https://www.pnas.org/doi/10.1073/pnas.2608464123 (https://www.pnas.org/doi/10.1073/pnas.2608464123)
Human organ trafficking and missing persons in China
Xuebo Wang (https://www.pnas.org/doi/10.1073/pnas.2608464123#con)
Edited by Daniel S. Nagin, Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA; received March 12, 2026
October 26, 2026
123 (44) e2608464123
https://doi.org/10.1073/pnas.2608464123 (https://doi.org/10.1073/pnas.2608464123)
Significance
This study addresses an ethically complex and highly sensitive issue in organ-trade policy, focusing on China's 2015 reform that ended the use of organs from executed prisoners. While most countries prohibit voluntary organ trade for compelling ethical reasons, such regulations can substantially constrain organ supply and exacerbate shortages. In turn, severe shortages may create incentives for illicit organ procurement and trafficking, including extreme forms of exploitation and violence. Our findings underscore the power of market forces: Even in a comparatively safe country such as China, severe scarcity may generate incentives for highly harmful illegal activity. More broadly, the results highlight a fundamental policy challenge: Regulations designed to achieve ethical objectives may also generate unintended consequences when they substantially restrict supply.
Abstract
The persistent shortage of human organs for transplantation has long been a global challenge. The prospect of substantial profit creates strong incentives for illegal organ trafficking, including murder for organ harvesting, yet empirical evidence remains scarce. This study addresses this gap by exploiting a unique quasi-natural experiment created by China's organ policy reform. From 1984 to 2014, executed prisoners were the primary source of transplant organs in China. In 2015, the Chinese government abolished the use of organs from executed prisoners, sharply exacerbating the organ shortage. Following this policy change, the number of missing persons rose notably nationwide. Employing difference-in-differences and triple-difference strategies, we show that, compared to cases unrelated to organ trafficking (e.g., voluntary disappearances), the number and incidence of involuntary missing persons plausibly related to organ trafficking increased significantly after 2015. The effects are especially pronounced among individuals with mental illness and in regions with higher transplant demand and greater transplant capacity. Although we do not directly observe organ trafficking, the spatial, temporal, and demographic patterns we document are consistent with the hypothesis that increased organ scarcity intensified incentives for illicit organ procurement. More broadly, the findings suggest that severe organ shortages may generate unintended and highly harmful consequences, even in a low-crime setting such as China. These results underscore the importance of accounting for behavioral responses and illicit-market incentives when designing policies that restrict the supply of scarce, high-value goods such as transplant organs.