ONE of the more settled traditions in the People’s Republic has been “harvesting” the organs of condemned prisoners for use in transplant operations. But in the past decade the number whom China executes has fallen by three-quarters, to 3,000 a year. For a medical system that could count on a flow of organs, this poses a problem. Executed prisoners used to supply nine-tenths of organs transplanted in China. The proportion is now about half.

Health officials badly need to find new sources of organs. In 2010 China began introducing donation schemes at hospitals. Persuading people to donate is a wholly new game in China, and it has been slow going. In the first year, hospitals in 11 provinces and municipalities managed 97 organ transplants from volunteers. Since then about 1,000 people have donated 3,000 organs. Hospitals in 25 provinces and municipalities now have voluntary schemes in place.

But demand is enormous. Some 1.5m people in any given year are in need of an organ, according to official figures. That includes 1m Chinese on kidney dialysis. Each year 500,000 die whose lives might have been saved, at least for a while, had they had a heart or liver transplant. About 300,000 Chinese are actually considered to be in the queue for organs, while a mere 10,000 approved transplants take place each year. An unknown number of patients turn to a black market.

The pace of voluntary donations should quicken. The hope is that by November all 165 hospitals licensed to conduct transplants will be able to boast voluntary-donation schemes. New hospitals wanting a licence for transplants will have to pledge not to use organs from executed prisoners—but those already licensed will be able to continue doing so, provided they adhere to “ethical standards”.

The ethics, however, are murky at best. Condemned prisoners (or their families) in theory volunteer to donate organs. But if no family member claims the body, it may be used without consent. Meanwhile, the financial incentive for prisons to sell organs remain high.

If more hospitals eventually opt out of using organs from executed prisoners, as officials hope, black-market traders may well step in. Patients wanting to jump the queue, as well as eager “organ tourists” from abroad, might pay for organs from executed prisoners, no questions asked. As long as demand exceeds supply, death-row inmates are worth more dead than alive.