Oireachtas Joint and Select Committees

Thursday, 6 July 2017

Joint Oireachtas Committee on Foreign Affairs and Trade, and Defence

Organ Harvesting in China: Discussion

9:30 am

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I extend a warm welcome to the witnesses for this part of the meeting which is on the matter of organ harvesting in China: Mr. David Matas, Mr. Ethan Gutmann, Dr. Enver Tohti Bughda, Dr. James McDaid, Dr. Conall O'Seaghdha and Ms Dongxue Dai. We will hear their opening statements before going into a question and answer session with the members of the committee.

Before we begin I remind members, witnesses and those in the Public Gallery to ensure their mobile phones are switched off completely for the duration of the meeting as they cause interference, even on silent mode, with the recording equipment in the chamber.

Members are also reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official either by name or in such a way as to make him or her identifiable.

I draw the attention of witnesses to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable.

I call Mr. Matas to make his opening statement.

Mr. David Matas:

I thank the Chairman for inviting us. A comprehensive strategy against organ transplant abuse in China has two prongs: efforts to combat the abuse directly in China and to combat complicity abroad in the abuse in China. I have ten recommendations addressed to each prong.

In terms of efforts to combat abuse in China the foreign policy of Ireland should incorporate these features: organ transplant abuse in China should be condemned; the Irish Government should conduct an investigation into organ transplant abuse in China and international instances should be asked to conduct such an investigation, which request should be made to the Council of Europe, the European Union, the United Nations Human Rights Council and the Office of the United Nations High Commissioner for Human Rights, with China being asked to provide historical and present death penalty statistics; China should be asked to make publicly accessible its aggregate data from its four transplant registries for heart, liver, lung and kidney; China should be asked to allow independent outside investigators access to hospital patient and organ donor files; China should be asked to allow independent outside investigators access to hospital financial records and in particular, the amounts received from patients for organ transplants and the amounts spent on all pharmaceuticals related to transplantation; China should be asked to allow independent outside investigators to make unannounced visits to transplant hospitals and organ donation centres; China should be asked to allow access to its prisons by the International Committee of the Red Cross; China should be asked to stop the persecution of prisoners of conscience, including specifically Falun Gong, Tibetans, Uighurs and House Christians; and China should be asked to disqualify from the transplant profession any person involved in the persecution of Falun Gong or other prisoners of conscience.

The second prong is governmental policy and parliamentary legislation to avoid complicity in transplant abuse in China. Legislation combatting complicity in foreign organ transplant abuse should incorporate the following ten features. Extraterritorial criminal jurisdiction should be enacted to allow prosecution for participation in organ transplant abuse. The law should allow the courts to assume jurisdiction over any accused within the territory irrespective of the status of the accused in the territory, whether the accused is a citizen, permanent resident or visitor. A Council of Europe treaty currently commits state parties to enact extraterritorial criminal jurisdiction for nationals but it does not go beyond that to permanent residents or visitors.

Legislation should ban brokerage, advertising, soliciting, trafficking and trading in organ transplantation. Reporting of transplant tourism by health professionals to the health system should be compulsory. Aggregate data accumulated from the reporting of transplant tourism should be publicly accessible. Entry bans should be imposed on those who have been complicit in organ transplant abuse. The ban should encompass visitors, students and workers, as well as immigrants.

The Government should be mandated to maintain a list of those banned entry because of their participation in organ transplant abuse. An exception needs to be made to state immunity legislation to allow those acting in an official capacity to be sued civilly for organ transplant abuse. Both public and private health insurance systems should be prohibited from providing coverage for transplant tourism. This form of health service should be uninsurable. Professionals should be subject to disqualification, losing their professional licences for complicity in transplant tourism. Pharmaceutical companies should be prohibited from engaging in anti-rejection drug trials in China.

Those are my recommendations. I and other researchers have come to the conclusion we did that organ transplant abuse against prisoners of conscience, primarily Falun Gong, is happening and that no precautions were put in place to prevent it from happening. Regrettably, that is still largely so. I submit that Ireland needs to put those precautions in place.

Mr. Ethan Gutmann:

I understand the members were up a bit late last night.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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We work late here every night.

Mr. Ethan Gutmann:

I understand that. I am rooting for Ireland to get the contract on the Rugby World Cup.

Four years ago, I gave testimony to the committee on how the forced organ harvesting of prisoners of conscience evolved from a handful of Uighur political prisoners being exploited for party cadres into a medical procedure employed in every province of China. Back then - it is wonderful to see familiar faces - I also gave the committee casualty estimates, including 65,000 dead Falun Gong, several thousand Uighurs, Tibetans and house Christians. In the passion of that moment the committee released a spontaneous statement condemning China for this procedure. Just outside these doors, people hugged and cried that day.

