Kidney transplant system under fire

PUBLISHED : Tuesday, 17 December, 2002, 12:00am
UPDATED : Tuesday, 17 December, 2002, 12:00am

A points system is being used to decide which of Hong Kong's 1,000 kidney patients waiting for a transplant get an organ first because of increasing demand and a constant shortage of donors.

Under the system, a patient has a better chance of a transplant if they live in the same area from which a donor organ originates - a factor which a patients' group said was irrelevant.

Only about 70 patients a year receive a new kidney, and only 40 or so of those come from donors with no relationship to the patient. Hospitals are fighting a losing battle to keep up with demand, Hospital Authority executive manager Beatrice Cheng Shun-yan said. Dr Cheng added that tissue matching remained the main consideration when deciding who gets an organ.

However, a patients' rights group urged the Hospital Authority to be more transparent about the points system to make sure no patient was losing out unfairly. 'The points system should be transparent and independent, and patients' groups should be consulted,' said Tim Pang Hung-cheong, a spokesman for the Patients' Rights Association.

Kidney patients comprise the biggest number of patients waiting for donor organs. The number of people suffering kidney failure has increased by 55 per cent since 1997, when there were 2,347 patients. Including many of those, there were 3,652 patients with the condition by September this year.

Of those, 1,000 have been put on the waiting list for a transplant, the ultimate treatment. There were 46 transplants in the first six months of this year, compared to 62 last year and 70 in 2000.

Dr Cheng said that in choosing who gets a donated kidney, the main priority for Hospital Authority doctors was whether the organ is a 'perfect match' to the patient.

'This is the most important determinant, not age, marital status, or employment status,' she said. 'Factors such as for how long they have been waiting for an organ and their medical condition are also considered. The age will be reflected in the medical condition,' she said.

However, she added that for 'administrative convenience' the district in which a patient lived was also considered in the scoring system. She said that for social reasons, it was preferable that a donated organ was used by a member of the same community.

This issue rarely came into play, since no two patients were exactly the same, nor equally suited to a donor organ.

'[But] everything being equal, if a patient lives in region A and there is a donor in region A, that would be an advantage. We would like donors and patients to come from the same catchment area,' she said.

She added: 'We have to allocate somehow.'

Patients' rights advocate Mr Pang said factors in the points system should include age, whether a patient is a family breadwinner, the seriousness of the disease and for how long they had been in the queue. He said that the district in which a patient lived should not be a consideration.

'The government also needs to come up with a more effective education campaign to encourage more people to donate their organs,' he said.

Dr Cheng said that because of changes in diet and lifestyle, diabetes is now the major cause of final-stage kidney failure among new patients diagnosed in public hospitals, a trend similar to most Western countries.

In 1997, 27 per cent of new patients with failed kidneys were diabetic. As of September this year, it accounted for 35 per cent, she said.