Hong Kong's only liver transplant centre - one of the best in the world - cannot maintain its excellence if it remains in the current 'rigid and outdated' public health sector, its head surgeon warns. Professor Lo Chung-mau, who leads the University of Hong Kong's liver transplant centre at Queen Mary Hospital in Pok Fu Lam, said the centre should operate independently of the public health care system. Lo expressed his frustration at how the development of liver transplants is being 'suffocated' by a brain drain, decades-old equipment and a lack of co-ordinated resources. Kelvin Ng Kwok-chai, a consultant surgeon who will leave the team by the end of this month, shared Lo's views. He is one of the four public doctors who can independently conduct a liver transplant. Lo's comments are significant, given Chief Executive Donald Tsang Yam-kuen's pledge to help develop health care services as one of the six pillars of industry that will diversify the city's economy. But such a rosy picture can never materialise unless fundamental changes are made to the health care system, he says. In reaction to Lo's calls for the team's independence, the Food and Health Bureau said it considered the present arrangement efficient and cost-effective. Since its first liver transplant in 1991, the centre has been honoured for its international excellence, and health officials frequently say it can attract medical tourists. Lo said: 'Many overseas liver transplant services have funding separated from other medical services. Working under the current public hospitals system, we cannot even sustain our excellence, not to mention making services a medical tourism attraction.' The team's services had been constrained by other public hospital services, he said. For example, the intensive care unit sometimes rejects the team's requests to admit seriously ill patients before a transplant even if there are spare beds, and there is no dedicated liver transplant ward. The team comprises surgeons from the university and Hospital Authority, whose workloads are not solely focused on transplants. The loss of skilled doctors is a serious concern. It takes an average of three years to train an experienced surgeon to carry out liver transplants. In the past few years, two transplant surgeons quit - one entered the private sector and another joined a team in Australia. Ng will be the third. Lo says the public sector now has only four surgeons - himself, the University of Hong Kong's head of surgery Professor Fan Sheung-tat, Ng and another consultant - who can independently conduct liver transplants. Since becoming head of surgery, Fan has seldom conducted transplants and the team is training three associate consultants. The strain on services is compounded by the closure of four of the 20 intensive care beds, and a 10 per cent cut in operating slots due to a serious shortage of nurses. Liver transplants are labour-intensive. Each operation involves six surgeons, eight nurses and four anesthetists working in two teams over at least 10 hours. Each transplant costs about HK$1 million and the team's workload is increasing, with more livers being donated. The team has completed a record 82 transplants this year, 10 more than last year. The hospital estimates 100 will have been carried out by the end of the year. Lo says the rigid salary structure - in which public doctors of the same rank are paid the same regardless of their skills - is demoralising. 'Since liver transplant surgeons need to do highly complex work and have to be on call seven days a week, I don't see why they are paid the same as doctors with less workload and stress. We are losing doctors who want a more decent life in the private sector or in other services in the public sector. The current pay system can support very basic medical services, but definitely does not encourage the development of excellence.' Ng said he would switch to private practice mainly to give himself more time with his family. 'Money is only one thing I consider. Having more time with my family is what I need the most. Now I have to be on call every single day, as long as I am in Hong Kong,' he said. Ng, who has been a transplant surgeon for four years, said the current pay system was unfair. He said liver transplant centres in South Korea and Japan - also leading centres for living donor transplants - had independent resources, such as their own medical teams and beds. 'Hong Kong has developed advanced liver transplant skills, but in terms of structure and resources we are lagging far behind. Our transplant team now has to draw resources from others to sustain its services,' he said. Lo also said the operating theatres at Queen Mary Hospital, built 70 years ago, were outdated and are not located in one block. There are two or three theatres on each of the six floors of the hospital's main block, and several others are in another block. The hospital has no centralised surgical equipment room, unlike other advanced medical institutes. Hospital Authority chairman Anthony Wu Ting-yuk said: 'The hospital needs more space. We are looking at any new land available nearby, and any other options for an expansion.' Lo said up to three overseas patients underwent liver transplants in Hong Kong each year and most found the service inconvenient. The bureau said the pay for doctors reflected the requirements and their skills at different levels in the grade structure. 'There is no need for a separate remuneration package for staff working in a different specialty,' a bureau spokesman said. The bureau said that with additional government funding, the Hospital Authority had provided HK$9.68 million for 2009-10 to strengthen liver transplant services.
