The liver transplant centre at Queen Mary Hospital is one of the best in the world. It has attained this standing despite the constraints imposed by the public hospital system. But the rules by which it exists are straining resources. If standards of excellence, and in consequence its reputation, are to be maintained, it has to be given independence. Professor Lo Chung-mau, the head surgeon, is frustrated by outdated regulations governing how the centre operates. Unlike transplant units in many other parts of the world, there are no dedicated medical staff or facilities. The surgeons do not get paid a premium over their Hospital Authority counterparts despite the three years of training they undergo to gain the skills needed. Unsurprisingly, doctors are being drawn into the private sector or other parts of the public hospital system. The government touts Hong Kong as a destination for medical tourists. It holds up the liver centre as the flagship of the high-skilled end of the public hospital sector. But the rhetoric is not backed by official support. The unit's doctors and nurses are using outdated equipment and cannot perform as many operations as they would like because of limited staff, a lack of beds for patients and having to share an operating theatre. There is no disputing the worth of the centre to the community. Hundreds of lives have been saved since it opened in 1991. This year, surgeons have already performed a record number of transplants, and there is no shortage of donors. The centre has more livers than it can handle. But the strain on resources is such that patients are being turned away. Reputations are not earned easily. They can be lost overnight. If authorities are genuine about moving the medical sector forward to provide better service and attract overseas patients, they have to demonstrate they are dedicated to that cause. Giving the liver transplant centre its own funding and dedicated staff and facilities would be a move in the right direction. This internationally renowned flagship must not be allowed to sink.