How the CCP Monetizes the Bodies of Its Prisoners | Matthew Robertson

[RUSH TRANSCRIPT BELOW] The Chinese communist regime has “created a market in the organs of their political enemies,” says Matthew Robertson, a researcher who has been investigating China’s organ transplant system for more than a decade.

Fluent in Mandarin, Robertson is a China studies research fellow at the Victims of Communism Memorial Foundation and co-author of a number of research papers on China’s organ transplant system including, “Execution by organ procurement: Breaching the dead donor rule in China.”

After conducting a forensic review of thousands of Chinese research papers, they found 71 cases where violations of the dead donor rule were essentially written into the paper itself.

In a moment that stunned the world, Chinese leader Xi Jinping and Russian President Vladimir Putin were recently caught on a hot mic with their translators talking about increasing longevity through repeated organ transplants.

What is the true extent of China’s forced organ harvesting industry? How are physicians in China complicit? It’s been known for many years that practitioners of the Falun Gong spiritual practice have been a prime target—but are they the only ones?

Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

Editor’s Note: Matthew Robertson previously worked as a journalist for The Epoch Times. 

RUSH TRANSCRIPT

Jan Jekielek:

Matthew Robertson, such a pleasure to have you on American Thought Leaders.

Matthew Robertson:

Hello, Jan.

Mr. Jekielek:

You describe it as state-sponsored organ trafficking. Sometimes it’s called forced organ harvesting. I’ve described it as a murder-for-organs industry in communist China. The bottom line is that something terrible is happening over there. And if you were to describe it to someone who’s maybe skeptical or who hasn’t heard about it and might find it unbelievable, how would you explain that to them?

Mr. Robertson:

I think you might start with what is the standard way that organs are procured and transplanted in most countries around the world. And that is from voluntary donors to recipients based on medical need. Countries around the world create a system that facilitates this altruistic transfer where there is, you know, a tragedy that has resulted in, most typically, brain death. This is in the case of vital organs; the individual is brain dead, declared so in the hospital, and then there is an organization that facilitates, you know, gains permission if they weren’t already a donor. And then that’s the kind of transplantation that we are mostly familiar with. 

So at least until 2015, and probably subsequently, China’s model of organ transplantation was very different. Almost the sole source of organs were prisoners of one kind or another: death row prisoners, prisoners of conscience/political prisoners, and in some cases, simply beggars—like homeless people—who were kidnapped and killed, according to PRC [People’s Republic of China] media reports. When I’m talking about state-sponsored organ trafficking, I’m talking about state, military, and paramilitary hospitals that have a transplant wing, and they’re performing transplants, but the organs are obtained, procured illicitly, often by killing prisoners. 

And then they are distributed not by medical need, but by the ability to pay cash to the recipient. There are some private hospitals; those are run by surgeons as a kind of a side hustle. Those surgeons are, of course, affiliated with the state, or they’re party officials, or they’re the party secretary of a hospital. But that’s basically how China’s organ transplantation system operated, and almost certainly continues to operate. 

Mr. Jekielek:

What would you say is the strongest evidence you’ve seen that this whole thing, which sounds almost unbelievable, is real?

Mr. Robertson:

I think ironically the strongest evidence is simply the utterances of Chinese officials themselves. You could look at an official statement by someone like Dr. Huang Jiefu, who was the former vice minister of health and is now kind of the great eminence of the transplant system. He’s sometimes called the transplant czar. He has admitted almost everything I just said. 

The idea that Chinese hospitals procured organs from prisoners is not disputed by, you know, the Chinese medical establishment. That there was buying and selling of organs is not disputed. The kind of dispute lies with the identity of the donors. That’s a matter of some controversy. 

And then perhaps the matter of scale or sophistication or organization or, you know, systematicity—these kinds of questions. I think each piece of the puzzle has a different kind of evidentiary trail. We could think about something like the involvement of surgeons in the execution process. The evidence there is Chinese medical publications that show quite explicitly that the donor was not deceased by any medical or legal criterion at the time of the procurement. And therefore, there’s a violation of the donor.

Mr. Jekielek:

You’re saying they were killed by the organs being removed?

Mr. Robertson:

Yes. So the removal of the heart is the proximate cause of death in those cases. That’s what our paper shows. Let’s talk about trafficking. So what’s the evidence of trafficking? In that case, it’s even more straightforward. Because you look at hospital websites before they were all taken down in 2006, 2007. But they’re all in the Wayback Machine or otherwise archived. And they would have price lists on their website for the organs. 

