Hong Kong must debunk myths about organ donation to help save lives, as organ failure becomes more common
Zareen Chiba urges efforts to change traditional mindsets and improve communication skills with potential donors, to bring Hong Kong on a par with other advanced societies
The death of Jamella Lo, 19, after a two-week wait to receive a double lung transplant for a rare pulmonary condition has renewed focus on the blind spots in organ donation and transplantation in Hong Kong.
With a rising incidence of non-communicable diseases such as diabetes and liver cancer leading to organ failure, the demand for organs has been rising in the past few decades while the number of viable donors are barely keeping up. The Department of Health's Centralised Organ Donation Register currently logs a waiting list of around 3,000 patients who require organ transplants to save their lives.
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Surveys by the University of Hong Kong have shown that despite territory-wide government campaigns, the local organ donation rate remains among the lowest in developed societies. Research studies on the topic reveal that a common reason for refusal is the traditional belief that the body must be buried intact, and the fear of the inability of one's family to accept donation due to related cultural reasons. Buddhist, Christian and Jain religious leaders have said that organ donation bears no conflict to the practice of their faith, and bodies such as the Catholic Church have commended the act. However, no solidarity of this degree has been shown by Chinese religious leaders.
The surveys also reveal two other significant reasons for hesitancy: the misconception that there is an age limit to donors, and the lack of transparency in the transplant system, leading to a mistaken belief that registered donors will receive poorer treatment in hospitals due to doctors' ulterior motives.
Hong Kong currently adopts an opt-in system for organ donation following death, and the donor's autonomy must be paired with family consent. Hence, the acquisition of viable organs depends heavily on the persuasiveness of each hospital's transplant coordinator in convincing grieving families of the altruistic nature of donation, and their ability to clearly detail the transplantation process.
Currently, academic training in the two local medical schools on requesting consent is insufficient. This, compounded by the lack of a concrete guide for obtaining consent, has led to mixed success rates in institutions such as the Prince of Wales Hospital, where it fluctuates between 19 per cent and 40 per cent among transplant coordinators. The success rate is significantly higher in European nations such as Spain and Germany, and in health-care systems where transplant coordinators possess tried and tested guidelines for obtaining consent. For example, family consent rates reach 100 per cent in some public hospitals in Spain.
Researchers, administrators and international organisations such as the World Health Organisation and the Transplantation Society have been looking for solutions to the global deficit of transplantable organs. Recently, medical research in 3D printing technology has suggested the possibility of printing organs and tissues to meet demand. While promising, this solution may take years to realise.
Meanwhile, nations have adopted different methods to address the organ deficit, such as the "presumed consent" (opt-out) system, where organ retrieval is performed unless an objection has been expressed by the patient when alive, and the "required request" system, where hospitals are legally obliged to approach the next of kin to discuss the possibility of the patient becoming a donor.
Both systems reduce ambiguities of the transplant process, and see family communication as key.
However, even before they consider policy changes, Hong Kong government officials should start by working in the community to debunk persistent socio-cultural beliefs and misconceptions. Medical students should also receive training about effective guidelines for acquiring consent and improving their communication skills with patients and their families. Only through increased community awareness and better communication can the number of viable donors match that which is expected of a developed health care system like ours.
Zareen Chiba, a senior medical student currently at HKU, writes about global health, science and technology