Relatives allege delay in transplant referral The family of a deceased liver patient wants an inquest to investigate whether Queen Mary Hospital delayed referring her for a life-saving transplant. At least two medical experts have questioned the management of the case and how the patient's chances of survival had been assessed. Queen Mary Hospital, the teaching hospital of the University of Hong Kong, has denied any wrongdoing. The 47-year-old woman, surnamed Shea, was admitted to the hospital in late February last year for primary biliary cirrhosis, a disease that slowly destroys the bile ducts and causes liver failure. During her admission, the hospital conducted abdominal tapping on Shea, who also suffered from jaundice. The medical team, headed by Lai Ching-lung, HKU's chair professor of medicine and hepatology, did not put her on the waiting list for a liver transplant during her stay. The team evaluated her condition according to the Model for End Stage Liver Disease (Meld), in which she scored 14. The hospital said Shea was seen by the liver transplant team, staffed by the surgery department, on March 20, May 15 and September 4, and there was 'absolutely no delay in treatment'. A spokesman said the team regarded the score of 14 as too low for a transplant. The hospital eventually put Shea on the waiting list in early September, but her condition deteriorated. She was admitted to the intensive care unit on September 14 and died three days later. The hospital spokesman said the team usually referred a patient for a liver transplant when their Meld score was 15 or above. 'A Meld score under 15 means the risk of having a transplant is higher than not having one.' Shea's family is seeking help from the Patients' Rights Association, while police are investigating to decide whether an inquest is warranted. Association spokesman Tim Pang Hung-cheong said the family had complained about a delay in referring the patient for a transplant. 'There is only one liver transplant centre in Hong Kong. If there is a problem in the prioritisation of patients, there are no checks and balances,' Mr Pang said. A local liver expert questioned the hospital's management of the case. 'Even if the patient's Meld score was rather low in March, why didn't the hospital evaluate her again in May? Why did the hospital have to wait until September for the transplant when the patient's condition became so bad?' A hospital spokesman confirmed the medical team did not assess Shea's Meld score again during a consultation in May because her condition 'was not bad at the time'. Another liver expert said patients with primary biliary cirrhosis should also have the chances of survival evaluated according to another model, known as Mayo. The expert said physicians should first use the Mayo score to evaluate the one-year survival rate of such a patient, followed by the Meld score for the suitability of a transplant. 'But of course, there is no hard and fast rule; all these scores are only models. There are different factors that a doctor will consider if a patient needs a liver transplant or not.' The Queen Mary Hospital spokesman insisted its use of the Meld score was correct. 'We use only the Meld score to prioritise the transplantation and not the Mayo score. The Mayo score is just an additional predictor model.'