The Shortage of Organ Donors in Hong Kong

Background

Hong Kong organ transplants are the same as in other countries and regions, with thousands of people waiting every day for organ transplants. Living death and donation of the body are the main ways of organ donation. Unlike other countries and regions, there is a lack of voluntary living donations in Hong Kong, so body donation is currently the main method of organ transplantation in Hong Kong.

As the social care level improves, organ transplantation can extend the lives of end-stage organ failure patients. Even though Hong Kong has a high level of organ transplantation, the real constraint on organ transplantation is the very low rate of organ donation. The number of donated organs is far less than expected each year.

For example, 2,318 people were waiting for kidney transplants in Hong Kong as of June 30, 2019, but in the first half of the year only 21 were donated. Looking back over the past decade, a total of 74 kidney donations per year and at least 59 cases have occurred. This means that every year, less than 3 percent of people have a chance to be reborn.

Hong Kong's organ donation rate ranks behind the world's developed countries and regions, according to IRODaT's report. Just 6.7 people donate organs per million people. In addition, in Spain, the number one, 48 per million people donated organs. This number is about eight times Hong Kong's figure.

So, what is the cause of the very low rate of organ transplantation in Hong Kong? What is the way to encourage people in Hong Kong to donate organs and in the following empirical observations, I will describe the three main reasons in-depth and provide appropriate solutions.

Consequences

Because in Hong Kong there are fewer cases of organ donation than those waiting for transplants. It causes every patient to take a long time to wait for a suitable transplant organ. They need to know that if a person gets ill, he or she needs immediate care, otherwise, it might be life-threatening.

It takes 51 months for a patient with organ failure to wait for a kidney, according to the Hospital Authority. Waiting for a liver takes 42 months. Waiting for a heart will take 21.7 months. Waiting for a lung would take 9.27 months. The longest, 352 months, almost 20 years are waiting for treatment. Is it true that every patient must wait twenty years for an organ transplant? It's impossible to answer. Survival rates will decrease year after year for patients without organ transplants. Even if after several years the organ is transplanted, the risk of postoperative complications increases. A patient can be killed by serious complications.

At the same time, when waiting for an organ transplant, patients need to take a large variety of drugs or procedures to slow down organ failure. These drugs and therapies can have side effects and take a great deal of time. A person with kidney failure, for instance, must be on hemodialysis three days a week, each taking four to five hours. It may also cause nausea, cramps, and headaches after hemodialysis.

Lastly, the cost of each drug and routine treatment for an ordinary family is a significant burden. And most organ failure patients are unable to work long hours, resulting in loss of income for them. Only with the help of family and friends, they can continue treatment.

3 Root Cause

Hong Kong people's traditional ideology.

Hong Kong is a Chinese place to live. In thought, philosophy, etiquette and even behavior are profoundly affected by traditional culture, and obviously, the practice of organ donation has a huge influence. Respect for the family, especially the wishes of the elders and the concept of the integrity of their remains, that is, the 'remaining of the whole body,' are of great importance.

If a family member dies and does not report organ donation, most members of the public will not be willing to donate the organs of the members of the deceased family, believing that they will be considered disrespectful.

Most people's thoughts are affected by Chinese terms, such as Confucianism's 'Our bodies, every hair and skin we receive from our family, and we must not attempt to harm or injure them. This is the beginning of filial piety,' otherwise 'parents ' filial piety' influences the desire to donate organs.

Misunderstandings About the Donation Process

People have had little access to relevant information in their daily life or training courses in the past. Therefore, people do not have a deep understanding of organ donation and do not have a clear understanding of the process of organ donation, relevant organ donation organizations, application registration procedures, etc. As a result, they have reservations about organ donation and are not actively involved in it, leading to a decline in the desire to donate.

In this respect, the academic and marketing shortcomings are not as strong as they should be, and their inability to achieve the desired results is closely linked to the production of time-to-time. Many high school students claim that previous classes have failed to raise awareness of organ donation and are not aware that they can enroll there as donors. Some members of the public consider themselves too young to be too young or do not need to consider organ donation (the public is not aware that there is no age limit for organ donation) which may be the reason why many students or members of the public have thought about donation but have not taken action to register as donors. The lack of public awareness of organ donation also makes them concerned that medical staff will not do their best to treat donors, make donations indecent, register data security is inadequate, or can not be canceled after registration.

Affected By the Organ Donation System

The rate of donation of organs depends not only on the public's attitude but also on the functioning of the entire mechanism and the matching of manpower and resources. In the opinion of the respondents, the current system of organ donation registration is poorly designed and not convenient for the public, which reduces their chances of participating in the scheme. Nevertheless, due to insufficient personnel and equipment in public hospitals, in particular, the lack of beds in the intensive care unit, medical staff (such as the Organ Transplant Liaison Coordinator and nurses in the Intensive Care Unit) have too much work to do, likely to miss potential donors and eventually lose any usable organs.

Solution

Increase effective participation channels to encourage active registration.