However, my testimony contained an error. My casualty estimates and those of my colleagues David Matas and David Kilgour were too conservative. In 2013, we spoke of tens of thousands murdered by the Chinese state. Today, we count the deaths in the hundreds of thousands. In 2013, we accepted Beijing’s claim of 10,000 organ transplants per year. Today, we know that is a lie; our 700-page update published last year presented explicit evidence that annual Chinese transplant volume is 60,000 to 100,000 per year.

In Washington DC, three Chinese researchers from the Congressional-Executive Commission on China act as sentries, warding off false information from reaching the US Congress. After examining our report for six weeks, the researchers delivered the verdict that Congress should hold a hearing. On the eve of that hearing, the House of Representatives passed a detailed and explicit resolution condemning China’s practice of harvesting prisoners of conscience. Two weeks later the European Parliament passed an identical resolution. Over the past year, every major Western newspaper has broken their silence on this issue. TheNew York Timeshas had seven articles and counting. Given this global momentum, why am I in Ireland today? The answer is that history is not changed by resolutions, but by actions.

Back in 2008, one man, a heart surgeon and son of a Holocaust survivor, challenged the Israeli Parliament to ban Israeli citizens from going to China for organ transplants and that parliament did so. Spain followed. In 2015 Taiwan did so. In 2016 Italy did so. One might ask what these countries have in common. Integrity is one aspect, as is a highly developed sense of tragedy and the historical wisdom to know that the big players - the US, UK and so forth - may not interfere with an ongoing crime against humanity. We cannot leave it up to them. None of these states paid any measurable price in terms of contracts with China or even in their relationships with China. I would be happy to answer questions on that.

This is an ongoing slaughter. In two high-profile conferences, including at the Vatican itself, Beijing pushed the line that Chinese harvesting of prisoner organs is pretty much over and done with. Neither attempt persuaded the conference, the press or, at the Vatican conference, the Pope, because he did not address the conference as he was scheduled to do.

David Matas, David Kilgour and I see no reform. Instead, we see an $8 billion to $9 billion Chinese transplant industry engaged in business as usual. We see a British architectural firm, TFP Ryder Healthcare, intending to build an organ-harvesting centre in Dalian, one of the most notorious organ harvesting locations in China. It is also the origins of the body show that is currently in Dublin. Human Rights Watch sees a comprehensive Chinese attempt to gather the DNA of the entire Uighur population of Xinjiang. Those DNA samples can then be used for tissue matching the organs of 15 million highly vulnerable people. We can no longer rule out the unthinkable. My name is Gutmann, so I do not take comparisons to the Holocaust lightly, but the phrase “Final Solution” persistently enters my mind and I suspect that phrase also occurred to many of the committee members just now.

What does this mean for Ireland? It means that if it is going to act, this is the critical moment to do so. I ask the committee members to seriously consider introducing some sort of ban regarding organ tourism to China or anywhere else we suspect illegal organ transplants are taking place. I look forward to a frank discussion and any questions or concerns on members' minds.

Dr. Enver Tohti Bughda:

Every time I talk about this, it appears I am attending confession and saying, "Please forgive my sins, forgive what I have done." How do the most respected people in a society turn into murderers? This is the most frequently asked question for me. To understand how, one must think like a Chinese. Born to the Chinese society, born straight into the washing machine and having one's brain washed from the very beginning, one then became a fully programmed member of the society, ready to fulfil the task ahead without asking why. This is the society created by George Orwell in his novel 1984, but in the real world.

Rumour of organ thieves can be traced back to 1990. I was then a young, energetic physician, an oncologist surgeon with a bright future in the society, working in the central railway hospital of ürümqi. During my time in our outpatient department, I saw at least three children with a scar on their bodies, indicating an organ had been stolen.

In 1995, it came to my turn to do it. It was a Wednesday, my two chief surgeons called me into their office and told me to assemble a team with the capability of the largest possible surgery and report to them on the morning of the next day. At 9.30 a.m. next day, we met at the hospital gate and headed towards the western mountain execution ground, where I was told to wait for them until hearing the gunshots.

After the gunshots were heard, we rushed in. An armed officer directed us to the far-right corner, where I could see a male in civilian clothes lying on the ground with a single bullet wound to his right chest. My chief surgeons ordered me to extract the liver and two kidneys. The man was alive and tried to resist my scalpel cut but was too weak to avoid my action. There was bleeding. He was still alive but I did not feel guilty. In fact, I did not feel anything but like a fully programmed robot doing its task. I believed I was carrying out my duty to eliminate the enemy of the state. After the operation, the chief surgeons took organs to strange-looking boxes and told me to take my team back to the hospital and remember nothing happened. I followed the order. We never talked about it.

It is not acceptable that a normal buy-one-get-one-free shopping pattern can be seen in organ transplantation. A predetermined date for one's heart transplantation means that someone has been made dead for one. Giving away organs to promote business means there are plenty of organs. An unlimited supply of organs can be achieved only if those organs are carried in living bodies and are waiting to be taken on demand.

