Hardly a case for closure

PUBLISHED : Wednesday, 18 December, 2002, 12:00am
UPDATED : Wednesday, 18 December, 2002, 12:00am

Any public medical authority faced with unlimited demand and finite resources has to face up to the unenviable task of making tough decisions about who should get treatment first and how best to organise resources.

Yet, when a points system used to decide who should get a kidney transplant has to consider, among other criteria, whether the patient lives in the same area as the donor, something seems amiss.

So is a proposal to shut down a liver transplant centre - where bureaucratic inertia had led to the wastage of a donated liver in June - on the grounds that one such centre would be enough for Hong Kong.

No doubt the Hospital Authority must have taken great pains to devise what it believes to be the fairest way of deciding which kidney patient should get a transplant when one such organ is available.

And the consultants hired to review how best to organise liver transplant operations must have drawn on their expertise in making their recommendations.

Yet, for the public, particularly patients directly affected by the decisions, they cannot help but wonder what is going on. They are entitled to know the basis on which key decisions are made about operations that may save their lives. Yet, it appears patients' rights groups have not been consulted.

On the face of it, the consultancy report on liver transplants, which proposes that the organisation and training for such operations should be concentrated in one centre, makes sense, as Hong Kong is geographically small and the organ donation rate is low.

However, one should never overlook the fact that Hong Kong has close to seven million people. The SAR's organ donation rate is currently low, and that is a problem. But the solution should lie in trying harder to encourage people to donate their organs should the opportunity arise, such as by hiring more counsellors to persuade relatives of those who had pledged their organs to abide by the last wishes of their loved ones.

Indeed, the signs are that more people are willing to donate their organs. With a higher rate of donation, no one hospital would be able to handle all the operations. As the population ages, the demand for liver transplants is also expected to increase from 15 per one million people now to 20 in five years.

Hong Kong has one of the highest rates of liver-related ailments, including liver cancer, in the world. It would be a pity if an existing centre with full teams of medical professionals who have honed their skills in a specialised operation had to be closed.

A little competition is always better than none, in business as it is in medicine.