The Chinese government may have been systematically misreporting the number of organs it claims it has voluntarily collected since 2010, according to new research published in BMC Medical Ethics.
In 2015 China promised the world they would no longer source organs from prisoners - their almost sole source previously.
The study, led by PhD scholar Matthew Robertson from The Australian National University (ANU), used statistical forensics on official Chinese datasets.
Our research shows Beijing's reported organ donation numbers don't stack up and there is highly compelling evidence that they are being falsified."
Matthew Robertson, PhD scholar, The Australian National University
"The figures appear to have been based on a simple mathematical formula, a quadratic function, which would be familiar to many high school students.
"When you take a close look at the numbers of organs apparently collected they almost match this artificial equation point for point, year in, year out. They're too neat to be true.
"These figures don't appear to be real data from real donations. They're numbers generated using an equation.
"It is difficult to imagine how this model could have been arrived at by mere chance, raising the distinct possibility that it was intended to deceive."
The study looked at data on voluntary hospital-based donated organs between 2010 and 2018 published by the China Organ Transplant Response System and the Red Cross Society of China*.
"We found major anomalies with the datasets, with implausibly high ratios of transplants per donor and mismatches when the two sets of data were meant to be identical," Mr Robertson said.
"Provincial and hospital-level data we examined also showed anomalies that are extremely difficult to explain.
"The implication is that it is highly likely the numbers the Chinese government have put out were not actually real figures created by actual organ donations, but instead generated by a simple mathematical formula."
The researchers also found the misclassification of non-voluntary organ donors as voluntary.
"This is all highly suggestive evidence of data manufacturing and manipulation that could only have been done by human intervention," Mr Robertson said.
"The patterns we observed in the data can only be plausibly explained by the falsification of official organ transplant figures."
The China Organ Transplant Response System (COTRS) forms the basis of China's current voluntary organ donation reforms, with every organ transplant allocated solely through it.
The Red Cross Society of China is mandated to verify and witness every such organ donation.
While data from COTRS is not usually publicly available, data from it has been published twice - in 2014 and in 2017.
Data from the Red Cross Society of China was previously available on four websites, with three of the websites recently taken offline. The dataset is currently available at http://www.codac.org.cn.
The researchers' findings have been reviewed by one of the world's leading statisticians - Sir David Spiegelhalter, former president of the Royal Statistical Society in the UK.
"The anomalies in the data examined...follow a systematic and surprising pattern," Spiegelhalter wrote.
"The close agreement of the numbers of donors and transplants with a quadratic function is remarkable and is in sharp contrast to other countries who have increased their activity over this period... I cannot think of any good reason for such a quadratic trend arising naturally."
Mr Robertson and his team's research comes just months after the findings of the China Tribunal, led by the former UN war crimes prosecutor Sir Geoffrey Nice QC.
The tribunal concluded 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".
Mr Robertson said the study's findings were globally significant.
"China's much-heralded organ transplant reform program was supposed to be the culmination of over a decade of international pressure, where finally they were reforming and ceasing the use of organs from prisoners," Mr Robertson said.
"As a result of these promises to reform, the same Chinese officials who promulgated this data were welcomed into the World Health Organization's transplantation task force, and Chinese surgeons began presenting in medical conferences again.
"Now we have found that the data was simply made up, based on an equation.
"With what our study shows, we think it is important the world take a closer look at China's organ transplantation system."
Robertson, M.P., et al. (2019) Analysis of official deceased organ donation data casts doubt on the credibility of China’s organ transplant reform. BMC Medical Ethics. doi.org/10.1186/s12910-019-0406-6.