Kidney patients last to be seen
Kidney transplant patients at Queen Mary Hospital, Hong Kong's only multi-organ transplant centre, are being pushed to the back of the queue, putting them at risk.
Other organs have a shorter 'shelf life' and so get priority in the allocation of the hospital's overstretched facilities and manpower, doctors say.
As a result, some kidney operations are being done well beyond the ideal time. The delay can reduce the lifespan of the organ in its new host significantly.
Queen Mary's chiefs of surgery and medicine say the deteriorating standard of kidney transplants is 'worrying' and 'unacceptable'.
The Hospital Authority's central renal committee, comprising experts at public hospitals, raised the problem with the authority last year.
Since 2008, when Grantham Hospital's heart and lung transplant operations were moved there, Queen Mary has been the city's only centre for heart, lung and liver transplants and one of four for kidney transplants, along with Prince of Wales, Queen Elizabeth and Princess Margaret hospitals.
The 'ischemic time' of a donated organ - the time that it is without blood supply, from when it is harvested to when it is transplanted into a recipient - is a key factor in the outcome of a transplant operation.
Professor Lo Chung-mau, head of surgery at Queen Mary and the University of Hong Kong, said that since the heart, lung and liver had shorter ischemic time limits, kidney transplants were always placed last in the queue for emergency operating theatres.
'If one donor provides several organs, we will be very busy conducting transplants of different organs, so renal transplant quality is affected,' Lo said.
Each donor usually provides two kidneys. The ischemic time for the second is longer than for the first, as the two transplants are conducted one after the other on two separate recipients.
Hospital figures obtained by the South China Morning Post showed that last year the ischemic time for the first kidney at Queen Mary was 12 hours, compared with 9.61-10.3 hours at the other three centres.
For the second kidney, it is 17 hours at Queen Mary and Prince of Wales and 13.4 at the other two.
But while the other three centres all use the second kidney no more than 21 hours after it is harvested, at Queen Mary this period can be longer - 26 hours in at least one case. The long ischemic time can lead to the grafted kidney functioning poorly.
The figures show that 44.4 per cent of second kidneys at Queen Mary suffer from delayed graft function - the failure of the organ to perform its normal function within the first seven days of transplant.
This is much higher than the 15 per cent at Prince of Wales, 27 per cent at Queen Elizabeth and 30 per cent at Princess Margaret.
Professor Daniel Chan Tak-mao, chief of service in Queen Mary Hospital's department of medicine, said the ischemic time for the second kidney exceeded 15 or 16 hours in more than 30 per cent of cases, which was unacceptable.
Chan said some of the damage to an 'overfrozen' kidney would not be known until many years later.
'For example, a normal kidney may last for 20 years, but a damaged one can be used for 10 years only,' he said.
'The standard has been deteriorating. It is not because of skills, but we have inadequate hardware and manpower,' Chan said.
'The situation is very demoralising, and that's why people keep leaving because they don't see a sign of improvement.'
'The government has been promoting organ donation but has never thought about what resources should be given to the transplant centres,' he said.
It was not a viable solution to set up more transplant centres to spread out the cases, as some members of the central renal committee had proposed, he said.
The four hospitals conducted 65 kidney transplants in 2008, 86 in 2009 and 74 last year. This means each centre takes care of an average of about 20 cases a year.
'Overseas kidney transplant centres are doing between 100 and 200 cases a year. Further sharing out cases among centres in Hong Kong would affect training and accumulation of experience,' Chan said.
Each hospital has its own list of patients waiting for a transplant. Since last year, Queen Mary has been sharing its kidneys with other centres in an arrangement in which the hospital that takes a kidney has to 'return' one to Queen Mary in the future, for the sake of fairness to patients in the different queues.
A Hospital Authority spokesman said the average ischemic times for the second graft kidney at the four renal transplant centres were 'within a comparable range'.
'However, since QMH is also a transplant centre for liver, heart, and lung, there may be situations where it will have capacity problems to deal with the second graft kidney for individual cases,' he said.
Queen Mary plans to hire two additional anaesthetists and 12 more nurses in the coming year to improve its transplant services.
hours that a kidney was left without a blood supply after being harvested from the donor in one case at Queen Mary Hospital