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Vital organs

A couple of years ago, I received a notice from my bank saying that in order to serve me better, they were closing down the branch I had been using for years. Needless to say, I do not use that bank any more.

Ever since, I have been suspicious of institutions - including government bodies - who claim that getting rid of something will somehow result in better service.

This is what we now see in Hong Kong, with the Hospital Authority having decided to shut down the liver transplant centre at the Prince of Wales Hospital, leaving Queen Mary Hospital as the sole service provider.

According to the Hospital Authority, this is 'ultimately in the interests of all patients and public in Hong Kong'. The administration insists that one centre is not being closed, but rather that the two centres will be merged.

However, there will be no merger of surgeons, anaesthetists, nurses or other professional members of the two transplant teams. What is being merged, as it turns out, is the list of patients. Instead of two lists, there will only be one.

Albert Chui Ka-keung, head of the liver transplant centre at the Prince of Wales Hospital, has pointed out that in Europe, there is one centre for every million people. On this basis, Hong Kong - with 6.8 million people and a serious hepatitis problem - should have at least two centres, he says.

The timing of the Hospital Authority's decision is curious. The closure of the centre at the Prince of Wales was announced months after Dr Chui embarrassed the authority by revealing that a donor liver - which could have saved a patient's life - had been discarded because of a quota system which limited the number of operations. After that, Dr Chui says, he has been politically persecuted and relieved of 70 per cent of his duties. And now, his centre is being shut down.

Secretary for Health and Welfare Yeoh Eng-kiong said that Dr Chui's charges of persecution following his whistle-blowing would be investigated.

However, Dr Chui said on Tuesday that there has been no investigation; what he now wants is an independent inquiry, run by outsiders, not hospital administrators.

Dr Chui's centre has not been shut down yet, but already he has been crippled.

While in the past he could, as chief of the liver transplant team, schedule and perform operations, now he has to seek approval from two people before proceeding, a time-consuming process that is hardly in the interests of the patient.

Will the public be better served by shutting one centre down, and by being deprived of a choice?

Just take one real-life example: Stephen Char. He tells the story of how he was told by Queen Mary Hospital in 1994 that he had inoperable liver cancer and that his liver was covered with cancer cells and two tumours. Mr Char then went to the Prince of Wales Hospital, where he was told that there was only one tumour - which was operable.

Today, Mr Char is alive and well. The experience so affected him that he is now actively involved in a patients' rights group. With only one centre, he said, 'you're passing a death sentence' every time a patient is told there is no hope.

A physician connected to the University of Hong Kong, who did not wish to be identified, thought it was preferable to have competition. The Hospital Authority is removing what competition there is, given that Queen Mary Hospital is already strongly favoured - by receiving $380,000 for every liver transplant performed - while the Prince of Wales Hospital gets nothing, and has to rely on private funding.

Besides, as the doctor pointed out, if there happened to be two liver donors in a single day, the team at Queen Mary Hospital 'will not be able to handle it' and one liver will go to waste. But if there was a second centre, that won't have to happen.

The Legislative Council's health services panel - the closest one can come in Hong Kong to a body that represents public interests - voted unanimously for two centres to be kept. But the Hospital Authority is unmoved. Its mind is made up.

The existence of two centres would motivate transplant teams as only competition can. And, to chronic liver patients, the continued existence of two centres could well mean the difference between life and death. Let's keep them both open.

Frank Ching is a Hong Kong-based journalist and commentator

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