With China's most famous living dissident, Nobel Peace laureate Liu Xiaobo, on the verge of death, his supporters continue to call for him to be allowed to leave the country — to either get medical treatment or at least die a free man.

In decades past, China sometimes released high-profile dissidents, who went overseas. But the days when China was willing to cut a deal with the U.S. or other countries and send a dissident into exile are long gone.

China today is far more confident of itself and its power relative to other countries, and analysts believe President Xi Jinping would be hard-pressed to see any benefit to releasing even the most celebrated dissident, especially in a year when a leadership transition is scheduled.

"Unless Xi Jinping sees why it is in his advantage to let Liu Xiaobo leave, why would he do it?" asks John Kamm, a San Francisco-based human rights campaigner and head of the rights group Dui Hua, Chinese for "Dialogue."

The only possible exception, he notes, would be "if Donald Trump were to pick up the phone with his buddy and say, 'Look, how about it? Let's do a deal.' That's the only chance we have right now."

Trump met with Xi at last weekend's Group of 20 summit in Hamburg, Germany, but there has been no indication that Trump raised Liu's case with him.

Liu, Kamm notes, is the second Nobel Peace laureate to be awarded the prize while in prison. The first was Carl von Ossietzky, the German journalist and activist who won the award in 1935 for his exposure of the Nazis' rearmament of Germany in violation of the Treaty of Versailles. Ossietzky was jailed in 1933, convicted of espionage and treason. He died in a prison hospital five years later.

Liu has been treated for late-stage liver cancer at a hospital in northeastern China's Shenyang city. By Wednesday afternoon Beijing time, it was clear that Liu was near death. The hospital said he was suffering from septic shock and renal and respiratory failure. His family declined to put him on a respirator.

Although China invited two foreign doctors, from Germany and the U.S., to help treat Liu, Beijing has dismissed calls by foreign governments for Liu to be treated overseas, calling it meddling in China's internal affairs.

A video of the doctors visiting Liu in the hospital on Saturday was released — apparently by Chinese authorities — to show Liu was being well cared for. The German Embassy, however, complained that China had breached doctor-patient confidentiality by releasing the video.

"It seems that security organs are steering the process, not medical experts," the embassy said in a statement on Monday.

Liu is on medical parole, serving an 11-year jail term for subversion. The literary critic and university lecturer helped draft a 2008 manifesto called Charter 08, calling for political reforms including the end of the Communist Party's monopoly on political power.

He also played an important role in the 1989 pro-democracy movement, after which he was jailed for the first of four times. Since then, he has not been allowed to publish in China and remains unknown to many, if not most, Chinese citizens.

Kamm, who left a business career to focus on human rights in the wake of the June 4 massacre near Tiananmen Square in 1989, has had as much success as anyone in getting information about Chinese political prisoners and securing their release.

After the massacre, China was hit with economic sanctions and its international image took a drubbing. But a few years later, China began releasing political prisoners, often to smooth over visits by Western heads of state that might otherwise have been tense.

Notable instances included the 1993 release of Wei Jingsheng, a leader of the 1978-79 Democracy Wall movement, and the 1998 release of Wang Dan, a student leader in the 1989 pro-democracy protests. Both initially went to the United States.

Over the years, Kamm has made more than 100 trips to China to discuss political prisoners' cases with justice and foreign ministry officials. And while he can still engage with his hosts, he says, "The channels are becoming narrower, and the acts of clemency are becoming rarer."

The difference now is that China already has achieved much of what it wanted by its previous release of dissidents. Chief among Beijing's goals was membership in the World Trade Organization, which it joined in 2001, and the right to host the Olympic Games, which it did in 2008.

Another difference is that China's economy today is about 40 times its size back in 1989, and so is its military spending. After years of trying to attract foreign investment, China is now a net exporter of capital.

"The big question for the international community now is: What does China need that can be exchanged internationally, strategically?" says independent commentator Wu Qiang.

In a sense, Wu adds, the lack of any easy answer to this question may signal the end of the sort of human rights diplomacy — or, as some commentators have called it, "hostage diplomacy" — practiced by the major powers in the Cold War.

Wu notes that China is preparing for a Communist Party congress this fall that will decide the leadership lineup for years to come. Its priority now is nipping any political challenges in the bud. And with government spending on internal security outstripping that of national defense in recent years, it is well-equipped to do so.

China's officials have "established nearly totalitarian social controls, especially over dissidents, and they're very confident about this," Wu says. "They are not concerned that Liu Xiaobo will have any political impact if he lives in China."

The government would, of course, lose that control over Liu if he were to go overseas. On the other hand, Chinese state media have also pointed out that dissidents tend to lose their influence on domestic politics when they go into exile.

When China showed prisoners clemency in the past, observers praised it as a sign of confidence. But Wu's point is that China now has a different kind of confidence: It no longer needs to cave into pressure from foreigners or give quarter to those it considers its enemies at home.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

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