News broke last June that the Chinese Communist Party, CCP, is giving Uighur people in Xinjiang a free national health check-up. With no explanation, we suspect that the CCP is building the national database for organ trade. It is also widely reported that the CCP is carrying out DNA tests in the region with the stated objective of improving the quality of life for the Uighurs. I believe this is a lie.

Dr. James McDaid:

Many thanks to the committee for hearing our statements today. I am a transplant surgeon in Belfast. Organ transplantation saves many lives but there is a big problem with inequality of access to organs in addition to a lack of organs. That is a problem in both the developed and developing world. Kidney, liver, lung, pancreas and heart transplants were once experimental treatments but they are now very much mainstream in medical practice. There is a movement to incorporate tissue donations, such as face and arm transplants. In spite of successful moves to increase organ donation rates, waiting lists for organs in Ireland and throughout the world continue to grow.

In Ireland last year, 280 transplants were carried out. There are currently approximately 650 people on the waiting list. The committee will hear more about that from Dr. O'Seaghdha shortly. People die waiting for organs. Quality of life while waiting is often very poor because of the severe symptoms of end-stage organ failure, including renal, heart and liver failure. These difficult circumstances place enormous strain on families and patients and can give rise to relationship breakups, job loss and many other problems.

The waiting time for organs varies from country to country. Depending on the organ, it is typically between one to five years. Between 5% and 20% of patients die waiting for organs. This very poor outlook and the very poor quality of life drive many people waiting for organs to seek them from sources other than the deceased donor waiting list. For kidneys, live donation from a family member or friend is a possibility but this fails to meet excess demand for organs. Some people have sought to obtain transplants through organ trafficking or transplant tourism. Unscrupulous medical teams and middlemen brokers exploit vulnerable donors and recipients for selfish profit.

China has been a major hub for transplant tourism for several years. Other hotbeds for this criminal practice include Pakistan, Egypt and India. At present, with the considerable amount of people trafficking through Libya, vulnerable individuals are exploited and sent to Egypt in order to pay for passage across to Europe on boats. China is unique among all these countries in executing prisoners for the sale of organs. Members of several ethnic and faith groups have been imprisoned for their beliefs and callously executed for their use of organs in transplant operations. This arguably constitutes a crime against humanity and must be condemned in the strongest terms. China sent two surgeons to the Pontifical Academy of Sciences' Summit on Organ Trafficking and Transplant Tourism in February 2017, which I attended. They openly admitted to the unethical execution of prisoners for organs. They described efforts in China to reduce the number of these executions but highlighted the difficulties in policing the laws in such a massive country.

Ireland must take a very critical stance during diplomacy with China in light of its horrific human rights abuses. Transplant tourism must be considered a crime, with prosecution of all involved parties. Global attention needs to be drawn to this issue.

Dr. Conall O'Seaghdha:

I am grateful for the opportunity to contribute to this important Oireachtas hearing on organ tourism, forced organ harvesting and trafficking in human organs. I am the medical director of the National Kidney Transplant Service in Ireland. My clinical specialty is transplant nephrologist, which is a medical consultant with expertise in kidney transplantation. All kidney transplantation in the Republic of Ireland is performed by the National Kidney Transplant Service, based in Beaumont Hospital, where I work. Last year, 172 kidney transplants were performed in the Republic of Ireland, comprising 50 living donor kidney transplants and 122 deceased donor transplants. As of the beginning of last month, there were 439 people on the kidney transplant waiting list in the Republic of Ireland, with a further 18 on the kidney-pancreas or heart-kidney waiting lists and an additional 87 people temporarily suspended from the waiting list for clinical or personal reasons. In total, there are 544 on the waiting list.

Due to welcome improvements in road safety and neurosurgical care, the rate of deceased organ donation has been steadily decreasing. The average waiting time for a deceased donor kidney transplant is currently 35 months. This datum is very skewed, however. Some patients on the list have been waiting over ten years, with little prospect of receiving suitable kidneys. The median waiting time, or the time by which half of the people on the waiting list have a transplant, is currently 19 months, which again underscores the skewed nature of the data.

While we have no official data on transplant tourism from Ireland, I can confirm there have been cases where patients resident in Ireland underwent kidney transplantations foreign countries and returned to Ireland for their post-transplant care. For the most part, these were patients born outside Ireland who travelled to their region of ethnicity for transplants and returned to Ireland for care afterwards. We are aware, however, of at least one case of an Irish citizen having engaged in transplant tourism also.

I wish to add my voice to those condemning the practice of transplant tourism globally and, in particular, I call for an end to the obscene practice of live organ harvesting in China.