So, okay, they’re clearly being sold. It’s a pay-for-treatment system. So all kinds of transactions are cash for the organs. So there wasn’t, at that time, a kind of state health insurance system that would cover these treatments. There’s an interesting piece of evidence that, when you dig into it, has so many different, really interesting implications about things we cannot observe that are worth discussing. Do you want me to?

Mr. Jekielek:

Yes, please.

Mr. Robertson:

Okay, this is a phenomenon called emergency transplants—emergency liver transplants, specifically. So I’ll explain what that means. If a patient in any country has acute hepatic failure, their liver fails. If they do not receive a new liver within a short period of time, then they are going to die, because the liver is required; it’s a vital organ. A patient in the United States, Australia, or the UK, for them to get that organ, they present at the hospital, their condition is diagnosed, and the need for an organ is established. 

And then they’re basically first on the waiting list. If in 24 to 48 hours there is a tragedy—there was a car crash or some other incident that renders a compatible donor brain dead—and that compatible donor has already registered as an organ donor, or their family agrees for them to become a donor, then the recipient will get that liver, and their life will be saved. 

So how do you do emergency transplants when you don’t have voluntary donors? The Chinese government has never explained that. What we know is that in 2005, they published the annual report of the liver transplant registry at the time that had a subsection, which included a certain number of the total hospitals doing organ transplants. And then in 2006, they published the same annual report. And these have both been deleted from the internet. 

They showed—I’m not going to get the numbers exactly, but it was something like 25 percent, and then the other was close to 30 percent. There were many that were done on an emergency basis, and then the remainder were done on an elective basis. So if you don’t have voluntary donors, this is what the government says; therefore all the organs are coming from prisoners. And yet to get a liver, you need a compatible donor who has recently died. Then you have possibilities. 

One is that it just so happened in every single case that a prisoner was going to be executed on that date when the need for that liver arose, and that prisoner happened to have a compatible blood type, and that prison and that hospital had some connection. So it had to be local. 

So the difference, you know, in the UK, it could be the entire country, but in China, there was no computerized system for allocating organs, and so it would have to be local. So that’s one. You can see a chain of increasingly implausible conditions that would allow that. Even then, it’s from executed prisoners. 

The other is something that you can see that doesn’t make sense in official publications. And then there are different inferential possibilities, like ways to explain this outcome. But they all strangely point in one direction. Well, the highly implausible one in this case would be that there were death penalty prisoners and they happened to be killed at that time, blah, blah, blah. 

But then the far more plausible one is that actually, the Chinese state had blood-typed a much larger number of donors, because if you’re going to have so many that are on this emergency basis, then you must need a larger pool from which to draw. And that would have to be at many places nationally because there are dozens of hospitals in this data set. 

And so just this one page in these two documents has this ripple of implications about what that actually means in terms of the logistics, donor sources, and what must have been happening to enable that to have been reported. And then sometimes, some of these hospitals—before there was international attention in 2006 by Kilgore and Matas, and everything else that went on then—they were saying, we have the bodies, or to that effect, very explicit statements that they have the donors ready.

Mr. Jekielek:

Right. I remember people were calling up and saying, yes, we can set it up for you on the other end of the line. Which is unbelievable when I think about it. It’s been a while since I looked at that evidence, by the way.

Mr. Robertson:

I think people just don’t believe the phone calls were real in those cases. Because they’re like, well, how could those be real? The interesting thing is, I did a sub-study of just those phone calls. And so I spoke to the investigators who made the phone calls and then got their downloaded Skype records from their actual account. They let me log into their account and downloaded them, and it’s got like the call time and date and then the duration of the call, and then matched that to the actual audio file. 

And then it’s got the numbers they called, and then I would call those numbers back and say, is this the so-and-so hospital? And they would say, who is this? And then I would hang up. And like, so I confirmed to my satisfaction that the call records showed that they made that call to that number for that length of time, and then the audio matched it. The calls are real. But yes, for anyone who’s actually looked at the transcripts, it’s rather extraordinary that these things would just be said on the telephone.

Mr. Jekielek:

So when it comes to the identity of the organs, you mentioned that this is contentious, the identity of the source of the organs. So what is it that you’ve come to believe based on your extensive research? 

Mr. Robertson:

So the most contentious point on that is whether they came from Falun Gong or not. And then kind of the more contemporary question is, are they coming from Uyghurs or not? And on both of these, I think you could think of the calls as direct evidence, potentially. Like, if you believe the calls, you have surgeons on the call saying, yes, we’ve got the Falun Gong organs. Are they like upselling? Are they just running their mouths on, you know, a random phone call? 

