Follow transplant education with legislation

THOUGH the Government rejected the Legislative Council's call for an ''opt-out'' organ donation scheme last Wednesday, the debate carried four messages: It shows there is still a large group among legislators and inside the Government who are reluctant to accept that the current opt-in system does not work.

It shows that many people misunderstand the opt-out system and consider it totalitarian. They failed to note that similar systems have been implemented in 15 democratic countries, including France, Sweden and Austria.

It shows many people are not aware that the Chinese cultural resistance to parting with the body after death is wearing off.

It drew legislators together for the first time to press the Government to evaluate the arrangements for organ donation and formulate an appropriate policy within a set period.

To date, about 1,800 patients in Hong Kong are waiting for organ transplants. Yet, only 60 cadaveric transplants are performed every year, so only three per cent of the patients stand a chance of surviving.

Last year, three million donation cards were distributed by the Government, but only 17 patients or their families agreed to donate organs before they died.

So what has Government been doing? It continues with the opt-in system and proclaims its legislation on organ donation is near-perfect.

The law - the Medical (Therapy, Education and Research) Ordinance - offers three provisions whereby the removal of organ/tissues from a body after death can be performed by medical staff.

Firstly, if the person gave written or verbal consent before two witnesses.

Secondly, if the person did not object to a removal and his or her family do not object. Thirdly, when the next of kin is not available at the time of death and medical staff are certain the deceased did not object while alive - something difficult to establish beyond a reasonable doubt.

The hard fact remains: medical staff can do nothing if family members object, irrespective of what the deceased wished or intended, as they have lawful possession of the body.

Many of my colleagues urged the Government to amend the law so that the wishes and intent of the donors be observed, regardless of objections from family members.

But few people sign or carry donation cards. In the past 10 years, there have only been two cadaveric organ donations at most each year by donors who have signed cards and are carrying them.

This means most of the organs for transplantation were harvested with the consent of family members, not the deceased, who had not taken out an option when alive.

Two recent surveys by doctors in Princess Margaret Hospital and the Hong Kong University showed more than half the respondents would donate their organs, and only 30 per cent objected for cultural reasons.

The surveys showed the younger the respondent, the better educated they were, and the more likely to support organ donation.

I believe an opt-out scheme enshrined in law is the way forward: the experience of Singapore in this respect proves useful.

Singapore tried an opt-in system for 13 years, but in vain. It distributed donation cards to 750,000 households, and only 27,000 people supported the scheme. In 1983, the government sold the idea of an opt-out scheme. However, it met with strong opposition.

The state then launched a five-year campaign with the message that every citizen should make his or her own decision while alive to opt in or out and should not leave the decision to family members.

It also explained that the proposed Human Organ Transplant Act did not violate human rights, as every citizen had a choice.

The act stipulates that the organs of all those between 21 and 60 who are physically and mentally sound, non-Muslim and have not chosen to opt-out while alive, should be removed from the bodies for transplantation, given that these people died as a result of accidents.

In Hong Kong, about 2,000 people die as a result of traffic accidents every year. If the law only targeted them, the number of people affected would be limited.

Having said that, I believe such a measure should be carried out in stages. We should start off by issuing opt-out cards. Consent would still be necessary from family members before a removal.

Once the level of acceptance by the public has been raised, then it is time for legislation.

For the scheme to succeed, the Government must, at the same time, strengthen work on education and publicity.

The concept of organ donation must be brought into the school curriculum at an early age.

Dr Leong Che-hung is Legislative Councillor for the medical functional constituency.