How Hong Kong’s hospitals can boost organ donation rates

Bernard Chan says the opt-in/opt-out debate aside, a cost-effective plan for Hong Kong would be to have trained professionals in hospitals liaise with families to boost donor numbers

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Momo Cheng (left) and her mother after she donated two-thirds of her liver to a critically ill patient in April. Cheng’s selfless act came amid public concern about low organ donation rates in Hong Kong. Photo: Handout

Published: 2:05pm, 25 May 2017Updated: 6:27pm, 25 May 2017

The issue of organ donations has recently been in the news again in Hong Kong. The sad case of 43-year-old Tang Kwai-sze highlighted the issue in April. Her daughter was willing to donate part of her liver, but the law did not allow her to do so as she was just short of her 18th birthday. A selfless and courageous stranger, 26-year-old clerk Momo Cheng Hoi-yan, volunteered to donate. Cheng was rightly hailed a hero and an inspiration to Hong Kong. Following her example, thousands of new potential donors registered with the Department of Health.

Perhaps Cheng’s heroism will have an even greater impact by helping to change public perceptions about organ donations – and ultimately the law. One legal issue raised by the case is about the minimum age of 18 for organ donors. Tang’s daughter even considered applying for a judicial review to get the existing law overturned. Several lawmakers and commentators now propose reducing the minimum age.

The real issue for Hong Kong is the very low donation rate among eligible adults, especially from the deceased

Hong Kong is broadly in line with international standards by setting the minimum age at 18. The aim is obviously to ensure donors are mature enough to make such a decision. However, some jurisdictions allow living donors to be younger; California, for example, allows donation at 15 with parental consent. Hong Kong could certainly consider lowering this age. However, this debate is something of a sideshow.

The real issue for Hong Kong is the very low donation rate among eligible adults, especially from the deceased. Over the years, several hundred thousand people – I am one – have picked up and signed organ donation cards to carry. And just over 250,000 people are recorded on the Centralised Organ Donation Register. However, family members must still give their consent for organs to be donated.

Because many are reluctant to do so, we have a rate of only around five or six organ donations per million people. In most developed economies, the number of deceased donors per million is far more: it is 13 in the UK, over 20 in the US and close to 40 in Spain. The result for Hong Kong is very long waiting lists for the most commonly donated organs: kidneys and livers.

Secretary for Food and Health Ko Wing-man opens a “Say Yes to Organ Donation” promotional exhibition, organised by his bureau and the Department of Health, at Kowloon station on May 6. Photo: Xiaomei Chen

In practice, this means that at any given time, several thousand people rely on often difficult procedures and treatments to keep them alive. And many die while waiting.

One explanation is the traditional Chinese belief that the body should remain intact after death. However, there is not much evidence that this is a common and strong belief today, especially among the younger generation. Another explanation is that people are ignorant or even suspicious about organ donation. The Hong Kong Medical Association website’s page on the subject assures readers that doctors will not switch off life support if they know a patient has signed an organ donation form.