Ms Dongxue Dai:

I thank the Chairman, Deputy Brendan Smith, the Vice Chairman, Deputy Maureen O'Sullivan, and the members for having us today. On behalf of the Falun Dafa Association of Ireland and all Falun Gong practitioners in Ireland, I acknowledge the help, kindness and compassion of the Irish people and Government over the past 18 years during the inexplicable and barbaric persecution of almost 100 million people in China. We have outside this room today over 50,000 petition signatures, collected mainly last year but also in previous years on the streets of Dublin and of various other cities and towns throughout Ireland. They are collected by my fellow practitioners, some of whom are sitting here and others of whom sit outside the gate in all weather, including heavy rain, cold, storms and baking sun. This petition came from selfless people who made a stand during this very dark hour for humanity. We dearly request - I was told this is not possible - that the signatures be handed to the Government. We presented the Government with many other signatures in previous years.

The petition demonstrates the peaceful appeal made by Falun Gong practitioners in Ireland and elsewhere.

One of two most commonly asked questions when we meet people is what is Falun Gong. Falun Gong is an ancient Chinese spiritual discipline that teaches people to follow the principles of truth, compassion and forbearance. We do five gentle exercises to make people fit and healthy. However, under the dictatorship of the communist party, large groups are not allowed to adhere to any ideology other than communism. For this reason, Falun Gong was banned in China on 20 July 1999 and nobody is allowed to practise it. The government estimated that between 70 million and 100 million people were practising Falun Gong by 1999. Many practitioners have been locked up in labour camps, prisons and brainwashing classes. These provide a possible source of organs, an issue about which the other respected guests spoke.

Besides organ harvesting, other forms of persecution and torture are also practised. Some members may be familiar with the case of Mr. Zhao Ming, a gentleman in the Gallery, on whose behalf we had a major campaign seeking his freedom. Mr. Ming was locked up in a labour camp for almost two years when he visited China on holiday and during that time, he was subject to various means of torture, which included sleep deprivation and the use of electric batons. He is only one of more than 1 million people who have been persecuted and he is lucky to be sitting in the Gallery today. We were able to secure his return because he was studying in Trinity College and had a connection to Ireland. Many other vulnerable, innocent Chinese people who are engaged in harmless practice have no way to have their voices heard. I refer in particular to those whose organs have been harvested.

I thank the committee and hope it will be able to do something. Ireland has helped a great deal already by securing the return of Mr. Ming and another student who is not present today. The joint committee has also held a number of hearings at which Falun Gong representatives have made presentations. We are very thankful for all the help we have received.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank all the witnesses for their presentations. They have outlined circumstances which would trouble anyone with a shred of decency or concern for human rights. It is horrific to consider the number of people involved. I recall that Mr. Gutmann made a presentation to the committee some years ago. He indicated this morning that he underestimated the numbers of victims of this particular practice at that time.

Mr. Bughda used the phrase "buy one get one free". In civilised society, we never thought such a phrase would be applicable to human organs. It is frightening that this practice is taking place.Trafficking of human organs is truly reprehensible and utterly demeaning of human life. It is a deplorable activity, which has developed into a global problem that violates human rights and the dignity of individuals.

We are Members of a Parliament that represents a small population. However, as I am sure will be reflected in members' contributions, we have an attachment to human rights and the dignity of the individual. The witnesses have engaged regularly with the joint committee, both at formal and private meetings, and all members are concerned about the activities they describe.

International co-operation is needed on this matter. Ireland signed the Council of Europe Convention against Trafficking in Human Organs in 2015. A legislative process is needed to implement the convention and the Department of Health must introduce certain legislative measures. While I am not au fait with the status of these legislative measures, we can engage with the Department and Minister to ensure there are no unforeseen delays in introducing these measures.

The presence of Dr. McDaid and Dr. O'Seaghda brings a national perspective to this issue. Through our work as public representatives, all members are well aware of the excellence of the services provided in the hospitals in which the two doctors work and the many patients throughout the island who are thankful for the work done by their teams and colleagues. Their presence reinforces the importance of this issue. Dr. O'Seaghda indicated he was aware of one person on this island who was involved in organ harvesting.

Dr. Conall O'Seaghdha:

Yes, we are aware of one such person. While it is very hard to get clear information on this, in circumstances where somebody travels overseas and returns within a short timeframe having had a kidney transplant, we can surmise, given the logistics involved in arranging an organ transplant here, that this could only have occurred by means of transplant tourism.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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Do colleagues of Dr. O'Seaghda and Dr. McDaid in Britain and other northern and central European countries have concerns that persons in those countries are participating in transplant tourism?

Dr. Conall O'Seaghdha:

This is a bigger issue in the United Kingdom. A colleague of mine who worked in Manchester until recently has indicated he encounters two or three patients every year who have returned from overseas having had a transplant. It is important to point out that these patients often return in very poor health. They experience high rates of transmissible infection, including hepatitis and tuberculosis, and outcomes are poor. One of the drivers of that activity is the difference in cultural make-up between, for example, Manchester and Ireland. For this reason, the problem is not as great here as elsewhere. However, we need to look forward because as society becomes more diverse, this is likely to become a growing problem here too.

