His condition worsened too. He suffered a 90 per cent decline in his vision and had two painful encounters with peritonitis, when his abdomen was inflamed.

When he could not bear waiting any longer, Yuen decided to try for a new kidney in mainland China.

“I didn’t ponder hard over this decision, I thought I’d just go up to the mainland and make a bet. If it didn’t turn out well, that would be the end of my life,” recalled the non-profit organisation worker, now in his fifties.

It only took nine months before Yuen received his new kidney at a Guangzhou hospital in 2018, but he had to communicate with his doctor secretly, and paid 780,000 yuan (HK$892,900) in cash for the transplant.

He has no idea who donated the kidney that saved his life.

Hong Kong to discuss cross-border organ donation plan with Beijing

“I would feel uneasy if I knew the truth about the organ, but people are selfish,” he said. “You won’t feel that much when you really need it.”

At the time, there was no official route for Hongkongers to undergo transplants in mainland China or receive organs from there.

Residents could only join the organ donation queue in the city, then hope and wait.

That could change, with health minister Lo Chung-mau revealing that Hong Kong hoped to regularise organ donations with the mainland.

Last month, he said the government hoped to establish a second tier to the city’s organ donation system, allowing organs from the city to be used across the border if there were no suitable matches locally.

Hong Kong baby Cleo now breathing unaided after first cross-border organ transplant

Similarly, organs from the mainland could also be considered for use in Hong Kong, if there were no suitable matches with patients across the border.

The change would mean less wastage of available organs, if there was no suitable recipient in the queue on either side of the border.

The proposal surfaced last December with the successful case of baby Cleo Lai Tsz-hei, the first patient to undergo a heart transplant in Hong Kong with an organ from the mainland.

So many patients, but few organ donors

Currently, Hong Kong and the mainland maintain separate organ transplant allocation systems.

At the end of last December, there were 2,451 patients waiting for new kidneys, the most sought-after organ for transplants. The average waiting time for a kidney transplant was 56.8 months, according to the latest data provided to the Legislative Council.

In Hong Kong, organ donation is voluntary and willing donors have to be registered. But even after being included in the organ donor register, their family members may have the final say in objecting to the removal of organs.

According to official data, there were 72 kidney transplants in the city’s public hospitals in 2021 and 56 last year.

There were a total of 356,093 registered donors in Hong Kong last year, although the number of new donors registered declined from 20,001 in 2019 to 12,500 last year, according to official data.

Heart transplant plea puts focus on Hong Kong’s lack of organ donors

The city has long faced a low organ-donation rate, which stood at only 3.9 people per million in 2019. That is the number of people per million in the population whose organs were removed for transplant after death.

This compares with rates as high as 49.6 per million in Spain in 2019.

In mainland China, the rate stood at only 3.73 people per million in 2021, according to the China Organ Transplantation Development Foundation, a government-registered non-profit organisation that advocates for organ donation.

Donated organs in the mainland are distributed through the China Organ Transplant Response System (COTRS) established in 2013. It is a database of donors, available organs and patients waiting for transplants, and allocates organs that become available.

China outlawed harvesting organs from executed prisoners in 2015. Since then only two sources are legal – live donations from spouses or family members, and donated organs from people who have died.

Human rights concerns have lingered over the mainland’s classification of voluntary donors, and the accuracy of COTRS data.

Last April, the Chicago-based International Society for Heart and Lung Transplantation, whose 3,700 members are doctors from more than 45 countries, issued a statement saying organ donations from the mainland should not be accepted.

It accused mainland authorities of continuing to “systematically support the procurement of organs or tissue from executed prisoners”, a charge Beijing has denied.

Hong Kong baby’s heart transplant sparks hopes of long-term cross-border scheme

Five siblings needed new kidneys

Citizens of Hong Kong, Macau and Taiwan have been allowed to enrol in the mainland’s organ donation system without having to inform their respective governments.

According to minister Lo, more than 3,500 Hongkongers were in the mainland queue for a transplant. He told Xinhua News Agency last December that about 1,000 residents had undergone transplants across the border.

For many years, there have also been unofficial channels for having an organ transplant and many desperate patients in Hong Kong have taken it.

Retiree George Yip, 70, has two brothers and two sisters and all five siblings have had kidney transplants in mainland China.

When his turn came, he went to the Second Affiliated Hospital of Guangzhou Medical University in 2019 and turned to a prominent surgeon who had treated one of his sisters successfully.

Nobody questioned him about his Hong Kong identity or if he had registered officially for a transplant. Yip recalled that during his stay in hospital after surgery, at least a third of the patients he met were from Hong Kong too.

“They all had referrals,” he said. “Seeing so many people there reassured me.”

Of the five siblings who underwent kidney transplants in Guangzhou or Beijing, one sister’s kidney problems persisted and she needed to continue with dialysis treatment.

Still, Yip’s experience left him feeling confident about the ability of mainland doctors.

In national first, Hong Kong baby girl receives donated heart from mainland China

Hongkongers treated the same as mainlanders

Dr Chau Ka-foon, honorary president of the Hong Kong Organ Transplant Sports Association, said that over the years, a substantial number of Hongkongers had sought kidney, liver and heart transplants not only in neighbouring Guangdong province but also in mainland cities such as Shanghai and Tianjin.

Back in the 2000s, she said, two-thirds of those waiting for a kidney would have gone to the mainland for a new organ after giving up on waiting in Hong Kong.

The mainland began an overhaul of its organ donation system in 2010. It established organ procurement teams across hospitals to encourage patients and their families to donate organs, and the COTRS system to allocate available organs.

A medical source familiar with mainland transplants said patients from Hong Kong were treated the same as mainlanders in queuing for an organ transplant in the national system, except that Hongkongers had to pay their own medical fees.

Like mainlanders, Hong Kong patients simply had to go to a hospital for a consultation.

“If the doctors feel you need an organ transplant, they will add you to the waiting list of the hospital,” the source said.

The insider said it was not possible for a doctor to bypass the national organ transplant distribution system and arrange an operation on his own.

While Hongkongers could choose to go to any mainland city for their transplant, mainlanders usually went to hospitals in the cities where they lived.

Heart transplant plea puts focus on Hong Kong’s lack of organ donors

Data from The Second Affiliated Hospital of Nanjing Medical University showed that the average waiting time for a kidney transplant was about three to four years.

According to the China Organ Transplantation Development Foundation, there were 11,037 kidney transplants across mainland China in 2020.

Organ transplant specialists in Hong Kong said they needed more details to understand how the proposal to allow the cross-border exchange of organs would work for patients.

Dr Kelvin Ho Kai-leung, founding president of the Hong Kong Organ Transplant Foundation, acknowledged that there were more organ donors in mainland China, but he was concerned about the waiting time.

“Even though there are more donors on the mainland, the total number of people waiting would also be higher,” he said.

“It could also be possible that mainland patients might have more severe conditions than Hong Kong patients, and Hongkongers may end up waiting longer. That won’t be surprising.”

However, kidney specialist Chau from the Transplant Sports Association said as long as Hong Kong’s transplant queue was not opened to mainlanders, there would be more organs available to Hong Kong patients.

“Close liaison between Hong Kong and nearby mainland provinces might be advantageous for Hongkongers. At least, it would mean that organs donated there won’t be wasted if there was no suitable recipient and could go to a suitable patient here,” Chau said.

Additional reporting by Ziwen Zhao