A peculiar kind of famine is affecting Chinese citizens as the demand for blood rises much higher than the legal supply. As hospital supplies run low, patients in need of the life-saving transfusions are resorting to agents called “blood heads.”

For many years, the Chinese government experienced difficulties in meeting the demand for medical blood supplies. By the 1990s, incidences of increased HIV cases due to poor bloodletting and hygiene practices in government-encouraged blood sales led to the program’s bad reputation. In an effort to create an improved, professional image, the government implemented strict guidelines for the screening process, and outlawed blood sales altogether. In accordance with these policies, many hospitals adopted the rule that only those in possession of certificates that prove they have donated blood can gain access to the blood supply.

This rule, as may be imagined, led to a host of related problems that impacted patients across the country. Not everyone is eligible or capable of donating blood in order to get the certificate, and those who are can only donate two times per year. For those who cannot give blood but still need it, blood heads are often their only option.

Blood heads operate by selling the certificates they obtain upon donating blood to others who cannot receive the necessary documents themselves. On average, a credit for 100cc blood costs more than $150. “To us patients, buying blood solves our problems,” said a retired Shanghai civil servant who suffers from a debilitating blood condition known as myelodysplastic syndrome. “If there were no blood heads, what would I do?”

According the World Health Organization, just under one percent of China’s population donated blood in 2011, the most recent year for which figures are available. Most legitimate donations come from students or military members. 2011 saw another blow to China’s blood donation program image as a woman who claimed to work at the Red Cross Society posted pictures on social media of her lavish and extravagant lifestyle, damaging the reputation of the government-supported charity.

Chinese officials have voiced an intention to crackdown on blood heads, but many feel that nothing serious will be done about the issue. “Don’t worry about the police. We’re outside most of the hospitals and we know all the police officers,” said a 25-year-old blood head from the Jilin province.