Mr. David Matas:

This exchange highlights the value of compulsory reporting because we are currently stuck with anecdotal information based on what somebody hears here or there about organ harvesting. However, the health system knows about the individuals in question because those who benefit from transplant tourism need anti-rejection drugs on their return. The information is available and if a compulsory reporting system were in place, it would be possible to arrive at aggregates without in any way violating doctor-patient confidentiality. We get caught in a vicious circle in which people do not know the extent of the problem and, as a result, not much is done about it. If a compulsory reporting system were in place, we would find out the extent of the problem.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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Before inviting members to contribute, is the violation of vulnerable individuals primarily carried out to facilitate kidney transplants?

Mr. Ethan Gutmann:

We believe kidney transplants probably account for the majority of cases but liver transplants have clearly caught up in China. China is the number one destination for liver transplants. The country is ahead of the rest of the world by far in terms of heart transplants, lung transplants and so forth. In fact, I am missing a spleen and China is the only country where it is possible to have a spleen transplant.

Photo of Maureen O'SullivanMaureen O'Sullivan (Dublin Central, Independent)
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I welcome the witnesses, especially those whom we have met on previous occasions. Sadly, the message from their contributions is that there is a lack of regard for the lives of certain people and that we do not value all life equally. Reference was made to some progress being made and motions that have been passed. Clearly, this will not be enough and action is needed. Apart from having motions passed, what other progress can be made in this area?

Mr. Matas referred to advertising. How is that done?

If I were in need of an organ transplant and wanted to go somewhere to get it, where would that be advertised? Obviously, it is an underground activity. Can we make headway in tackling organ harvesting by addressing the advertising aspect?

If transplant tourism is to be considered a crime, it must be recognised internationally. International organisations must work together and take that on board.

Regarding the conference that Dr. McDaid attended where Chinese surgeons admitted to doing this, what was the reaction? Should international medical organisations play a stronger role? Doctors take an oath, but what has been done undermines that oath. How did the doctors at the conference feel when these matters were raised with them?

According to the note that we received, China asserts that it has embarked on reforms. Is there any sign of that happening?

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I welcome the witnesses. We have heard testimony on this matter previously. When I first heard of it, I was shocked and did not believe that any human being would do this to another. Maybe I was a bit naive about whether a country would do this to its citizens. Even the associated language appals me - "organ tourism". I know of people who travel abroad to get dental treatment or have operations, such as facelifts, done. That is common, but we are discussing someone travelling abroad for a transplant not knowing, or maybe not wanting to know, from where the organ came.

I know people who have donated kidneys, for example. A colleague - a councillor out my way - donated a kidney to a friend of his this year. A close friend of mine died while awaiting an organ transplant. I know of families' desperation for their loved ones, for example, children. However, the idea that someone would use organs in these circumstances is appalling.

I was not aware of the Egyptian connection with the refugees. Could the witnesses expand on that point? Some of us are involved in international organisations, so I would like to raise the matter there.

Mention was made of a possible case and the necessary treatment. Is there an onus on the medical profession to report that to anyone? What would be the ideal approach?

The Houses are collectively appalled by the situation, so if legislation was introduced, Members from all parties and none would support it. The concern is that drafting the legislation might be delayed, but I accept that the matter is probably complex.

Mention was made of banning citizens from travelling to, for example, China for organ transplants. How would that work? The witnesses gave examples of other countries having done this. People can genuinely claim to be travelling on a tourist visa, but an onus arises when they return seeking treatment. How would that work physically? How can it be inserted into law?

Although I asked this question previously, people at home will want to know the answer. Is this just happening to Falun Gong practitioners in China? I believe not, but the witnesses might explain whether it is happening to other political prisoners as well, for example, the Uyghur minority and Tibetans.

Does China allow the Red Cross to visit prisoners in jail? Could the Red Cross play a role in stopping this?

We have a note asserting that China has embarked on reforms of organ donation and is stamping out illegal and unethical practices. I have been told that the embassy here is in co-operation with other EU states and is supposedly monitoring these reform efforts. What does that entail exactly?

The British firm TFP Ryder Healthcare intends to build an organ harvesting centre in Dalian, which was referred to as one of the most notorious areas for organ harvesting. Can any legal action be taken in that regard?

I am conscious that many of those involved are travelling out of desperation and want themselves or loved ones to stay alive, but what can we do to close off that option? The moral argument is probably lost on them. If people break a legislative embargo, should they be sent to jail or fined? What is the ultimate sanction?

I am sickened to my stomach by the idea of organ harvesting. I presume that is why some of our members are missing. There is a sense of disbelief. The idea that anyone would do this to another individual is immoral and all of those words. The language around it is appalling.

