By Didi Kirsten Tatlow and John Feng
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China Decoded is Newsweek’s in-depth newsletter about China’s growing influence on the world. It goes beyond the headlines to examine how Beijing thinks, how its policies travel beyond China’s borders, and what they mean for the United States and its allies. Readers can sign up for China Decoded here to receive each edition directly in their inbox.
The newsletter is written by journalists with deep experience covering China. Didi Kirsten Tatlow, Senior Correspondent for International Affairs and Investigations, has reported extensively on Chinese politics, influence and security. John Feng, China Editor, is based in Taiwan and covers China’s domestic politics, foreign policy and the strategic competition between Beijing and Washington.
Below, for Newsweek Members, we are reproducing the latest edition of China Decoded in full:
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The ‘Circularity’ of Power
When one of my children was at elementary school in Beijing, the principal’s car drove over a student playing hide and seek under a pile of coats in a playground that doubled as the teachers’ car park. The boy was badly injured but survived.
Parents were terrified, and furious. We demanded the school ban vehicles from the playground. Teachers countered: “Where shall we park?”
We threatened to demonstrate outside the school gate. That frightened the school leaders, since the local government prioritized “stability” and would punish those who failed to deliver. Chinese schools have a Communist Party secretary as well as a principal and the CCP position is more powerful. Under pressure, they drew up a plan to address this—desperately serious—safety problem. Point No. 1 was: “Hotly love the motherland” (re’ai zuguo; 热爱祖国). It is a standard CCP loyalty phrase.
Worried that the effort would collapse under the weight of CCP-style political correctness and self-prioritizing, I asked how that was relevant. The question shocked the room. “It’s very relevant!” a teacher gasped at me. Yet the playground-as-a-car park problem was never quite solved.
Something similar—loyalty to the system, first—may be happening with China’s doctors. And it may be behind one of the country’s ghastliest, dirtiest secrets: forced organ harvesting. In 2019, at the conclusion of a People’s Tribunal into the issue in London, Sir Geoffrey Nice, a former prosecutor at the International Criminal Court, called China “a criminal state” for what he judged was the ongoing practice of forcibly extracting organs from prisoners, including prisoners of conscience and other people. Full disclosure: I gave testimony at that tribunal about my own experiences in China reporting on the issue.
It’s an indescribable horror. And yet the situation has garnered surprisingly little attention internationally. Mainstream media largely avoid addressing it. Overseas medics and researchers continue to collaborate with China’s transplant doctors. The country has become very good at that branch of medicine.
A new report aims to show what’s going on today. Chinese Communist Party Control—the Party’s Hold on the Medical Profession and Transplant Sector is the first in a series called, Red Flags: Indicators of Ongoing Transplant Abuse in China.
Published by the International Coalition to End Transplant Abuse in China (ETAC) and authored by Sarah Cook, the founder of China Rights Analytics and Advising and the former research director for China, Hong Kong and Taiwan at Freedom House, this first report suggests the root cause of the problem: CCP control of every aspect of China’s medical system.
As well as prisoners, the Uyghurs of western China, who have been heavily persecuted, members of the Falun Gong spiritual movement, and Church of Almighty God believers are at high risk, the author believes.
Since 2015, Chinese officials say that they have cleaned up their act, introducing independent oversight via organizations that mimic Western ones and establish good practice, such as a Chinese Organ Procurement Organization and the Red Cross Society of China. But these are not independent of the CCP, the report shows.
This creates a kind of echo chamber of power where obfuscation and abuse are baked in since no one can disobey.
Like schools, hospitals are run by a CCP party secretary with ultimate power.
“There’s no independent oversight, there’s only circularity,” Cook said in an interview.
Cook shows that many leading transplant doctors are also CCP members who have sworn their loyalty and secrecy as the Party Oath requires. More “circularity.”
This chart shows what the researchers were able to identify (it’s not an exhaustive picture):
...