The way that I have approached this is that I have a paper as part of my dissertation that specifically looks at this question of the identity of the organs because that’s significant. If the organs are coming from death penalty prisoners, you have a situation where the state can explain the emergency transplants potentially even by death penalty prisoners, where the state has blood-typed prisoners, but they just haven’t actually carried out a formal judicial execution until they’ve been required for an organ. 

And the other possibility is obviously they’re doing extrajudicial executions of political prisoners. And so prior to, you know, 2017, 2018, when the mass detention of Uyghurs took place, the repression of Falun Gong was the largest repression of a religious group in China. There was mass detention starting in 1999. In terms of the organ transplantation system, one would not expect, without any prior information, that the growth of transplantation and the detention of a particular religious dissident group would be connected. But if you look at indicators of transplantation activity, several key indicators suddenly go up in the year 2000, six months after the repression. 

For my work, what I’ve been able to gather is a large corpus of medical publications. I downloaded something like 100,000 PRC medical papers, and usefully, they’re in a single database. They show when you do a lot of things to code them according to their content and whether they are like a clinical paper about a particular transplant. They suddenly go up in the year 2000, and then they dip a little bit in early 2006, which happens to be when the actual revelations of forced organ harvesting.

Mr. Jekielek:

It’s called, it was when I first realized it was real that then I felt the evidence. I mean, I didn’t want to believe it. I remember, right, that this seems so outlandish. But I felt at that point the evidence was compelling enough that it was real.

Mr. Robertson:

Sure. So that’s like you have this temporal observation. There are two explanations, right? When you see mass repression of this group, mass detentions, and then blood tests, these phone calls, and targeted organ examinations. There are some particularly acute cases where a surgeon has another hat as the leader of an anti-Falun Gong propaganda group, and that’s unusual. Why would a liver transplant surgeon also be specifically involved in repressing a religious minority? 

On the other side, there’s a well-known case of a security official who performed a lot of transplants and oversaw a lot of transplant operations. This security official was directly involved in the repression of this group. It’s evidence like that, blood tests, organ examinations, and so on. You’ve got to explain the outcome that you observed, which is a lot more transplants. So you’ve either got this explanation that they came from this group, or you basically have to say that it was actually death row. 

So the death row system is an order of magnitude larger than anyone has observed. Moreover, it continued to grow, even as all indicators about death row showed that it was receding. These are the reports by human rights organizations based on their estimates and discussions with Chinese officials, some leaked documents, and then significant reforms to the death penalty system in 2007 that centralized review to the Supreme People’s Court. 

There are a lot of laws associated with the death penalty system. That is a topic that has received far more scholarly attention than organ trafficking. It is a highly implausible set of hypotheses or claims that you would have to advance; you would have to show that it was actually the death penalty all along.

I’m not clear there’s a third competing hypothesis for this outcome. To the extent that it’s contentious, it’s driven by, I would imagine, just a simple lack of knowledge of the observations, the outcome, like lots of transplants, and a lot of growth in the transplant infrastructure. There are so many different ways of measuring that growth: the number of surgeons, the number of hospitals performing transplants, new hospitals and hospital wings, and the advancement in different kinds of transplants, because a liver can be transplanted in different ways. 

Chinese surgeons have been on the cutting edge of surgical improvement in performing transplants. You need to do a lot of transplants for these things. Everything shows there were lots more transplants being done. You have to explain that. The paper I have, the dissertation, looks at the competing explanations and then chases down data that supports or doesn’t support either of them.

Mr. Jekielek:

And the bottom line is, the other explanation isn’t very plausible. I mean, of course, I’m familiar with your work.

Mr. Robertson:

Yes, so the death row explanation hasn’t even been seriously advanced, but it’s the only alternative. But no one has come out and claimed that. 

Mr. Jekielek:

That paper, and thank you for co-authoring it with Dr. Jacob Lavee, is one of the closest things to a smoking gun. It’s written into the transplant literature that these transplant surgeons and researchers are killing people by extracting their organs, as we discussed earlier. It’s shocking. I mean, it’s shocking to me that they let you publish with that headline, actually. I’m really glad they did because I think a whole lot of people suddenly understood something they didn’t understand before. What kind of interest has that paper generated? You know, I guess, what has come out of that subsequently?

Mr. Robertson:

I found it to be incredibly compelling. The two things that strike me as interesting about that paper are that the finding itself wasn’t the shocking part to Dr. Lavee and me. It was that we actually saw the data. Both of us were prepared to believe that this was real based on work that had already been done, but we were only surprised to find that we could actually count lots of them through some, you know, looking through these papers with some basic coding methods that can now be done much easier with AI. So that we found them at all was the surprising part to us.