In light of today's intervention by the witnesses, I hope that we can push this legislation forward. There is genuine political will among us all to tackle and eliminate this practice. If we can push those countries that are involved in these unethical practices in a certain direction, give us examples of how.

Photo of Gabrielle McFaddenGabrielle McFadden (Fine Gael)
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I apologise for being late. I was attending another briefing. The disadvantage of speaking third is that the questions one wanted to ask have already been asked. The witnesses are welcome. I am just as horrified by this situation now as I was when I read of it previously.

Deputy O'Sullivan asked a question about something that had struck me immediately. How are these trips to China being organised for people? Obviously, someone cannot go to a travel agent to book flights and accommodation for this. Where do people get the information that they need to book all of this?

We have been told that reforms are taking place in China, but what kind of reform is it and is there any evidence of it? What can we do as a country? I presume that we can run a campaign educating people who are travelling to China for transplants on where these organs might be coming from and how they were taken from others. A friend of mine had a kidney transplant and I know how desperate he was to have it done, so I can understand people's desperation. If they were educated on where the organs were coming from, though, their eyes might be opened.

I am fascinated by the organisation of a trip to China for this purpose. How does one do that? There must be a way of stopping it.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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Whichever witnesses wish to respond to the various questions can do so now.

Mr. Ethan Gutmann:

The last question is one which has arisen several times. There is much misinformation on this globally and this has been something that the Chinese state has encouraged. There is much talk about organ brokers and the shadowy criminal network operating in this area. There is one, and it is called the Internet. It is that simple. If members do not believe me, they can go onto the Internet, type "help, I need a liver" in Google and within the first 20 response they will find a website which changes constantly, but is always there, and which has a discussion board involving people who have had transplants or are looking to have one. Very quickly, one will find advice that a person can go to Tianjin central. That is not surprising because the Chinese were advertising Tianjin central on the web for years. They only stopped in 2014 because it became such a major issue and it was a huge embarrassment that this advertisement was up there.

We estimate that Tianjin Central hospital does over 5,000 transplants each year. This is half of what the Chinese claim they do annually, in just one hospital. They speak English. Everyone will say that and the message board is one of two sources that one will find this information. It is that simple. If one can come up with the money, they can secure the transplant in record time. In other countries, one can find kidneys because people will sell a single kidney but it is only in China where they can come up with a liver. It has been documented in around 25 cases that it can be done within four hours. No one can live without a liver and there is no way to come up with a liver unless one has a living human being, or should I say, a huge stable of living human beings, where they have all been tissue matched, are ready to go and someone can come in and get that organ within several hours. The warm ischemia time, the time when an organ is being transferred from one person to another, is estimated to be two minutes or zero in most cases of these emergency liver transplants.

This is more evidence of something the committee has heard from Dr. Enver Thohti Bughda, that this is done while people are alive. There is not a huge mystery about organ tourism; it is an intentional piece of monkey dust which the Chinese have thrown up about this. I do not doubt that one can go to Egypt and get a kidney. I do not doubt that there are several countries in the world where one can do that but there are only two countries that harvest political and religious prisoners and they are the People's Republic of China and ISIS. I do not recommend the hotel facilities in Syria right now. It is true that there is a bigger problem overall, but this goes beyond it. We are not merely looking at Falun Gong but Uyghurs, Tibetans, and House Christians. The Uyghurs may be coming online with DNA testing, which is also tissue matching testing, but it has dual purpose. It tells us that the Uyghur population, the Muslims of China, are suddenly under great threat when millions of them have been DNA tested. The Chinese say it is for their health but we cannot believe that. There may be many purposes, and we can discuss that further, but there is no question that there are still prisoners who are being harvested for their organs.

We do not know the exact percentages but anyone who has been close to the data in the way that myself, David Matas and David Kilgour have, has concluded that they are mainly prisoners of conscience. They are often arrested without any due process whatever. They cannot be charged with any capital crimes and in the case of Falun Gong they are absolutely non-violent. Often, they are people who are not even on the books and are being put to death. This is where this huge pool of organs is coming from. I would like to say that this is science fiction but I was here in 2013 and I am afraid that the evidence has become exponentially worse and more explicit since then and that is why we are starting to see the reaction.

Dr. Enver Tohti Bughda:

One should bear in mind that Chinese society is one which believes the body is taken to the next world, and they do not want the body to be taken apart. That is why the numbers on the Chinese national organ registration are ridiculously low, so where are these organs coming from? Human rights organisations are illegal in China but one can see charitable organisations for animal welfare everywhere. It means human life is worth less than animals. In asking how it can happen, it is comes down to the party, the CCP, which created the infrastructure and made these atrocities possible.

Mr. David Matas:

I have taken note of the questions as they were asked, and counted 17 of them. I will try to run through them as quickly as possible.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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Ten of them were mine.

