🩰🫀Ballet Theater, Banned Religion & Bad Transplants
What you need to know about the People's Republic of China and Organ Procurement
What does a traveling ballet theater group have to do with the dead donor rule in organ transplantation?
Recently, a physician assistant called me to discuss a case where a patient declined an organ transplant “for religious reasons.”
“What religion do they practice?”
“I don’t know, but my colleague says it’s some kind of Chinese cult.”
“Ask if it’s Falun Gong.”
“What’s that?”
“Have you seen the Chinese ballet signs all over town?”
“Wait…. What does that have to do with this??”
They are more connected than you might think.
The Spectacle of Shen Yun Ballet Theater
Every late winter, from December to January, Shen Yun ballet posters cover the San Francisco Bay Area. The pervasive advertising - usually a ballet dancer leaping in a billowy costume - is almost impossible to ignore.
In late 2019, my then 9-year-old daughter, captivated by the posters, wanted to see it. We’re ballet fans. My cousins were both professional dancers. I loved when their companies hit the road, and I’d have a rare opportunity to see them dance in person.
But why had I never heard of this ballet company?
Why were the ads so vague? Posters claimed the show was “Reviving 5,000 Years of Civilization” but supposedly couldn’t be shown in China. I watched a few videos, and while I could only find videos produced by the company, it seemed like a high-quality production with well-trained dancers.
So, I forked out the cash for tickets to attend a January 2020 show in San Jose.
My mom, aunt, daughter, and a close friend dressed up, piled in our car, and headed to the show.
Flawless Dancing, But Make It Weird
The show began, and to my surprise, it was spectacular. The flawless dancing, with colorful, gorgeous costumes accentuating each dancer, drew us in. The choreography was arranged to maximize the impact of the dancers’ skills and costumes - with dozens leaping in perfect synchrony, waving their giant gauzy sleeves.
The dancers displayed striking interpretations of Chinese myths. A bright jumbo LCD screen provided an ever-changing, digital set dressing with ancient gods leaving their homes in the clouds to grace dancers with gifts and wisdom. It was beautiful, but there was no storyline to follow.
During brief interludes, manicured MCs had the audience parrot back the Mandarin phrase for “I love Shen Yun” and introduced the religion Falun Dafa, or Falun Gong.
Anti-Chinese Propaganda, But Make It Ballet
Suddenly, the scenery morphed into a bustling, modern street in China. The eye-popping, colorful costumes were replaced with modern clothes, and religious people were color-coded as morally good and sullen people teens dressed in black as bad. The character we’re meant to follow wears a yellow dress. (Many photos I found later show Falun Gong practitioners wearing the same shade of yellow). There were people with posters professing their religion. Suddenly, communist police ballet dancers were harassing, abusing, and arresting people. They violently arrest the yellow dress-wearing dancer and haul her off to jail.
I looked over at my friend, and we shared a what-the-hell-is-happening-right-now look.
Later in the show, we were again jostled into a dingy scene where a Falun Gong practitioner was kidnapped by Communists, taken to an operating room, and murdered for their organs.
I knew about allegations of Chinese organ trafficking, but I didn’t get how it ended up in a ballet.
After the show, I googled Shen Yun with a very different eye than when I went to YouTube looking for dance videos.
A few journalists had written about Shen Yun and the weird propaganda - reinforcing that I hadn’t been hallucinating:
Jia Tolentino’s 2019 New Yorker essay “Stepping Into the Uncanny, Unsettling World of Shen Yun”
Alix Martichoux’s 2019 SFGate essay “After years of ignoring Shen Yun billboards, I finally bought a ticket so you don't have to”
Religious-Political Propaganda
The hit-you-over-the-head religious-political propaganda drew a dramatic connection to current transplant ethics issues in China. The organ harvesting dance reminded me of all the evidence that China actually was murdering people for their organs. I knew it impacted “prisoners of conscience,” but I didn’t know how it connected with Shen Yun and Falun Gong.
I’m not a religious person, and I’m suspicious of anything that smells remotely of proselytization or propaganda. I hadn’t expected Shen Yun’s conservative religious content, anti-Chinese propaganda, or such a gory turn to current events.
Shady Organ Rumors
As an ethicist and transplant anesthesiologist, I’d been following the shady organ trafficking stories out of China for years.
I didn’t realize until watching Shen Yun that Falun Gong were the primary people being persecuted in China or that they were using their ballet theater shows to spread the word. It put the inescapable advertising into perspective.
Honestly, I felt a little betrayed by the Shen Yun show. I had hoped for an escape from the serious clinical ethics issues I face at work regularly. I wanted gorgeous dancing and entertainment, only to suddenly be thrown into a massive ethical controversy mid-show.
I also recognize this is a minor inconvenience compared to being a political prisoner and being murdered so a government can steal your organs.
What is Falun Gong?
