Mainland surgeons transplanted 3,741 livers, 8,103 kidneys and 80 hearts last year, according to industry sources.

But a leading mainland transplant surgeon says he knows of only 20 cases in which family members agreed to donate dead relatives' organs in the past six years.

Chen Zhonghua, from Wuhan's Tongji Hospital, has estimated that more than 99 per cent of organs transplanted in China come from executed prisoners.

Sources have said the mainland will have to consider other ways of getting donors as the number of executions declined and demand for transplants increased.

'It's impossible for anybody or any organisation to get accurate statistics in the absence of a registration system to monitor organ sources, surgery processes and recipients on the mainland,' one source said. 'But you have to include the possibility that some commercial centres have omitted mentioning surgery on foreign patients due to the sensitive source of organs and other hospitals may have exaggerated the number of surgeries they have performed as a way of inflating their reputations.'

Professor Chen said the number of liver transplants performed in China had doubled in each of the past two years, while the number of kidney transplants jumped from 5,000 in 2003 to more than 8,000 last year. Each top-level hospital in every major city had an organ transplant centre and at least 1,000 transplant surgeons took part in the annual meeting of the Chinese Society of Transplantation.

He said a lack of regulation meant that prices for transplant surgery varied from tens of thousands of yuan to hundreds of thousands of yuan. The main cost was involved in procuring the organs, particularly the expense of going through court and police channels.

'Many hospitals have PR staff and their targets are the local courts because without judicial approval and assistance, hospitals cannot approach prisoners or get blood tests,' Professor Chen said.

Driven by the huge profits, a number of large commercial transplant centres have emerged in recent years and have advertised their services overseas. Due to the relative ease of obtaining organs in Chinese hospitals, more and more foreign patients who would otherwise have to wait for years to get a replacement organ are coming to China for operations, attracting harsh criticism from the Word Health Organisation.

In November, Vice-Health Minister Huang Jiefu told a WHO meeting in Manila that China would regulate organ procurement from executed prisoners. A source said a commercial transplant hospital in northern China had paid 20 million yuan to reserve the procurement of organs from all the executed prisoners in the area.

'But this cannot be confirmed, because nobody in the industry will break the rule of silence, even though everybody knows the procurement of organs from executed prisoners is almost the only way to get organs in China,' the source said.

Before the Ministry of Health issued a rule this week banning any kind of organ sales and raising the entry threshold for institutes wishing to carry out the procedures, there had been only a temporary rule issued by the Ministry of Public Security, the Supreme Court and several other state departments in October, 1984.

That rule stipulated that the organs of executed prisoners could be procured for medical use on the condition the donations were voluntary or came from unclaimed bodies. But with the high demand for organs and lax administration, hospitals have tried to increase the number of organ donors by appealing to court and police officials.

'Once a court agrees, the doctors can go to the execution field, wait in a sterile van, and harvest the organ right after the execution,' a transplant surgeon said. 'Such experiences are a severe moral and mental shock to many surgeons, because the prisoners do not usually die immediately after they are shot. But surgeons have to act quickly to get the organs due to freshness requirements.

'To some extent, the doctors are part of the execution. That is too much for many young doctors to accept ... but if you want to do the transplants you have to face the reality.'

Professor Chen said the transplant surgeons ought not to be blamed.

'It's the malfeasance of the government. Because, as the doctors would say, 'if the police and government don't regulate, why should we worry? And after all, we are rescuing patients'.'

Despite the failures of the existing system, Professor Chen was optimistic about the future of organ transplants on the mainland, with more open discussion of legislation and greater social awareness of the issue.

'China has to change the current model, to encourage voluntary donation and accelerate the legislation,' he said. 'Sooner or later using organs from the executed prisoners will become history.'Vivian Wu

Professor Chen will address the annual meeting of the Hong Kong Society of Transplantation at the Island Shangri-La tomorrow.