At any one time, hundreds of thousands of people around the world are waiting for an organ transplant.

Several things conspire to make supply of organs fall far short of demand. Organs deteriorate rapidly after death; transplants generally require the consent of the individuals involved (or that of their families); and in almost every country organs cannot be legally bought or sold.

In China, where each year around 300,000 people are put on a transplant waiting-list, one way of relieving this pressure has been to “harvest” organs from executed prisoners. Once the main source of transplanted organs, the share from prisoners is reported by the government to have halved in recent years (mirroring what is believed to be a large decline in executions). From January 1st, the government is expected to put an end to such organ harvesting altogether, and all transplanted organs will need to come from volunteered sources. The new system would still be vunerable to abuse: prisoners could be pressured into donation, for example. But if forced harvesting stops, the public’s willingness to donate must increase from relatively low levels to make up the difference.

China is not alone in having low transplant rates in Asia—even richer countries such as Japan and Singapore fall far short of Western countries. Most transplants in these countries (China is an exception in this regard) also tend to come from live donors, compared with under a third in the West. That suggests there is a lot of room to increase the deceased-donor supply, whether through public-information campaigns or “opt-out” donor-consent regimes (which presume everyone’s consent unless they express otherwise). China is considering a legal standard for brain death, enabling exploitation of intact organs while a patient’s heart is still functioning but recovery is deemed impossible.

Such efforts run into local obstacles, however. Religious and cultural beliefs about the ‘integrity’ of the body are often blamed for low organ-donation rates in China. Another problem is more down-to-earth: although four-fifths of respondents to a 2012 poll in Guangzhou thought donating organs was “noble”, a slightly higher number feared their body parts would end up for sale. After years of taking prisoners’ organs without permission, the  government must now convince the public that their donated organs will be used in accordance with their wishes. government must now convince the public that their donated organs will be used in accordance with their wishes.

Spain leads the world with 80 organ donations and transplant per million people.

Via The Economist