The other was that it wasn’t actually new information. It had already been shown by the World Organization to Investigate the Persecution of Falun Gong [WOIPFG], an advocacy group that has all this evidence on the repression of Falun Gong. In a paper, and it might have even been two papers by Huige Li and colleagues, it had been shown that there were instances of this. I think what Dr. Lavee and I added a systematic methodology and got it into a journal. But the actual bare facts were not new. 

That’s interesting because it kind of suddenly makes something real because an institution in a position of authority has declared it to be so effective. But it was already real before we got it published. I think that’s interesting because a lot of this seems to hinge on questions of authority. Who has been authorized to declare something to be a fact about this topic?

Mr. Jekielek:

So you use a lot of these computational methods. You mentioned that some of them can be done better with AI language models today. Can you just give me a basic picture of what you do, what you specialize in, and your kind of career trajectory?

Mr. Robertson:

Yes. The field is called computational social science, or social data science is another term for it. It’s simply using computers, building data sets out of text, wrangling text into grids, extracting variables from unstructured text, and then doing statistics on them. For example, with the medical papers, that was many months and thousands of lines of code just to get into the website and download all the files. That’s only the beginning because once you’ve got it, you now need to extract the text from the PDF files. There’s nothing glamorous about it. So it used to be really hard to do that before AI. You had to actually write code yourself. But now you can just tell the computer to write your code as long as you know exactly what it is you want.

Mr. Jekielek:

So how did you get into this?

Mr. Robertson:

I was frustrated with the epistemic status of the topic. Some people thought it was real, and some people didn’t think it was real. There seemed to be taboos around figuring out what’s going on and doing so properly. Also, I had a great deal of ignorance about what it actually means to do scientific research, especially on a topic like this. And so I wanted to figure out how to actually produce knowledge. 

What methods do you need to create reliable knowledge on things that are hard to study? It’s interesting to reflect in hindsight that it’s not clear that actually producing knowledge artifacts changes what people think. You would think it would, but there’s not a necessary relationship between those two. It’s not one-to-one, but it does help. I’d like to think so.

Mr. Jekielek:

I can tell you it does, because again, this is the reason why I often cite your paper, the Execution by Organ Procurement paper, because it’s highly compelling knowledge, knowledge that was created as you described or at least resurfaced and validated. 

Mr. Robertson:

Yes. It also relies on authority to a degree. We trust that because it’s the American Journal of Transplantation, and the reviewers have done their job. 

Mr. Jekielek:

I think it’s, based on my opinion, I think it’s particularly valuable because, as you mentioned, there’s a bit of a taboo around this issue, right, in all sorts of areas, in academia, in the transplant industry, as you well know. Yet it was actually validated by a very, I guess, prestigious authority on the issue. And so I felt that that actually elevated the issue considerably, right? Because I would imagine they actually experienced some pressure or some thought about perhaps not doing it, as is often the case with publishing contentious things. In my mind, the use of Falun Gong practitioners for these organs has been pretty well established through your work and the work of some others. However, the next claim is that at some point, Uyghurs started being used the same way. 

And to me, this makes perfect sense because, unfortunately, this issue wasn’t dealt with in any meaningful way, and these types of crimes against humanity have a way of spreading when they’re left completely unchecked. So it makes perfect sense that that would happen. We know that Ethan Gutmann, who’s one of the big researchers on this issue, is working on a book as we speak, looking at this question when it comes to Uyghurs. He’s written one of the more definitive books on the issue in the past, The Slaughter. But what, in your mind, is the reality of this having moved or at least incorporating the Uyghurs as a source?

Mr. Robertson:

To begin with, you have a situation where hundreds of thousands to up to a million, to over a million, who knows, a large number of people have been incarcerated. It’s been described as a genocide by the U.S. State Department. And then we know from the Xinjiang police files, this is a leaked case of documents that was leaked to my colleague Adrian Zenz at the Victims of Communism Memorial Foundation, that shows that there’s been mass blood testing of this population. And then there’s large-scale DNA collection as well. 

And then there are accounts by survivors of strange medical examinations, such as urine tests that are repeated. It’s not clear what condition that’s aiming to detect. So it’s not just urine tests, but also ultrasounds of abdominal organs, CT scans, urine tests, blood tests. These are, especially when they’re repeated, not aimed at assessing the general health of the detainee. They seem targeted. 