Falun Gong is a modern qigong religion founded by a man named Li Hongzhi. He registered the group with the Chinese government in 1992 and toured the country, spreading his beliefs and religious exercises through a series of lectures. The practice's popularity, with its focus on morality, meditation, and health, skyrocketed. Soon, Falun Gong had tens of thousands of followers. Li left China in 1995 for France, and became a U.S. permanent resident in New York State in 1998. There is an outstanding warrant for his arrest in China.
While it’s a new religious movement, Li claims to be a conduit for thousands of years of previously secret knowledge. He claims to have trained under mediation masters, though these have been refuted by people who knew Li as a young man.
Is Falun Gong a repressed Chinese religion with a weird dance troupe? Yes.
But it also promoted numerous dangerous, bigoted, and straight-up bizarre beliefs.
“To his followers, Li is a God-like figure who can levitate, walk through walls and see into the future. His ultra-conservative and controversial teachings include a rejection of modern science, art and medicine, and a denunciation of homosexuality, feminism and general worldliness.” - Brandy Zadrozny for NBC News
In a 1999 interview with Time Magazine, Li stated that he believes aliens from other dimensions walk the Earth and are responsible for introducing technology, war, and immorality to Earth. Li refers to himself as a “being” who came to Earth to prevent the destruction of humankind from rampant evil. When asked if he was a human being, Li replied, "You can think of me as a human being."
Falun Gong's followers are exceptionally dedicated and devout. People who successfully leave the religion say they are accused of being agents of the Chinese Communist Party.
It sounds like a mashup of ultra-right-wing Christian movements with Scientology.
Shen Yun & Epoch Times
The Shen Yun Performing Arts organization was founded in New York in 2006 and began touring the following year. The organization now has multiple touring groups and performs in nearly 100 US cities and several international locations.
ProPublica’s Nonprofit Explorer shows that the arts group had $229M in total assets in 2022 (the last year where public filings are currently available).
Another Falun Gong outlet, the conspiracy-fueled newspaper The Epoch Times, became the country’s most successful and influential conservative news organization. The paper capitalized on Trump’s candidacy, covering him favorably on their rise in prominence. The paper is also a top purveyor of Shen Yun advertising.
The financial and structural connections between Falun Gong, Shen Yun, and The Epoch Times remain mysterious.
Violating the Dead Donor Rule in China
The Dead Donor Rule is a critical feature of transplantation ethics. Organs should only be procured (“harvested”) from people who are already pronounced dead - either by neurologic criteria (brain death) or cardiopulmonary death. (A notable exception is living organ donation, where a living person may donate one kidney and part of a liver.)
We are never supposed to kill someone to get their organs.
You can’t donate a heart, both kidneys or a whole liver and still be alive afterward.
In America, if you qualify for a heart transplant, you might wait for years for a well-matched organ to become available when someone else dies. Not just any organ will work. Organ donor’s tissues are checked against a registry of people who need an organ, looking for patients who are a good match based on the patient’s clinical severity, lab results, height, weight, and distance to transport the organ, among other factors.
In China, heart transplants could be scheduled - sometimes only a few weeks after listing a patient. If organs were only available from people who were dead, how were Chinese physicians scheduling transplants weeks ahead of time? How did they know that a person with a well-matched organ would suddenly be dead on that specific day?
Chinese prisoner’s executions were scheduled to ensure their organs were available when needed for transplantation. Prisons were (and are likely still) essentially used as organ banks. China claimed in 2015 to have ended the practice, but in early 2020, the international community still didn’t buy it.
The practice fuels domestic transplant programs and a highly profitable transplant tourism scheme.
Free, Voluntary, Informed Consent for Organ Donation
Organs should always be given altruistically, with free, voluntary, informed consent. There should never be coercion. The practice of removing organs from incarcerated people has been prohibited by the Nuremberg Code, the Helsinki Declaration, the Belmont Report, Amnesty International, the World Health Organization, the World Medical Association (WMA), and the Declaration of Istanbul.
But despite these widely recognized ethical principles in transplantation, Chinese law allows executed prisoners to “donate” their organs. They claimed this was voluntary, as a way to redeem themselves for their crimes.
People condemned to die don’t have the agency to be able to consent or refuse organ procurement.
Uncovering the Chinese Organ Trafficking Business
Accusations of forced organ removal in China first surfaced in 2000. Concerns continued to mount in the following decade, indicating that China developed an industrial-scale organ trafficking practice that harvests organs from executed prisoners of conscience.
Two international human rights lawyers, David Kilgour and David Matas, escalated these concerns in a 2006-2007 report. The Kilgour-Matas report found that "the source of 41,500 transplants for the six-year period 2000 to 2005 is unexplained," concluding that "there has been and continues today to be large scale organ seizures from unwilling Falun Gong practitioners."
In a landmark 2014 paper, Organ Procurement From Executed Prisoners in China, the authors highlighted the human rights violations and lies in the Chinese organ procurement and reporting systems:
China performs the second-highest number of organ transplants after the US.
