This story has been made freely available as a community service to our readers. Please consider supporting SCMP’s journalism by subscribing . The dire plight of a 65-year-old Hong Kong woman at the top of a waiting list for a heart transplant has turned the spotlight back on the public’s reluctance to support organ donations, with one advocate calling for more public education on the issue and a review of the relevant policies. Finding an organ donor for Kitty Hui Pui-lan, who was recently struck down by acute heart failure, is a challenge as the person must have a similar body size to the patient, one of her doctors, Michael Wong Ka-lam, on Wednesday said. Hui is at the top of the waiting list for patients of her blood type and body size. Wong said the “golden time” was now as she might succumb to complications at any time within the coming weeks or months. Only eight heart transplants were performed last year, down from a peak of 17 in 2018, according to Hospital Authority statistics. Seventy-six patients are in need of a new heart in Hong Kong, with an average waiting time of more than six months. A retired secretary, Hui was in early April diagnosed with acute myocarditis, or inflammation of the heart muscle, with her heart functioning at just 11 per cent of normal levels. “My wife and I lived a normal life … We have no chronic illness, high blood pressure or diabetes, nor were we in any need of long-term medication,” Hui’s tearful husband, Simon Lo Chung-sun, 68, told a radio programme on Wednesday. “So it was to our surprise that my wife suddenly felt stomach discomfort before the Ching Ming Festival. No one knows the cause leading to the illness. But now, she has stayed more than a month in the intensive care unit, with tubes all over her body.” Hong Kong doctors issue urgent appeal for heart transplant to save life of woman Wong, one of Hui’s two attending doctors, said multiple tests had been carried out to find out the cause of her condition, all to no avail. Her other doctor, Oswald Joseph Lee On-jing, dismissed her condition was in any way linked to the third Covid-19 vaccine shot she received in late January. Pharmaceutical firm Pfizer, which supplies one of the two Covid-19 vaccines approved in Hong Kong, said myocarditis was a possible side effect of the shots, stressing that the odds were low, with a study in Israel showing only two in every 100,000 people developing such a condition, mostly males aged between 16 and 19. “A heart transplant is the only and best treatment option,” Wong, an associate consultant of the Cardiac Medicine Unit at Grantham Hospital told the same radio programme. “She can eat and talk now … If there is a suitable donation today or tonight, now is the ideal, golden time. “As for how long this golden time can last, it depends on complications during the period. It can be said our support is in a race against complications.” Wong said complications could cause her condition to deteriorate at any time and might include blood clots, bleeding, severe infection and organ failure, due to a machine attached to Hui’s body that helps keep her heart beating. Potential donors should be blood type O positive and have a similar body size to Hui of 154cm in height and 42.9kg in weight. The donor’s sex was not a concern. Wong noted that over the past almost 30 years, patients had to wait more than six months for a transplant. So far, five heart donations were made this year. The figure was eight and 10 in 2021 and 2020 respectively. “Every year, even without the pandemic, heart transplant cases have been rising and falling. Every year is different, this is not a fixed number,” Wong said in an earlier appeal on Friday. “The main reasons for the fluctuations are the number of donations and whether there are suitable matches, there are a lot of different factors.” Dr Kelvin Ho Kai-leung, founding president of the Hong Kong Organ Transplant Foundation, explained that one of the factors contributing to the city’s low heart transplant rate compared with other organs was that a heart had to be taken from a deceased person, while other organs such as kidneys could be retrieved from a living donor. Unlike a kidney transplant, the donor and recipient of a heart must have a similar body size, Ho said. “If the donor has a bigger body while the recipient is smaller in size, the heart would be too big for the recipient,” he said. “If the heart of the donor is too small, it would be like having insufficient horsepower in a car … and not suitable for transplant.” Currently, the city retrieves organs from patients who have suffered brain death, which occurs when the brain of a person no longer functions, but a life support machine keeps their heart beating. Families of such patients might struggle to come to terms with the situation and refuse to give their consent for organ donation. Another approach involves resuming a deceased person’s blood circulation after the heart has stopped functioning for two to five minutes, and then retrieving the organ for a transplant, but it is not widely adopted in the city. Currently, the city takes an opt-in approach to donation, meaning a person will be considered as an organ donor if they have given explicit consent. Emergency appeal to save young Hong Kong woman’s life whose organs have failed In 2017, officials looked into whether the law could be changed to allow children to donate organs as living donors, after the judiciary barred a 17-year-old girl from giving part of her liver to save her mother, who was dying of acute liver failure. The teenager was three months shy of 18, the legal age for a living donor. But the idea did not gain much support from the public and it was eventually put aside. Discussions were also raised on whether the city should adopt an opt-out system, meaning everyone would be assumed a willing donor unless they specifically objected to it. A public survey carried out by the government from late 2016 to early 2017 found that around one-third of respondents supported adopting an opt-out system, while a similar proportion opposed it. The remaining held a neutral position or had no opinion. Ho said that the government should ramp up education about the opt-out system and launch a proper consultation to gauge public views, adding that similar measures should also be taken to promote organ donation following cardiac death. In Switzerland, a new opt-out law was passed in a referendum with 60.2 per cent of votes on May 15. However, families can still refuse if they know or suspect their loved one would refuse to donate their organs. Spain also operates a similar opt-out system. Lo said he and his wife had been married for 40 years and were each other’s first love. He recalled that when they were first married, Hui would wait until late in the evening to have dinner with him. “During our dinner, we talked about the good and bad things that happened that day,” Lo said. “It was very heartwarming, she helped me deal with all the small and big issues at home.” He said this “close relationship” continued even after they retired. “I hope people who care can donate their deceased family member’s heart to bring hope to my wife,” Lo said. “My wife and I will carry on with the donor’s legacy with gratitude to contribute to society.”