China’s cabinet, the State Council, issued regulations in 2007 for voluntary organ donations. But it has struggled to popularize the practice. Chinese customs call for people to be buried or cremated with their organs intact.

People’s Daily, the official newspaper of the Chinese Communist Party, said that China had 150 people who needed organ transplants for every organ that was donated voluntarily. The newspaper did not say how much of the difference was made up from executed prisoners.

China has 300,000 patients with end-stage liver diseases, but in the first 11 weeks of this year there were only 546 transplants of livers and other major organs, the newspaper said, adding that “the majority of the sufferers die while waiting agonizingly to receive them.”

The Dui Hua Foundation, a human rights group in San Francisco, estimated in December that China executed 4,000 people a year. While that is still more than the rest of the world combined, it is down from the estimated 8,000 executed in 2007, the year that the Supreme People’s Court regained the authority to conduct a final review of death sentences approved by lower courts.

The Chinese government does not release statistics on executions. Official news media reports appear to suggest that the death penalty is used heavily against drug traffickers and gangsters, with rare instances of government officials and business executives being executed in extreme cases of corruption or endangering public safety, like during a recent scandal over faulty pharmaceuticals.

Dr. Darren Mann, a consulting surgeon with experience in organ transplants in Hong Kong, which retained an autonomous health care system after the British returned the territory to Chinese rule in 1997, said that people with histories of intravenous drug use were likely to be overrepresented in prison populations and would be more likely to have fungal and bacterial infections.

Organ transplant recipients are treated with powerful immune suppression drugs to prevent them from rejecting transplanted organs, but the drugs also leave the recipients highly vulnerable to any infections that the donor’s immune system may have been keeping in check.