And then there is at least one instance where a hospital and a work camp are literally next door to each other with a crematorium. That’s in an RFA [Radio Free Asia] report. And that’s strange. Recently, the government announced that they were building more hospitals in Xinjiang. There are still many transplants being performed, but the official explanation that they’re from voluntary donors seems at least partially implausible because figures appear to have been manufactured. 

So the registry data associated with the reform program appears to have been falsified based on a simple equation. We have a paper about that that was published in 2019. So it’s rational to believe that Uyghurs are being harvested for their organs. And I feel like I’m not sure what else as an analyst one is permitted to say necessarily. We don’t even have such a clear outcome that is crying for an explanation because we don’t even know the number of transplants anymore. 

Before 2006 and 2007, and even into the 2010s, a lot of stuff was being published on Chinese hospital websites. When a whole lot of international attention started coalescing on it, it seems a lot of that just got pulled. And now there’s a voluntary transplant system, and surgeons aren’t going to the media and just mouthing off about how we did 2,000 liver transplants at our hospital last year and things like this. Our ability to even observe the activity is diminished. And so, I mean, that’s the state of affairs there. I have a book chapter about it, and I use the words of, you know, the vulnerability. So they’re obviously vulnerable to this abuse. 

Mr. Jekielek:

You know, this question of vulnerability is really interesting and very important, and I think actually is a piece of the evidential epilogue because when it comes to the Falun Gong, for example, you have a population that the dictator at the time has said should be eradicated. That didn’t necessarily mean to kill everybody, but to re-educate them, transform them. The language, as we know, is very strong. And of course, these types of things can escalate easily from something that could mean, at the beginning, re-educate them or something like that to something that makes it a lot easier for someone to do things of this nature. 

And the unwritten rule that all Falun Gong deaths will be considered suicides. It’s okay to torture these people in extreme ways to re-educate them. Right? Or the fact that they don’t reveal their names because they don’t want to implicate their relatives or have problems. So there you have this huge nameless incarcerated population, and people just are dying because of torture. And so would you really miss anybody because they were organ transplanted, and you wouldn’t even know that that’s what happened, right? It’s just a unique kind of scenario that these people are existing in. The vulnerability, I think, is an incredibly important part, which often I guess is overlooked even when I talk about the issue. 

Mr. Robertson:

You mentioned something about the language used. The surgeon that I spoke about was both a liver transplant surgeon and involved in anti-Falun Gong activities. On the question of language, I found a book that he edited and had stamped, For Internal Circulation. In the foreword to this book, he writes that Falun Gong is a cancer on society. 

This struck me because he’s a liver transplant surgeon; he removes cancer. You can see the sense in which he probably thinks if he’s killing these people, it’s not bad. If he’s writing that these are evil people who are destroying the foundations of our society, and they’re a cancer, and so on and so on. It’s obviously genocidal language.

Mr. Jekielek:

One of the things that struck me after first reading your paper, again, Execution by Organ Procurement, was that clearly this practice, I mean, this was not an exhaustive search of all the transplant literature in China that you looked at. You found, I think it was 71 cases in that paper where this dead donor rule was violated, where people were being killed by the organ extraction itself. There’s probably a lot more, right?

Mr. Robertson:

The funnel is like this. The transplant is performed. Some number of those transplants that get performed have a paper written about them or are included in a paper. If you think about how many transplants a doctor might do, what portion of them actually get written into a paper? It’s probably a fraction. So there’s an initial selection there that not only could we find the paper or was it in the database and did we find it with our search, but was it even written up? 

So that’s the first thing, and that’s why we probably only got 71. Did we find it in our database? Did we include it properly in our keyword searches and stuff? We had to chalk several dozen that didn’t have a very explicit statement about intubation, which is the insertion of the breathing tube and the ventilation of the patient. Where it said that they were ventilated, we didn’t include those because it didn’t say the specific word, intubate. 

We could have declared 100 and something if we used a slightly less stringent criteria. We have several paragraphs that explain why we think they really should have been part of it. But we just wanted to be extremely careful in, like, you know, segregating the ones that were explicit about intubation, the specific act of intubation. And then probably what was identical, the turning on of the ventilator.

Mr. Jekielek:

There’s probably a lot more. That’s kind of what we’re getting at here. But the issue is that because there’s so much of this reality happening where people are being killed by the organ extraction itself, it’s kind of become normalized for surgeons to do this. So surgeons have become murderers. 

Mr. Robertson:

There is a technical challenge in the procurement of a heart from someone who is alive and walking around. You can’t kill them so that their heart stops beating, because then the heart will not resuscitate. There’s not really another way, even theoretically, to do heart transplants from executed prisoners. So the way that it could be done theoretically is if somehow the judicial system is able to conduct an execution that is a brain death execution. 

