In China, executed prisoners provide the main source of organs for transplantation. Physicians take blood samples from the prisoners and match tissue types to transplant recipients. Once they are killed, their organs are transplanted into patients wealthy enough to afford transplantation at Chinese hospitals.

Patients from countries such as Canada, Australia, Israel, the United Kingdom and the United States travel to China and purchase organ transplants through brokers. At least 12 companies – of which two are in Canada – use the Internet to market transplants in China. Their websites assure prospective customers that organs are available within days or weeks. China's Health Ministry is trying to regulate the sale of organs to foreign patients, but brokers continue to sell transplants at Chinese hospitals.

China's long-standing policy of denying accusations that organs are taken from executed prisoners, its practice of concealing the number of citizens executed every year and the secrecy surrounding China's judicial system, prison system and military hospitals have made it difficult to know how to respond to reports that Chinese physicians use executed prisoners as their main supply of organs. Earlier this year, however, Jiefu Huang, China's vice-minister of health, acknowledged that most cadaveric organs in China are obtained from executed prisoners.

Chinese transplant physicians are estimated to have performed more than 60,000 organ transplants. These transplants were performed in a country with no legislation establishing brain-death criteria for determination of death, no organized national system of organ donation by informed, consenting donors, and widespread cultural and religious norms that make the concept of organ donation alien to many individuals.

The canard that prisoners in China provide informed, voluntary consent to organ donation must be dismissed. Imprisoned individuals can easily be intimidated with violence or hints of repercussions for family members, or reassured with false promises. Physicians, police officers, prison officials and prisoners who have left China dismiss the claim that informed consent is sought from prisoners. Huang Peng, a former prison official at Shenyang No.2 Prison in the province of Liaoning, says: "There is no family willing to have their loved ones' organs taken. And there is no such thing as a prisoner who volunteers." Gao Pei Qi, a former member of China's Public Security Bureau, says: "Basically, they look at the prisoner's body as whatever they want it to be. They would take the prisoner's skin, if necessary."

Family members of executed prisoners say they are not asked for permission to have organs removed from their relatives. To the contrary, numerous reports reveal the outrage families experience when they discover that organs were taken from their executed kin.

China's practice of taking organs from prisoners creates powerful economic incentives to sentence and execute individuals. It is possible that many prisoners are executed precisely because of the financial benefits that flow to court officials, police officers, prison guards, doctors and hospital administrators as a result of commercial organ transplantation.

Now that we know that executed prisoners provide China's primary source of transplantation, we must respond to this violation of human rights and principles of medical ethics. Given the number of organs taken from executed prisoners, most research papers by transplant physicians in China must draw on data obtained through research dependent on organs taken from prisoners. Abstracts, papers and posters prepared by transplant doctors in China must be rejected by medical journals and scientific conferences because of their use of data obtained through human-rights violations. Routine involvement of Chinese physicians in taking organs from executed prisoners means that physicians and researchers from China should not have access to transplant training programs in other countries. An international ban on training Chinese physicians in transplant techniques should continue until China renounces taking organs from executed prisoners and ensures that all transplant programs meet basic international standards.

China's practice of killing prisoners and taking their organs raises serious questions about why the Chinese Medical Association is permitted to retain membership in the World Medical Association. The WMA unreservedly condemns China's practice of taking organs from executed prisoners. And yet, the Chinese Medical Association remains a member. This contradiction needs to be addressed, and the Chinese Medical Association's membership should be revoked.

The transformation of China's prison system, judicial system and laws governing organ transplantation must be led by social reformers within the country. Chinese doctors, lawyers, judges and hospital administrators all need to contribute to separating hospitals from execution sites and prisons and developing organ transplantation programs meeting international human-rights standards. Other countries must enact new legislation or enforce existing laws prohibiting the buying and selling of organs. International organ brokers must be prosecuted and their business operations disrupted. Legislators need to confront the emergence of "transplant tourism."

Governments, human-rights organizations and medical societies must condemn China's use of executed prisoners as a ready supply of transplantable human organs. We must shift from debating whether China takes organs from executed prisoners to taking practical action now that we know with certainty that executed prisoners there provide a ready supply of organs for commercial transplantation.