China's announcement that it will end the practice of using transplant organs from executed prisoners next month may be largely cosmetic, activists say.
According to state media, human organ transplants will rely on voluntary public donations and on donations from living relatives from Jan. 1, 2015.
The ruling Chinese Communist Party has already pledged to end the controversial practice, and has set up a voluntary donors' register to that end, but demand for transplant organs vastly outstrips supply from donated sources.
Some 300,000 patients are placed on waiting lists for organs every year, with only one patient in 30 ultimately getting what they need.
According to Huang Jiefu, head of the China Organ Donation Committee, Beijing has nonetheless "always been resolute" about ending it.
"Donations by the public should be the only source of organs for transplants," Huang was quoted as saying by the English-language China Daily newspaper on Friday.
But voluntary donors are few and far between, according to Huang, who blames traditional Chinese beliefs that the body must remain intact at death in order to pass to the next world.
Huang also cites "concerns as to whether organ donation can be fair, just, and transparent," according to state-run broadcaster CCTV.
According to a researcher at the U.S.-based Laogai Research Foundation who declined to be named, such fears aren't unfounded, particularly where "voluntary" donations can still be coerced out of prisoners under the total control of the authorities.
"It's always possible for them to bend the rules around voluntary donations," the researcher said. "For example, they could pay the prisoner's family some money, or get them to persuade the prisoner."
"They could even force the death row prisoner to sign a consent form, making it a voluntary donation; all of that is likely, and entirely do-able," the researcher said.
"So I think it's going to be pretty difficult to implement this ban in any genuine manner."
Xie Jiaye, head of the California-based America-China Association for Science & Technology Exchange, said basic inequalities in Chinese society also make the operation of a voluntary register highly problematic.
"In China there are always going to be problems with this because, privately, words can be had, and money can be exchanged, or people can use their personal connections," Xie said.
"In this way, people who were at the back of the line can move forward to the front."
He welcomed the new rules on voluntary donations, but said they won't put an end to the black market in transplant organs.
"This won't rule out profiteering, or the use of transplant organs using illegal methods," Xie said.
He said China needs far greater transparency in public life before such a system will work fairly for all.
"But perhaps they could achieve this in the bigger cities, and use the Internet to publicize the details, so that patients and their families and other people can register, and see the source of the organs," he said.
"Transparency can help put a stop to these criminal activities, but the implementation of the law must be strengthened, for example to include punishments for the unauthorized removal of organs," he added.
In the southern Chinese city of Guiyang, the family of surgery patient Xie Yourong says she died on the operating table after having her bladder and uterus illegally removed during routine surgery.
"My mother was in pretty good health, but she went into hospital to have blood in her urine checked out," Xie's daughter Zhang told RFA on Friday.
"She died so someone could get rich," Zhang said. "Some people have no morals; they have lost their humanity."
"And how would we know what was going on in the operating theater? My mother was cut up like a beast in a butchery."
She said such doctors prey on unsuspecting ordinary people who come in for regular procedures.
"Anyone who doesn't have medical knowledge and who doesn't like to kick up a fuss is in danger of becoming a victim," she said.
Allegations like Zhang's are commonly seen on China's Internet, but relatives have little hope of proving them, nor of bringing those who steal organs to justice.
Reported by Lin Ping for RFA's Mandarin Service, and by Wen Yuqing for the Cantonese Service. Translated and written in English by Luisetta Mudie.