So it can’t be a firing squad; it probably can’t be hanging or some other method because it has to be a very targeted method of killing that is only brain death killing. And then they would need to be intubated immediately by the medical personnel. And that’s how the medical establishment or the profession of doctors could be kind of insulated from the actual act of killing. That is highly logistically complex. In a state like China, the medical profession does not have actual professional autonomy. It’s an arm of the state. And that’s the key. 

So when you say that doctors have become killers, yes, it’s how you define a doctor, but the thing that goes into being a doctor—so we have a lot of connotations to the term doctor. Well, they kind of understand themselves to be doctors, so there’s like this Hippocratic Oath, there are professional associations, you have kind of all this institutional scaffolding around this role. So in a state like China, some of those things are present, but they’re also controlled by the Communist Party. 

And so I think that goes somewhere to explaining kind of what we see because if the medical field is an arm of the state, then it becomes less surprising, perhaps, because, you know, the doctors are perhaps acting in their capacity, not merely as doctors, but as agents of a state entrusted with a certain responsibility to conduct this particular activity. They don’t have much choice in it because they can’t say, no, I don’t want to do that. Or the consequences of saying, no, I’m not going to do that, are extreme.

Mr. Robertson:

Yes, I’ve heard people being concerned for their own lives. If you’re a doctor at a military hospital, and the supervisor says, we’re going to retrieve organs now. You can’t just say, oh, sorry, boss, I’m not into that.

Mr. Jekielek:

So how did this whole thing begin? My contention is that, you know, this system, first and foremost, provides an unlimited, on-demand, like, source of organs for every party elite forever. That’s the system that has some huge value above and beyond the financial value. It’s something that’s kind of unimaginable for most people and in most settings. Your thoughts? 

Mr. Robertson:

To begin with, before there was marketization or the privatization of the healthcare system, and you know the reform era, there were transplants happening. You know, in the ’70s and the ’80s. Of course, the ’80s is when the economy is changing and state controls are being lifted. The earliest that we can trace the origins of the CCP healthcare system, there has always been a chair or a vice chair of the healthcare committee of the CCP who has been a transplant specialist. And the personal physician to Zhou Enlai was a transplant specialist. So what can you infer from that? Well, to begin with, a little bit more about this healthcare committee is probably helpful. So the leadership has their own special healthcare system.

Mr. Jekielek:

And I just want to jump in. This is incredibly important to know. This is not obvious to everybody that’s watching.

Mr. Robertson:

No, and it’s also unusual. There’s a whole paper just about the CCP’s healthcare system for treating the elite by Cai Wenxuan. And it’s one unexpected consequence of this tightly controlled healthcare apparatus. So it delivers the very best healthcare that China can offer, mostly through military hospitals. But in cases where officials have been, you know, not in line with party leadership, healthcare has actually been withheld from them. And so it’s even a tool of control for the leadership. 

But in any case, you have this system that delivers top-notch healthcare through certain, mostly military hospitals. It’s always had a transplant official. And so since the ’90s, there have been defectors and different kinds of information about organ harvesting. This is all pre-Falun Gong stuff. And there wasn’t at that period, like China wasn’t wealthy, like it was in the 2000s. And there was a limited pool of donors. 

And so as I read it, you kind of have this confluence of events where China is getting rich, it’s being integrated into the global economy. Surgeons who have done training in Japan or the United States are coming home. And the healthcare system has been basically de facto privatized. And China has an economic growth model that is based on directly incentivizing officials. It’s called prebendalism; it’s the fancy term. 

But it’s where a form of graft is incentivized and encouraged and allowed as a means of economic development, where officials who grow their local economies or their work units are allowed to skim off that growth. And hospitals are no exception. And then suddenly you have an influx of this detained population that can apparently be killed with impunity at a time when, you know, hospitals are being privatized, and you have this talent in transplantation. 

So you’re asking, how did this all begin? We can’t know if there was an order to kill these people. But I argue that’s not a necessary condition for what we observe. You just need markets. They created a market in the organs of their political enemies. They were filling a demand because the demand for organs is very big. And if you just have these people detained, you can make them effectively slave laborers, or you could monetize them by converting their bodies into organs. 

So it’s not like it’s rational under the conditions of that system to monetize them. I don’t see anything that’s so hard to believe or so implausible. Like, we might be shocked. We might say, well, that’s really bad. But within the constraints of that system, with the incentives of that system, it just seems so obvious. 

Mr. Jekielek:

And the abject lack of moral boundaries in that system would be another piece to add.

