Kidneys and livers for transplant are in short supply the world over. The waiting lists in Hong Kong are long, and dozens of people die each year before donors can be found. Educating to overcome cultural sensitivities has long been the biggest challenge; a record number of donations this year shows that the effort is paying off. It is, therefore, disappointing that the message seems not to have fully filtered through to the medical community and authorities. An analysis of Hospital Authority data from 2003 to 2007 reveals that more organs would have been available - and presumably, lives saved - had greater manpower and attention been given to referring cases to transplant teams. The finding is obviously at odds with the long waiting lists. Transplant doctors have long been highlighting the dilemma they face. Here is a lesson, showing that nothing should ever be taken for granted. The assumption is that hospitals are well versed in the challenges to human health. Knowing what these are and how to deal with them is essential to being prepared. The first line of defence is having well-trained doctors and nurses. There should be enough of them to cope with everyday situations and emergencies. Hong Kong's reputation for transplants takes expectations to a higher level. We have doctors able to transplant bone marrow, corneas, hearts, kidneys, livers, lungs and skin. They have an international reputation for their skills. We presume they are backed by a system able to quickly identify donor organs and match them with patients. The study found this not to be the case. Some organs that might have been donated could not be used because of late referrals or poor maintenance given to potential donors. Other opportunities were being missed because doctors and nurses were not putting forward cases for possible transplants. The system flies in the face of the work being done to convince the community of the worth and necessity of signing up to organ donation. Our city falls far behind most other developed societies when it comes to organ donations. Hong Kong's rate is 4.2 patients per million people, compared to 35.1 in Spain, 21.5 in the United States, 10.7 in Britain, 10 in Australia and 4.8 in Singapore. Chinese culture maintains that a body should be fully preserved after death. Education that transplants can save lives, and an organ registration programme, are slowly chipping away at tradition. So far this year, 34 livers have been donated for transplants - six more than for all of last year. But the number still falls far short of demand; at any one time, there are more than 100 people waiting for transplants. One-third generally die before they can be given the gift of life. The waiting list for kidneys is 15 times longer, although dialysis means that disorders of that organ tend not to be as life threatening. Public education is working and needs to be furthered and strengthened. Those who donate organs have to be better honoured; the only recognition at present is the awarding of a certificate to relatives. But it is not just cultural barriers that need to come down. Public hospitals need to put in place more robust systems to ensure that the opportunity afforded by donors' generosity has the best possible chance of saving lives. This means more funding to ensure an adequate number of medical staff for transplant teams, and training to give them the necessary skills.