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Ninety percent of the organs used in Chinese transplants come from executed prisoners, according to a new commentary in The Lancet, a British medical journal.

The shocking statistic is one indicator that China’s organ transplant regime needs help, despite recent moves to clamp down on unethical behavior. Major questions exist about the rights of (imprisoned) donors, widespread medical tourism, and quality assurance.

“[A] legal framework is urgently needed to regulate professional behaviour, to establish clinical protocols, and to restore equilibrium between the extreme demand for organs and their limited supply,” write the authors, who include include Jiefu Huang, Vice-Minister of Health in Beijing.

The call for regulations of transplants comes as part of a large set of articles in The Lancet on reforming the Chinese health care system. China’s economy has grown at a torrid pace, but its social infrastructure hasn’t kept up. Check out the series for a sobering look at how to keep 1.3 billion people healthy.

Working from public reports, Amnesty International estimated that at least 470 people were executed in the country, but the real numbers “were believed to be much higher.” The organ data adds factual evidence to Amnesty’s belief, as an estimated 11,000 organ transplants, mostly kidneys and livers, were performed in 2006 alone.

“The long-term goal for social development is to abolish the death penalty but, until then, regulations need to protect prisoners’ rights and desires and separate transplant programmes from the prison system,” the authors conclude.

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