Mr. Robertson:

Sure. You need a definition of morality, but sure.

Mr. Jekielek:

Sure. I mean, morality that us and most people that would be watching this show, the basic level of morality—like, you don’t kill people for monetary gain. We’re talking about such macabre things. Please continue.

Mr. Robertson:

What you say is really interesting, because I think implicitly, the objection or the aspect of it that perhaps leads to a lack of credence in these claims is that they seem really bad. And so therefore it couldn’t really be that bad. But I think it’s helpful to just put aside how we think about whether it’s good or bad and just look at the actual constraints and incentives of the actors in that system. 

Because then you would see that probably everyone would agree with all the things I said, like it’s obvious, but they wouldn’t do, but then you kind of—you basically have to like everything bottoms out at some absurdity heuristic and so you kind of—it’s whether you think it’s more absurd that the actors in that system would elevate these notions of morality, however we think of them, in that environment. And like, that seems to me way less plausible than that they would just respond to the incentives that they’re actually operating on.

Mr. Jekielek:

Well, and I just—but something you just reminded me of that I haven’t thought of in years, but there was this, I think, official directive against Falun Gong. It was something like bankrupt them financially, destroy them physically, and destroy their reputations. I think there were three things like this. The destroy them physically part, again, sort of, you know, speaks to the incentive structures. 

And the incentive structures, as we know, in a communist society, whatever is said at the top, your success as a party member or a societal member is your ability to implement the strategies or tactics or whatever that are said at the top, however inhumane or macabre they may be. We use the term extractive repression. Explain that.

Mr. Robertson:

When political scientists look at cases where authoritarian states repress their population or subgroups of their population, it is thought to be a cost. You’re expending, you know, the resources of your security apparatus and you’re maybe undermining your legitimacy and so on. I’m simply attempting to direct attention. to a form of repression that is profitable and which the state can then use to enhance its capacities through the act of repression. So it’s not a cost to the state because they simultaneously profit financially, you know, both individual surgeons and then hospitals and the medical system. 

But China wins recognition globally for being a leader in transplant techniques, you know, and publishing in top journals, and kind of winning the praise, not kidding, of Western surgeons for innovations in transplantation that happen in China. Again, it’s about making sense of this, you know, this very unusual form of state activity, and to try to unpack how it does make sense. So that’s like where the term comes from and how I’ve tried to kind ofde-puzzle the issue. 

Mr. Jekielek:

You just reminded me of something we’ve talked about before, which is just the odd reality. This is something, you know, having sat in this, looking at this issue for 20 years, I had never considered how odd it is that this extractive process of, you know, monetizing human beings of your own population for a state to actually be, you know, at some level selling the body parts of their own citizens to foreigners. 

Mr. Robertson:

It somehow seems perhaps more perverse that it is one state’s own citizens, and then the beneficiaries are citizens of foreign countries. But following the logic of the market, you could see, well, foreigners are going to pay more. And the kind of demand for an organ is very high because that’s a life, that’s someone’s life. So they’re willing to pay lots of money, obviously. So again, it makes sense if you think about it.

Mr. Jekielek:

Here in the U.S. where we’re interviewing, there’s a number of pieces of legislation now that have actually passed the House. There’s one that’s still in committee in the House and is now at the Senate trying to deal with this issue in various ways, broadly speaking, sanctioning individuals that are involved would be part of that. Some of it is actually creating a reporting system where the government has to gather data to try to figure out what’s going on with it in more detail. 

Another part is preventing certain medical systems from paying in the case of, you know, insurance or Medicare or something, kind of paying. That’s more at the state level at the moment, although the one in this bill and committee does that as well. I’m curious if you have any thoughts on this sort of legislation to try to deal with this issue somehow for, you know, people in civilized countries.

Mr. Robertson:

 It seems like a fairly good initial response. I mean, we say initial, but it’s 2025 and this issue has been known about for over 20 years. So the kind of remedies, I think if we accept or believe that PRC doctors have done all these things, it is also simultaneously interesting and unusual that they simultaneously wish to be part of global health governance or they don’t want to be a pariah state. 

And so PRC health officials have made tremendous efforts to try to make sure that they’re not considered a pariah state. And so that includes extensive interactions with global medical bodies and experts and surgeons in the United States and elsewhere. And so legislation that prevents them from entering the United States has got to be awkward and embarrassing for them at the very least. It means that the conferences can’t be held here if you think of it in terms of all the scale of remedies. It seems not even beginning to redress, you know, the gravity of what’s alleged, but it seems better than nothing to the extent that the state wishes to craft policy in response to this. 