In 2005, a Chinese government official and liver transplant surgeon admitted that more than 90% of these organs came from executed prisoners.
By 2013, official Chinese data indicated nearly 50% of organs were still from executed incarcerated people, but the math wasn’t mathing
Very few non-incarcerated Chinese people elect to donate organs, so it doesn’t make sense that so many incarcerated people would.
We can’t possibly believe that every healthy incarcerated person is coincidentally scheduled for execution on the exact day a matching recipient is available. (scheduled transplant surgeries)
Minority groups are clearly targeted. The most among the Falun Gong, but also other groups such as Uyghurs, Tibetans, and Christians.
There is a near-total lack of transparency in the military-run prison labor camps and no way to map the sources of organs.
The authors also created a valuable timeline of significant events related to transplant services in China:
Claim to End the Practice of Forced Organ Procurement
In 2014, Chinese authorities claimed they would end the practice of stealing organs from incarcerated people by 2015. They claim organs now only come from voluntary donors, but data indicate that Chinese hospitals continue to perform many times more transplants than they can have ethically sourced donors.
In 2016, The American Journal of Transplantation published a perspective article, Transplant Medicine in China: Need for Transparency and International Scrutiny Remains. Without any evidence of significant changes to the Chinese organ procurement system, there is no evidence to support that China has changed its ways:
“Given the allegations of crimes against humanity in China in the form of the killing of executed prisoners and prisoners of conscience—mainly of Falun Gong practitioners—in a state-led, systematic process, demands for transparency are indispensable.”
The 2016 film Hard To Believe worked to spread the word about the humanitarian abuses in China’s transplantation programs.
The China Tribunal's Revelations
The International Coalition to End Transplant Abuse in China (ETAC) pushed for an independent investigation of the human rights abuses against Falun Gong and other persecuted groups.
In response, the China Tribunal was formed as an independent tribunal for forced organ harvesting from prisoners of conscience in China. The seven-member panel held its first public hearings in December 2018 and released its final report in March 2020 - just a few months after I saw the Shen Yun ballet.
The China Tribunal’s mandate was “to address and answer specific questions that arise from existing evidence of systematic, widespread forced organ harvesting from prisoners of conscience in the People’s Republic of China.”
“The Tribunal’s members are certain - unanimously, and sure beyond reasonable doubt - that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims.”
The Tribunal also concluded that Falun Gong practitioners were the primary source of organs in China - likely constituting attempts at genocide. Uyghurs have also been significant targets of this practice. Based on the massive scale of medical testing on Uyghurs, they may also be considered an ‘organ bank’ in China.
“The Tribunal has had no evidence that the significant infrastructure associated with China’s transplantation industry has been dismantled and absent a satisfactory explanation as to the source of readily available organs concludes that forced organ harvesting continues till today.”
Comparison to U.S. System
Maintaining the ethical integrity of the complex American transplant system requires constant reassessment. Organ procurement organizations tasked with obtaining as many organs as possible from willing donors still show significant discrepancies in outcomes. Patients seeking organ transplantation in the US still suffer significant racial equity barriers. Every day, 17 people die waiting for a transplant in America.
Recently, President Biden signed an executive order to reform the organ transplant system, the Organ Procurement and Transplantation Network (OPTN). The US system still needs massive improvement, but we’re much further along than China.
As an individual physician, I have to be careful never to care for both a donor and a recipient. I recognize that even the perception that my care for a dying donor might have been in the service of getting organs for someone else is profoundly harmful. Maintaining the dignity and ethical care of donors is never negotiable.
No Surprise Falun Gong Avoid Transplantation
Knowing the broader picture of Falun Gong in China, it’s not surprising that practitioners in the US would avoid transplantation. Separate from the religion's supposed avoidance of medical care, I can’t imagine what it would take to trust that the US organ system is not run like China’s.
Falun Gong may harbor numerous bizarre beliefs, but they also carry the trauma of attempts at their suppression and extermination in China through organ stealing. I can’t imagine accepting an organ if I thought it might be from someone who was murdered for me to have it.
Transformative Impact
Connecting the dots between Falun Gong, the Shen Yun propaganda machine, and China’s monstrous organ trafficking practices helps me provide context when these cultural issues arise in my ethics practice.
I might not have pulled these concepts together if my kid hadn’t wanted to see a weird ballet.
Holding our governments and healthcare systems to high ethical standards regarding the dead donor rule and the ethical treatment of incarcerated people are two essential elements. Understanding the major transplant ethics problems in China helps remind us that there are principles that should never be violated in the service of transplantation.
Wow-this is mind blowing! So I had *no* idea about any of this but have been confused by this traveling ballet for years. Since adopting my son from China, we make an effort to take part in Chinese culture (as much as we can in Cincinnati, Ohio) and I'd thought about us going to this ballet. The postcards though state children are not allowed in big bold letters. I always thought that was strange for a ballet but never thought it was content-related, rather-I thought the audience didn't want kids in it.