Two-thirds of organ donors in China are executed prisoners, state media reported today, as health officials launched a national donation system.
The authorities have previously acknowledged that corneas, kidneys and other body parts from criminals have been transplanted. But the new figure offers a startling insight into the scale of the country's reliance on death-row inmates, despite laws supposed to curb the use of their organs.
Officials hope the new scheme will tackle the thriving black market in body parts, and encourage voluntary donation, which remains far below demand. The state newspaper China Daily said that about one million people needed transplants each year – but only 1% received them.
"Transplants should not be a privilege for the rich," said Huang Jiefu, vice-minister for health.
He said written consent was required from condemned prisoners but added that they were "definitely not a proper source for organ transplants".
He told China Daily that some hospitals ignored the rules because of high profits. The newspaper said experts estimated that more than 65% of donors were criminals who had received the death penalty.
Two years ago, China ruled that organs from executed prisoners would be given only to family members, and that living donors could give body parts only to relatives or those with an "emotional connection".
But the percentage of transplants from living donors has risen from 15% in 2006 to 40%, said Professor Chen Zhonghua, of the Institute of Organ Transplantation of Tongji Hospital. He told the newspaper that since 2003, only 130 people on the mainland – which has a population of more than 1.3 billion – had signed up to donate their organs following their death.
Tales of foreigners travelling to China for transplants and illegal transplants from living donors are rife, and the newspaper said that middlemen specialised in faking documents to evade the law.
It added that patients could pay up to 200,000 yuan (£18,000) for a kidney.
This year, a study in the journal Clinical Transplantation said that only 4% of transplant experts surveyed believed procurement processes in China were ethically sound. It also cited World Health Organisation figures suggesting that around 10% of transplants occurred via "transplant tourism" in 2005, with China among the leading destinations for patients.
A World Medical Association agreement – signed by China among others – asks countries not to use organs from death-row prisoners because of concerns about whether they have truly given informed consent.
"The implementation of the death penalty is completely opaque in China – there is absolutely no transparency," said Phelim Kine, Asia researcher for Human Rights Watch. "Therefore, there is a complete lack of transparency with regard to transplantation and the disposal of the organs of death-row prisoners, whom we now know constitute the majority of donors in China."
He added that it seemed "highly unlikely" that prisoners were giving organs only to their families if they constituted 65% or more of donors.
The number of people executed in China is a state secret, but Amnesty International said that at least 1,718 people were executed in 2008 – more than in any other country – based on recorded cases. Human rights groups suggest the true number runs into several thousands, although officials say their "kill fewer, kill carefully" campaign has cut the numbers and have pledged to further reduce use of the death penalty.
The new transplant scheme, run by health officials and the Red Cross, will match needy patients with potential donors and encourage people to allow their organs to be used after death.
Huang said it took 20 years to create a nationwide system in the United States, but that China hoped to roll out the 10 pilot projects more quickly.
"The system is in the public interest and will benefit patients regardless of social status and wealth in terms of fairness in organ allocation and better procurement," he added.
