Following is a question by Hon KP Chan on measures to encourage kidney donations:
Most patients suffering from end-stage nephrosis need long-term dialysis treatment, but not only does dialysis fail to cure the disease, it also seriously downgrades the patients’ quality of life. As such, kidney transplant is the only chance for them to gain a new life; yet, the number of patients waiting for kidney transplant in Hong Kong last year was much higher than the number of donations and the ratio of such two numbers was 20 to one, which was much higher than the corresponding ratios for lung (six to one), cornea (two to one), liver (one to one) and heart (0.6 to one). In this connection, will the Government inform this Council:
(a) given that a telephone interview conducted by the Department of Health in 2007 revealed that about 70% of the respondents were willing to donate their organs after death, yet as at the end of last year, only about 70,000 members of the public had registered under the Centralised Organ Donation Register, representing only 1% of the total population, which was much lower than the outcome of the telephone interview, whether the authorities have reviewed the reasons for such significant discrepancy; besides, according to the data of the International Registry of Organ Donation and Transplantation, Spain’s deceased donor rate of 34 donors per million population (pmp) in 2009 was the highest in the world, and the rate in the European Union was 17 donors pmp on average, while that in Hong Kong was only about five donors pmp, whether the authorities have analysed the causes of the much lower number of deceased donor organ donations in Hong Kong as compared to other places, so as to propose means to rectify the problem at source by adopting measures conforming to the traditional culture of the Chinese;
(b) given that the number of living donor kidney transplants in Hong Kong accounted for less than 10% of all kidney transplants last year, which was much lower than the rate of 40% in the United Kingdom and the United States, whether the authorities have studied the problem of the rate of living donor kidney transplants in Hong Kong being much lower than that of the European and American countries, and make reference to the examples of other countries to educate the public that they need not wait until the end of life before making organ donations; and
(c) given that “paired donation” (i.e. matching one pair of donor and patient to another pair of donor and patient) has become increasingly popular in many countries in recent years, leading to a significant increase in the number of living donor organ donations; and according to the statistics of the United States Department of Health and Human Services, the number of living donor kidney transplants through paired donation had surged from four cases in 2001 to more than 400 last year; but during the same period, the number of living donor kidney transplants in Hong Kong had dropped from 14 to seven cases, whether the authorities will consider exploring through enacting legislation and from various perspectives if “paired donation” may help the over a thousand of patients waiting for kidney transplant in Hong Kong?
For patients suffering from end-stage organ failure, organ transplant is often their only hope for gaining a new life. Currently, there are about 400 organ donation cases per year in Hong Kong, of which about 90% are cadaveric donations. Organ transplants in Hong Kong, from both cadaveric or living donations, are subject to regulation under the Human Organ Transplant Ordinance (HOTO), the main purpose of which is to ensure that no commercial dealing is involved in organs for transplant.
Organ donation and transplant – and eventually whether they can save patients – depend on a number of factors. The Hospital Authority (HA) already has mechanisms to handle and coordinate the clinical aspects involved in the process. Yet, one of the most important factors beyond our control is the attitude of the general public towards organ donation. In this regard, the Government’s policy is to gradually inculcate a culture of organ donation in our society. Over the years, the Department of Health (DH) has joined hands with HA and various sectors in the community to promote organ donation through different ways, including rallying support of community leaders from various sectors for organ donation, so that more people become receptive and willing to donate organs.
My reply to the respective parts of the question is as follows:
(a) Hong Kong has seen a general trend of increase in organ donation rate, rising from about four for every million of our population in 2005 to about seven in 2010, which is higher than that of many advanced economies in Asia, such as Singapore (4.6) and Japan (0.8), though lower than some Western countries. Organ donation rate is affected by a number of factors, including demographic structure and death rate, attitude of individuals and their family members, and clinical factors, etc. Given the differences in background and circumstances, it is inappropriate to make general comparison of the organ donation rate of Hong Kong with other regions.
At present, members of the public may register their wish to donate organs after death through the Centralised Organ Donation Register (CODR) managed by DH. Currently, more than 78,000 registrations were recorded at the CODR. Apart from registering at the CODR, the public may also carry signed organ donation cards or express their wish to healthcare workers if they wish to donate organs after death. Even in the event that a deceased person did not indicate his/her wish on organ donation by registration through the CODR or carrying signed organ donation cards, the organs of the deceased can still be donated to save lives with the consent of his/her family members.
According to data from HA in 2010, among those assessed to be suitable for organ donation, the rate of the family members giving consent for solid organ donation was about 50%. This has remained steady over the years. We hope that, through promotion and education, the message of saving lives with organ donation can be more widely disseminated to the public, so that more people, especially family members of the deceased, will be receptive and willing to contribute to the cause of organ donation.
(b) For kidney donation, the number of living donations has remained steady in general from 2006 to 2010, with an average of 10 cases per year. The number of cadaveric donations has been increasing in overall, rising from 53 cases a year to 74 a year. The proportion of living donations among all kidney donations has thus reduced because of the increase in the number of cadaveric donations. In contrast, in the case of liver transplant, living donations account for a greater portion of the overall number of liver donations at a proportion of about 60%.
There are more considerations to be taken into account for living donations over cadaveric donations, such as the medical risk of and rehabilitation support for both donors and recipients. Healthcare professionals in public hospitals will consider and examine all clinical factors involved. Generally speaking, living donations are more common between those who are genetically related or parties to a marriage. There were also cases with no direct family relationships, which are permissible under the HOTO as long as there are no commercial interests and dealings.
When promoting organ donation as a commendable life-saving act, we do not differentiate between cadaveric and living donations. Nonetheless, for practical reasons and as borne out by statistics, cadaveric donations will continue to be the main source of organ donations.
(c) In view of the limited number of cases in Hong Kong suitable for living kidney donation and transplant, the chance of making a paired donation is also limited. There were cases in the past assessed to be suitable for paired liver donation and transplant and in compliance with the requirements of HOTO, and such donations and transplants were arranged and executed in public hospitals with the approval of the Human Organ Transplant Board (HOTB). Such transplant is allowed under the existing law so long as no commercial dealing is involved. Whether there will be cases of paired donation and transplant depends on the considerations and judgement of the attending physicians having regard to relevant clinical factors, as well as whether approval from the HOTB has been obtained.