I think it’s really interesting and illustrative to compare the kind of global reaction to organ transplant, the kind of organ trafficking or transplantation abuses to what happened with psychiatric abuses by the PRC. In the mid-naughts, China was, again, actually an abuse against Falun Gong primarily, and then others as well, where the state was using psychiatric care homes, but, you know, psychiatric torture facilities, and injecting these people with drugs. They had a whole diagnosis of mental illness associated with this, like Qigong-induced psychosis.

Mr. Jekielek:

And they had various medicalized methods of detaining people for their religious beliefs and then torturing them to elicit confessions and so on. But I just want to clarify this. They created a diagnosis to allow them to incarcerate Falun Gong practitioners for practicing their faith.

Mr. Robertson:

Yes. So this is quite well known. And the reason, in fact, it’s so well known is because of a man called Robin Munro, who is like a chief inspiration for me. He was a researcher for Human Rights Watch [HRW] during this period. And he did a lot of really groundbreaking work on abuses in orphanages and all kinds of things. His work on this topic, psychiatric abuse, was presented to the World Psychiatric Association [WPA] Conference, I think it was in Japan at the time. 

Then Human Rights Watch had a media campaign on this. It’s a credible international human rights organization. So with the weight of that organization he corralled it, or there was internal buy-in. But they threw their weight behind this and mobilized their resources. They browbeat the international psychiatric establishment into taking China to task for using psychiatric doctors as part of a religious repression campaign.

The China Psychiatric Association [CPA] was being threatened with being kicked out of the WPA. The upshot was that the CPA acknowledged no wrongdoing. They said  it was scurrilous allegations and all this sort of thing, but the abuse stopped. It actually stopped. So it appears that there’s been a resurgence in this method of abuse. 

But legitimately this is a campaign where the PRC was doing this particular kind of abuse, there was a channel of pressure applied to them through, you know, like a combination of a respected human rights group, media, and then the professional associations with clear consequences for Chinese psychiatrists, who then, one imagines, applied, you know, back pressure internally that, like we can’t be doing this like China will lose face. It’s not just going to be bad for us psychiatrists, keeping in mind that they may not have even wanted as a professional body to be associated with this, but they don’t have a choice. So anyway, that was the outcome. 

If you contrast that to the transplant case, I mean everything is different. So you don’t have a Human Rights Watch or Amnesty International that has thrown their weight behind this and has not even said, the pattern of evidence is disturbing. So there’s been nothing. And then influential media have not reported on it. Or when they have done so, they have sought to cast it out by saying, whatever’s going on, it’s probably not what they say. 

Mr. Jekielek:

Or sometimes they say they’ll say, well, Falun Gong practitioners claim that, as opposed to there’s a well-established body of evidence that claims that.

Mr. Robertson:

Sure, yes. And so there’s all sorts of ways of using language to subtly delegitimize perspectives—this is my reading. The effect of all this is that there’s no kind of environment under which the transplantation society or the World Health Organization or other relevant bodies are kind of the global interface with the Chinese transplant establishment, so they’re not incentivized to put pressure on them. There’s no consequence for not caring about it or doing anything about it. And so there’s no pressure on the China transplant establishment. And so there’s no incentive to even change the activity. 

But I’m sure if the U.S. government wanted to actually put pressure on professional associations and so on, like states have all kinds of tools. They’re very powerful entities that can do things in the world. So if you would list all the possible things that could be done, it would be as long as your arm. And the legislation is going to address some of them. Of course, depending on if you look at all the tools that the U.S. government has to change realities, I’m sure there’s countless more things that it could do.

Mr. Jekielek:

Right. Well, no, it’s really fascinating from what you just told me, which I wasn’t familiar with the details of how this all came to pass, is there’s a playbook of something that worked. And you could replay that. And this is something, frankly, that almost anyone could participate in if they are part of a human rights organization, or could choose to become part of one, or could, you know…

Mr. Robertson:

The key was the elite networks that led to that effect. So it kind of depends on many things, like people who have more power doing things.

Mr. Jekielek:

And some of those people are certainly watching right now. Well, this has been an incredible, illuminating conversation for me. And it’s great to finally have you here and on the show. You know, I often talk about your work as part of my work. And a final thought as we finish, perhaps?

Mr. Robertson:

I think that anyone who is curious about organ-harvesting and wondering if this is actually a thing, I would say just read the papers. Just look at them and use your own brain to assess the evidence.

Mr. Jekielek:

Matthew Robertson, it’s such a pleasure to have you on the show. 

Mr. Robertson:

My pleasure. 

 

This interview was partially edited for clarity and brevity.