But now, the specially formed China Tribunal in London has declared there is no doubt that state-sanctioned forced organ harvesting is occurring on a massive scale.
Made up of members from the United States, United Kingdom, Malaysia and Iran, including experts in human rights, transplant surgery and international relations,the independent tribunalheard from 50 witnesses and examined an enormous volume of visual and text evidence over the past year.
That included testimony about the barbaric practices, including organ removal on live patients.
Dr Enver Tohti worked as a surgeon in China and was instructed to perform organ extractions on unwilling subjects.
“What I recall is with my scalpel, I tried to cut into his skin, there was blood to be seen,” Dr Tohti told the tribunal of one such live procedure. “That indicates that the heart was still beating … at the same time, he was trying to resist my insertion, but he was too weak.”
A map of hospitals in China that carry out organ transplants shows they are in proximity to known detention centres.
The number of operations performed, the incredibly short waiting lists for recipients and the expansion of facilities demonstrated “beyond a reasonable doubt” that “forced organ harvesting has been committed for years throughout China on a significant scale”, the report said.
Chaired by the esteemed Sir Geoffrey Nice QC, the tribunal heard most of the detainees murdered for their organs were political prisoners from the Falun Gong movement as well as ethnic Uyghurs.
The practice, which China continues to deny, constituted genocide and industrial-scale murder and torture, Sir Nice said.
“Forced organ harvesting is of unmatched wickedness, on a death-for-death basis, with the killings (from) mass crimes committed in the last century,” he said.
The tribunal heard forced extractions had been taking place from at least 2001 onwards, although the practice likely began long before that.
An estimated 60,000 transplant operations had taken place each year over the past two decades, the bulk of which were done with organs from murdered prisoners, the tribunal found.
“In addition to years of imprisonment without fair trial, brutal living conditions, torture and the threat of death, survivors gave evidence about being subjected to physical examinations including blood tests, X-rays and ultrasounds,” the tribunal reported.
“Experts report that the only reasonable explanation for these examinations was to ensure that victims’ organs were healthy and fit for transplantation.”