This month the Journal of the Royal Society of Medicine (JRSM 2007;100:119) carries my essay concerning the extraordinary rise in the number of organ transplants in China, available off a shopping list, to international health travellers. Where do so many organs come from? Nobody knows for sure. Macabre videos have been shown of criminals, ropes around their necks, consenting to their organs being used after their deaths. Since I wrote some months ago the story has rumbled on surfacing most recently in the Irish Medical Times last week.

In my piece I considered the hypothesis that the organs of healthy prisoners were destined for the transplant market from the outset and taken under anaesthesia - and that is the means of their execution. A very knowledgeable international figure tells me that the word on transplant street is otherwise. He says the prisoners are shot in the head, dragged into a van, and hastily eviscerated. I am not sure if that is better or worse. What it does do is to separate the judicial act of execution, which is a matter for the state, from the work of doctors.

My time in medicine has run parallel to the surgical and ethical developments in transplantation. I was a clinical student at the time of the first human to human transplant and in the flurry of about 100 mainly one-off heart transplants that followed Guy�s had its day on 16th May 1969. As a cardiac surgical houseman in 1970 I rubbed shoulders with other members of the Guy�s up-all-night crew, the emerging breed of kidney transplanters. When I worked as the �head injury SHO� at Addenbrookes in 1971-1972 the same ilk were around the doors of A&E and ITU waiting for patients to become cadavers. Later I did both donor and recipient heart transplant operations and know first hand the spectacular benefits. Grateful people, unrecognisable in their regained health, greeted me in the hospital corridor.

But transplantation has a dark side. Young fit people must die suddenly and tragically. Years ago I left the bedside of a youngster and shared a few words of hope with his grandfather. I had sorted out his chest but the state of his brain was in the balance. In the morning I arrived to find the theatre changing room in the state of devastation so well described by Ian McEwan in �Saturday�. Slumped in our coffee room was a stranger to me � one of the organ retrieval team. Whose organs had been taken I wondered; it was the youngster. I was deeply concerned that �my patient� whose bedside I had left the night before had been eviscerated without my knowledge. �That�s your problem mate� he said. The fact is that he was absolutely and totally right - if a touch insensitive. His job was to take the organs out expertly. Neither ensuring consent for the donation or what would happen to the organs afterwards were his part of the process. My piece in the JRSM explains how these thoughts led me via China and the Falun Gong to the holocaust.