Mr. David Matas:

Deputy Maureen O'Sullivan asked if there had been any progress. There has been, both in China and abroad. Mr. Gutmann mentioned four countries which have enacted legislation, and that is some progress. There are other signs of progress also. Within China, legislation has been enacted which made promises, and gave priority to locals. The trouble is that it has not solved the problem and it has not been comprehensive. Before there was nothing, and now there is something, but we still have the problem. Mr. Gutmann answered the question about advertising. On the role of international organisations on international crime, the Council of Europe has come up with a treaty and the World Health Organisation has stated some principles. The UN rapporteur on torture and religious intolerance has put questions to China at the UN committee against torture, and asked China to conduct an international investigation. Generally, when one is dealing with international crime, there is a legal principle of complementarity which means that states should do it locally first. I do not think that we should be relying entirely on international organisations to deal with this issue. The first line of defence for international crime should be states rather than international organisations.

On the role of international medical organisations, the transplantation societies developed a couple of good policies, one on China and another on sourcing organs from prisoners, but the first line of defence should be a national transplantation society. What I see with national transplantation societies is that their ethical systems are underdeveloped to deal with this issue. They do not deal comprehensively with transplant tourism. Those need to be developed.

Deputy Crowe's question about the onus is an important one. The onus should be first on China to explain its source of organs and anyone dealing with China should be satisfied beyond reasonable doubt that its source of organs is proper. That is not now the case, rather there is much wilful blindness, which is a problem.

On how a ban on travel would work, I am not in favour of putting patients in jail. What one needs to do is get at the brokers and advertising. This is a point that Senator McFadden made, that there has to be as much public education as possible. A number of city councils in Ireland have passed resolutions on this which is very useful in public education. The health Ministry could be doing more and the foreign Ministry could do more about alerting people about what happens.

Again, the profession could be alerting people more. How many doctors tell their patients that if they go to China there is a risk that somebody will be killed for his or her organs?

On the question of whether the Red Cross visits prisoners in jail, the answer is that they are not allowed to do so. At one time a Chinese official said they could, but when the Red Cross tried to arrange a visit it was not allowed. In regard to legal action against a British firm, I am a lawyer so I cannot answer that question. The problem is that legislation that would prevent something like this happening locally is not extraterritorial in effect. What Ireland, Britain and other countries need to do is put in place legislation that allows for extraterritorial rights such that they can impact upon things that locals are doing outside of the country.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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Would anyone else like to comment?

Ms Dongxue Dai:

On Deputy Crowe's question of how one human being could do this to another human being, from my perspective the problem is the brainwashing machine of the Communist Party. For instance, the Falun Gong, some of whom are seated here or can be seen on Grafton Street and so on, are normal citizens of society but in Chinese Communist Party propaganda they are vilified, demonised and labelled as enemies. When doctors previously did the harvesting they did not feel guilty because they were only carrying out a task but nowadays they are paid large sums of money for doing so. Following the destruction of traditional culture and several political movements, including cultural revolution, the former party leader encouraged everybody to make money. Nowadays in Chinese people's minds there is nothing left only money. When people can make money they will do anything and everything for that purpose.

Dr. Conall O'Seaghdha:

On the issue of counselling patients, on occasion, patients arrive with printed material asking about this. I have polled all the transplant nephrologists in Beaumont Hospital. To be clear, when this issue arises we would dissuade the patient in the strongest possible terms, based on the source of the organs but also on outcomes for the patients.

Deputy Crowe asked about the situation in Egypt. I cannot speak knowledgeably about that except to say that I know of a patient of Egyptian origin who returned to Egypt to receive a kidney transplant this year. The matter of mandatory reporting is complex. Any legislation around that would need to take into account that there are some circumstances where patients can legitimately return to their country of origin for transplantation. The usual story we are told is that their brother or other family member is living in Pakistan, Nigeria and so on and they have to return home to have their transplantation. There is some complexity around this. It is not possible as a physician to tease that out. There are also circumstances where patients can legitimately travel to other countries. We have an organ sharing programme and we have a paired exchange kidney programme which we are currently setting up with Belfast. Paired exchange arises when a person wishes to donate a kidney to a spouse but cannot do so for immunological reasons and a similar pair exists such that we can swap organs. For this to function well, we need a large pool of patients to draw from. We have a memorandum of understanding with Belfast, which is being drafted. In circumstances where that arises, patients will legitimately travel to receive transplants. There are important details that need to be factored in rather than an overall issue of a patient not being permitted to travel to receive a transplant.

