FOR many years, donating life-saving organs has been virtually taboo in China, resulting in a huge gap between organ supply and demand.

Today many Chinese people, despite high levels of education, find it difficult to choose between donating a body part to save another person’s life and keeping their own body intact in a vague belief that they will be reincarnated whole.

But traditional attitudes are changing.

An increasing number of people are willing to donate by registering as volunteer donors, especially young, educated women. They represent the major of donors nationwide, according to Tang Zhaoxiang, associate director of the Organ Donation Office of the Shanghai Red Cross.

A national registration website (www.safelife.org.cn) for volunteer organ donations was launched late last month to increase the pool of donors. It will be fully operational by June.

Anyone can register their willingness to donate by providing basic information, including ID number, contacts and organs to be donated. The registry is confidential, accessed only by authorized personnel, and can be terminated or changed at any time by the prospective donor.

The families of donors will receive priority in receiving organ transplants. Donors receive free cremation and transport.

However, immediate family members — spouses, parents and children — must consent to donations and they can override the stated wishes of a deceased prospective donor. This is not uncommon.

Donors must meet three conditions: They must be brain-dead, their heart must have stopped and their organs must be healthy — then preservation of organs and transplant is urgent.

China has not adopted the standard of brain death only, and there is emotional resistance to donating the organs of a brain-dead person whose heart is still beating.

“The national website will broaden channels for donors and improve education about the need,” according to Tang.

Similar online registration has been open on the Shanghai Red Cross website (www.redcross-sha.org) since December 2012. More than 2,200 people have registered their willingness, around 1/10 of registered prospective donors in China.

Every year more than 300,000 Chinese need an organ transplants, but only around 10,000 actually receive one (not including corneas), according to the National Population and Family Planning Commission.

The ratio of supply and demand for liver in China is around 1:35, while that for kidneys is around 1:40, according to Tang. The gap is probably greater in Shanghai where many people come for treatment, including transplants.

Because of the huge gap, organs from executed prisoners represented a major source of organs for years. Chinese officials have promised, however, that some time this year, organs will only be taken from executed convicts who have freely volunteered and whose families have consented.

The three major sources have been executed prisoners, close living relatives and voluntary donors.

Voluntary donation will play an increasingly important role and reliance on organs from executed prisoners will be phased out, according to the National Population and Family Planning Commission.

The emphasis is also on transparency to ensure that organs are not trafficked and that influential people in need do not jump to the head of the line and bribe their way to transplants.

Traditional aversion

Many people have expressed reservations about donating because they thought the distribution system was unfair and weighted toward people with power and money, instead of the needy.

Although ideas are changing, the traditional belief is that the body should be intact to enter the afterlife and that a body with a missing part will also be missing that part in the next life.

It has been considered very inauspicious to donate bodies for anatomical studies, even the corneas. It is considered a “bad death” if a dead body is cut or an organ is missing.

Around 20 percent of the organ transplants in 2013 were from close relatives, more than 50 percent came from voluntary donations, according to Huang Jiefu, chairman of the China Organ Donation Committee.

Only 0.02 people in every 1 million population voluntarily donated an organ in 2010; that increased to 0.1 in 2011, 0.32 in 2012, and 0.56 in 2013, according to Huang.

“It is good to see many Chinese people nowadays have gradually abandoned their traditional belief, and become registered voluntary organ donors, but there is still a long way to go,” says Tang from the Shanghai Red Cross.

In fact, not many registered donors can actually make donations, he says, citing criteria of brain death, cessation of heart beat and healthy organs. Family members have also blocked donation plans of their loved ones, he adds.

Tang says the online registration system so far has played a bigger role in advocacy and education than in actually sourcing organs. The biggest potential source are the 17 city hospitals authorized to perform transplants.

He estimates that there will be one prospective donor on each ICU bed each year, amounting to around 5,100 prospective donors in Shanghai. “Assuming only 10 percent are confirmed, that’s 50 to 60 donors a year,” he says.

That’s only an assumption at this stage. Only five transplants from voluntary donors were carried out last year since a new transplant program was launched in Shanghai in December 2012, Tang says. Eight have been carried out so far this year.

Most of the successful transplanted organs in Shanghai came from children, since only parental consent is required, and many young parents are more open to the idea that their child will somehow live on in another person.

“There can be nothing worse than watching loved ones passing away,” Tang says. “But something good may happen if their organ saves another’s life.”

All donated organs from the city’s 17 authorized hospitals will be collected and distributed to the neediest patients in the city’s organ transplant system, Tang says. They may be sent to other provinces if there’s no matching recipient in the city.

“We will try our best to make the distribution comprehensive and fair,” Tang states.

Organ collection and transplant are authorized in 169 hospitals around China. The standards and quality of each will be reviewed in the middle of this year. Violators will lose certification, according to Huang with the China Organ Donation Committee.