The report points out that when it comes to doctors, China’s medical oath is different from elsewhere. Its first pledge is: “I will dedicate myself to medicine with love for my motherland and loyalty to the people.”
The Physician’s Pledge adopted by the World Medical Association in 1948 and revised in 2017 includes a direct prohibition missing in the Chinese one: “I will not use my medical knowledge to violate human rights and civil liberties, even under threat.”
No one is saying that there are not kind and excellent doctors in China who fully understand the humanitarian principles involved. Just that they are working in a system that demands specific behaviors, and extracts an omerta, or law of silence.
And perhaps that’s the root of the horrific problem that caused Sir Geoffrey to say in 2019, when passing judgement at the end of the Tribunal:
“The conclusion shows that very many people have died indescribably hideous deaths for no reason. That more may suffer in similar ways, and that all of us live on a planet where extreme wickedness may be found in the power of those, for the time being, running a country with one of the oldest civilizations known to modern man which ideally we should be able respect and from which we should be able to learn.”
Sir Geoffrey declared China guilty. ETAC’s new series of “Red Flag” reports will suggest what’s going on today, with the first one outlining why we still know too little about it.
Didi Kirsten Tatlow is Senior Correspondent, International Affairs/Investigations at Newsweek. She is based in Berlin, Germany. You can get in touch by email here.
The Data Story
Kirsten and I love to discuss China’s deeply intertwined party-state “system,” where the presence of the long-ruling Communist Party can be found at every level in public and private life, from the very top of government to the smallest grassroots organization.
It’s a fascinating, if at times dry, subject for us because no other major country functions this way, and understanding what exactly counts as “normal” in China helps us examine the actions of its leaders as well as the motivations behind their policies.
The system is the theme today because as human rights researcher Sarah Cook notes in her report, China’s healthcare sector has medical organizations that on the surface could be mistaken for independent bodies like those in the United States, when in reality they are organized under a completely different hierarchy beneath the CCP’s leadership—that is, its oversight and control.
Centralized control of public institutions like hospitals was a feature of the former Soviet Union too, but, in academic terms, China may be the only successful modern example of how Marxist-Leninist doctrine might blend in with a high-functioning society and economy.
For decades, Beijing extended its oversight within state-linked organizations, but its desire for more political security is growing at every level under the CCP’s current general secretary, Xi Jinping.
The diagram above shows a three-tiered structure of Party supervision that is typical in medical and education institutions of a certain scale, where the real decision-making power rests with a Party committee and its Party secretary at the very top.
At middle- and lower-management level, general Party branches and smaller Party branches exist in a well-defined chain of command to ensure conformity to the CCP’s values and its strategy.
The Party had more than 101 million members at the end of 2025, according to its own accounting. That’s about 7 percent of China’s population of 1.4 billion. Strikingly, the CCP said it had “over 5.43 million primary-level organizations,” referring to those established in the three-tier system.
Party positions naturally are held by Party members, and often is the case that these senior cadres wear an administrative hat too, if they have the necessary qualifications. But as Cook argues, the weight of their roles isn’t equal—their loyalty to the Party will always come first.
There are potentially sound arguments for the CCP’s wish to see and know all: it wants to avoid the emergence of alternative centers of power, especially in state-owned enterprises in strategic sectors. In the private sector too, China fears unchecked growth can be disruptive, for example, by creating interest groups that exercise an outsized influence over the direction of economic plans.
As Cook and others note, however, the system has obvious flaws, including conflicts of interest in favor of the Party’s interest—particularly problematic where medical ethics are concerned.
It means clinical expertise and medical ethics governing things such as voluntary patient consent during the organ donation process could be undermined when decisions are superseded by political imperatives defined by the hospital’s Party committee.
The world learned during and after the COVID-19 pandemic that Beijing’s international healthcare partners, including even the World Health Organization, could not guarantee that the Chinese system would be transparent or forthcoming.
John Feng is Newsweek's China Editor based in Taichung, Taiwan. You can get in touch with John by email here.
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