Dr. James McDaid:

I will conclude by responding to the questions from Deputies Maureen O'Sullivan and Seán Crowe about the Vatican Summit and the Egyptian transplants situation. The Pope, in a statement he made a couple of years ago, said that he wanted to do his best to stamp out people trafficking and, as an aside, organ trafficking. This is what gave rise to the summit in the Vatican. With regard to China's role in the summit, it was steeped in controversy in that from the outset there were questions about whether the Chinese should even have been invited to the summit, against the background that China, Egypt, Pakistan and India are countries that are deeply involved in organ trafficking. There was no controversy around inviting delegates from India and Pakistan but there was a big question about whether the Chinese should have been invited. Earlier, Mr. Gutmann made the point that the Pope was supposed to address the summit and meet with us all but he pulled out at the last minute because of controversy over the Chinese. He did not want to be seen to be endorsing the Chinese visit or to be photographed with them. The Chinese presented their data. I spoke briefly afterwards with the Deputy Health Minister, Huang Jiefu. In their statement they admitted that they have been executing prisoners for organs in China. They would not be drawn on prisoners of conscience, Falun Gong, and so on but they admitted to large-scale execution of prisoners. The summit was shocked by this, understandably, and people condemned it. It was the one time in the summit when one could palpably feel the temperature was rising. People were arguing and questioning the Chinese delegates and they did not really believe what they were saying. The Chinese said that they have now made it illegal and they are trying to stamp it out but that it is difficult to police with so many hospitals and so on involved. They were met with a lot of scepticism and condemnation.

With regard to the Egyptian situation, there have been many reports recently about Libya being a hot bed of people trafficking. Many refugees from Syria travel to Libya to get transport to Europe on inflatable boats, as a result of which thousands of people have died. In addition, thousands of economic migrants from Sudan, Somalia and Nigeria are congregating in Libya, which right now is a country without a Government. It is lawless and akin to the wild west. The people from Syria and the economic refugees from North Africa pay enormous amounts of money to people traffickers to get passage to Europe. When they arrive in Libya to get on the boats to cross the Mediterranean the people traffickers ask for further payment. When the refugees point out that they already paid in Syria or Sudan for passage to Italy the traffickers tell them that they cannot get on the boats unless they pay again or, that if they donate a kidney it would pay passage for five people, the refugee and four members of his or her family. They do not do the organ harvesting in Libya. It is done in Egypt where there is a better developed health care system. In Egypt their organs are harvested for local people or paying foreign people. Interestingly, the European Union has a special prosecutor in Libya, an Irish man named Aonghus Kelly, who is working on this issue. I told him I was coming here and he is very keen to get involved. I can pass on his contact details to the committee if it is interested in furthering the Egyptian transplant tourism issue. The big difference between Egypt, Pakistan and China is that in China this is veiled in secrecy but in Egypt and Pakistan the cases have been uncovered, reported in the press and people have been arrested. Many of surgeons and physicians have been put in jail in Egypt but in China organ harvesting is veiled in secrecy, the media is suppressed and so it is difficult to know what is going on there.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank Dr. McDaid for his contribution. There are medical councils in each jurisdiction. It would be important that they would communicate the concerns of the physicians and medical professionals to their relevant health departments and governments. The representative organisations would have ongoing contact with their relevant government department on a regular basis. Regardless of the country it is important that medical professionals with the expertise and knowledge would make an issue of it with the relevant health authorities.

Mr. Matas referred to legislation not being extraterritorial. That is correct but there is a value in the European Convention against Trafficking in Human Organs that was adopted in 2015. The Irish Department of Health must introduce legislation to transpose those provisions into domestic law. All member states can transpose the provisions of that convention into domestic legislation. That is the value of the European convention.

What I said at the outset, and I am sure members will agree, is that we will communicate directly with the Minister for Health following this meeting, stating that we had a formal meeting with the witnesses in regard to the need to bring forward this legislation. I am sure it would meet with the approval of both Houses of the Oireachtas.

We will ask the Minister for Foreign Affairs and Trade to raise this issue as a specific item at a meeting of the Council of Foreign Ministers. Obviously, each Minister can table an item for discussion. We should encourage our Minister for Foreign Affairs and Trade, Deputy Simon Coveney, to put this matter down for discussion and try to garner support among other member states as well.

I thank the witnesses sincerely for their contributions. They have exposed extremely frightening and troubling activities which are heinous crimes being committed against vulnerable people. Let me assure them that they have our support and we will be glad to pursue other ways that we can be of assistance.

Ms Dongxue Dai:

Some of my colleagues who are here and others who are off-site have worked with the county councils on this issue. Of the 31 county and city councils in Ireland, 17 of them have passed this motion. As the Chairman said, it is possible that Ireland will be able to do something to represent the county and city councils which passed this motion and to bring it to the notice of others. That would be helpful.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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The joint committee is aware some local authorities passed this motion. The local authorities which passed it should convey that message to the Minister for Foreign Affairs and Trade through the Department of Foreign Affairs and Trade. It is important the message is sent to the Department of Foreign Affairs and Trade. It would be no harm if the said local authorities communicated directly with the embassies also. I thank the witnesses for their contributions.

Sitting suspended at 10.45 a.m. and resumed in private session at 10.55 a.m. and in public session at 11.15 a.m.