when their loved one is warm, his heart's going, a machine
is making his lungs go up and down; when for all the world he's just in
a coma?" In many corners of the world, including part of Asia, people
hold strong, entrenched taboos against violating the body after death.
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- Dr. Neusy would like to create centers in less medically
advanced nations where the needy might be screened and matched with potential
donors, usually family members, and then prepared before finally being
brought together to the U.S. and other rich nations for the operation.
Others promote the free market as a way to meet the demand for organs.
One group of supply-siders operates a http://web.organselling.com/~htk
Web site and on August 26, 1999, a kidney from a live potential donor
was offered up on eBay before site managers closed the bidding down.
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- On the furthest fringe, some scientists are hoping to
master techniques that might allow newborns in future generations to be
equipped with a genetic repair kit"stem cells or other tissue frozen
at birth or even later for eventual cloning into needed organs. Enterprises
like the longevity company YouthCell have been founded on this premise.
Scientists are also trying to perfect transplants from livestock into humans.
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- But social and technological change takes time. Meanwhile,
no one expects Chinese bureaucrats to readily forsake an easy source of
income like selling organs from the laogai. "If you have a government
more or less imposed on the people, you can do that, so in China it's not
a problem," says Distant.
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- Diflo, for his part, says he came forward not to seek
attention for himself but in hopes of kicking off public discussion and
scrutiny of the issue. "I don't see myself going on a world speaking
tour," he says. "The whole reason I spoke up about this is that
I was having a difficult time taking care of these patients because of
my own repugnance at what had gone on and how things had happened. It really
comes from a more personal place. It comes from my own outrage."
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