Why hasn't President Obama rebuked China for organ harvesting of its prisoners?

Transplant tourism is one of those dangerous businesses that proliferate in many developing-world countries. The intersection of rich foreigner frantic for a kidney, cornea or liver and poor local desperate to make money has spawned an illicit organ-trafficking industry, from India to Brazil. China is attempting to move towards a more ethical, voluntary organ donation system that can service the nation’s growing needs, but… that is proving easier said than done… In China, as in nearly all other countries, the number of patients in need of transplants far exceeds the number of organs available.

China is unique, however, in trying to make up this imbalance by harvesting organs from the prisoners it executes, a policy fiercely criticised by foreign transplant specialists and human-rights advocates. In 2007, in order to crack down on what appeared to be a growing trade in Chinese organs harvested for foreigners willing to pay tens of thousands of dollars, Beijing banned living organ donors, apart from family members or others who were “emotionally connected” to the needy patient. The regulations prohibited the organs of executed prisoners from going to anyone but their relatives.

China’s tough laws were viewed as commendable. But since then it’s not clear whether the regulations have been strictly enforced. Indeed, if a 2009 article in the state-run China Daily is to be believed, more than 65% of organs transplanted in China at that time came from executed prisoners.

Back in 2006, the Chinese Health Ministry said that “very few” transplants conducted in China used the organs of executed inmates. But around that time I reported on a broker called Bek-Medical, which was based in Japan and advertised “fast, cheap and safe” transplants for Japanese patients who were willing to travel to China. One of the broker’s staffers told TIME that the company organized 30 to 50 operations a year.

The source for all the kidneys and livers? “Executed prisoners,” said the Bek-Medical employee. Beyond the death-row controversy, the Chinese press has been covering other aspects of an organ black market.

In March, Southern Weekend, a muckraking newspaper based in Guangzhou, reported on a migrant worker who decided to sell his kidney, had second thoughts, but was forced to have the surgery anyway in order to get his identification papers and other valuables back from the trafficker. China, like most other nations, faces a chronic lack of organs for local patients, particularly ones who don’t have the money to secure an illegal one. The organ shortfall is compounded by traditional taboos against becoming a posthumous donor.

In January, the Health Ministry began a pilot-organ donation network that is being run with help from the Red Cross Society of China. But the national system hasn’t really caught on yet. The person tasked with rectifying all this is Vice-Minister of Health Huang Jiefu, a liver-transplant specialist who still practises medicine alongside his political work.

He is unusually forthright about China’s problems, and although he says that progress during his tenure has been less than he had hoped for, most observers praise him for what he has achieved. While acknowledging that the black market still exists, he tells The Lancet that many of the grossest abuses have been curbed. “Before the year of 2007, there were over 600 medical institutions performing organ transplantations; this was a very chaotic situation because there was a lot of financially-driven malpractice and substandard transplants taking place.”

By licensing transplant programmes and holding them to a set of standards, he now reports that only 163 programmes are authorised to undertake such surgeries.