Opt-out is used by the United States, the United Kingdom, Australia, Canada and most Asian countries. Many European countries like Spain, France, and Italy are adopting the 'opt-out system,' which predestines the public to donate their useful organs unless they object to it during their lifetime. Opt-out countries tend to have higher body donation rates, with an average of 36 and 35 donors per million citizens in Spain and Croatia. In 2014, a British academic study found that from 2001 to 2012, the average body and organ donation rate in countries adopting the opt-out system was 14.24, while in countries implementing the opt-in system only 9.98.

Opt-out is generally effective in increasing the rate of donation of bodies and organs, based on international experience, but the measures are controversial. Most people assume that to enforce the policy rapidly, Hong Kong does not have the necessary social conditions. It is necessary to improve the current registration system. The first step is to make participation platforms more and more convenient. In addition to promoting registration, most young people believe that an 18-year-old person has the independent ability to decide whether to donate their own organs after death. While Hong Kong people are 18 years of age to register as voters, the government suggested that when citizens receive 18 adult identity cards, provide relevant information to donate organs while body and form will provide three free options to 'attend,' 'not to participate' and 'not to decide;' all applicants will apply three free options, once again by referring them to the health department of immigration. On the one hand, it will increase active channels of participation in the program, and on the other, it will encourage applicants to focus on their essential civic obligations.

The government is also currently holding flyers on organ donation at mobile blood donation stations, transportation departments, the immigration departments, and health departments. Despite the fact that organ donation leaflets are now accessible in a number of hospitals, further collection places could be added, such as 41 public hospitals, all private hospitals, and even clinics for private practice. At the same time, in addition to distributing promotional leaflets, a voluntary identification alternative as an organ donor may be added to the blood donation or driving license application form, passport and other documentation to provide more opportunities for the public to demonstrate their willingness to participate in the scheme.

Donors are encouraged to express their intention to their friends and relatives as soon as possible so as not to miss the opportunity to donate.

Hong Kong's legislation attaches great importance to patients ' family members ' rights and interests. Even though the deceased has promised to donate organs, if the immediate family members refuse, the medical staff can do nothing. Indeed, the decision of the deceased's family is largely a matter of choice even in opt-out countries. If legislation is adopted to ensure that the deceased's donation intentions can be implemented, family members and medical disputes will easily be resented. Therefore, should follow the Australian continent the practice of 'giving life' activities, through education and publicity, called on citizens with the family to discuss the desire of organ donation, teach them to use the appropriate opportunity and communication strategy, take the initiative to the family on the reasons behind, significance, let them have mental preparation, agree with each other, avoid missed donated by row in the future.

Once the donor has completed the central register, the system will send a thank-you note and provide an opportunity to 'share with others' so that the decision can be communicated to friends and relatives by e-mail or other electronic media. In addition, the health department may send an organ donation card to a member of the public registered in the central organ donation register to make it easier for the donor to display the card to his or her relatives and friends on appropriate occasions.

Enhance the image of the donation scheme and make good use of the garden of remembrance as a tribute.

Although many people are aware of the concept of body and organ donation, the scheme does not have a standardized name and the logo is not sufficiently popular to make a deep impact. To create a clearer image, it needs to portray the image. The government should refer the Hong Kong University to the body teacher and the Chinese University of Hong Kong's silent teacher, for the body organ donation system has an apt new name, such as an angel of life, simple to support, easy to sunshine, a good impact on the general public, also to show gratitude for the donors, ideally, the donors feel respected, collect more.

At the same time, while in Kowloon Park there is a 'life· love' garden with the theme of organ donation, most residents do not recognize or view it as an ordinary garden without understanding the real significance behind it. Although there are pillars inscribed with organ donation slogans, they are not very impressive, nor do they express clear gratitude to the donors; as for the exhibition of health education and information center next to the park, fehd information is mainly displayed. Only two of the pamphlets refer to organ donation, but very few of them. The government will erect in the gardens bronze plaques or stone tablets inscribed with organ donor names. If in the future there will be too many donors, they can be replaced by a list, granting organ donors public recognition and respect. The government can also take the lead in setting up an 'organ donation day' to coordinate large promotional activities every year in the memorial garden and include more information on organ donation in the exhibition and information center, including individual leaflets or pamphlets.

In cooperation with the Chinese Permanent Cemetery Management Committee, the HA can also refer to the practice of the 'silence professors' body donation program at the University of Hong Kong to set up an area for the organ donor ashes where families can choose to place the donor's ashes and pay homage. The government can also work with organizations of civil society to accompany families in need of paying tribute to show respect and concern. After completing the organ donation procedure, the HA should continue to have contact with the family members of the donors, who sometimes need counseling and support, for example, if the family members may be complained about by other family members after agreeing to donate the deceased's organs, and they are still in constant concern; At the same time, the donor's family can form an effective publicity network to assist in the promotion of organ donation.

In-depth community to answer difficulties, rally unity support from different sectors. Make good use of the forum of a liberal education to promote education in life and death.

Elderly people's desire to donate organs is not low, but there may be a lack of relevant information that prevents them from registering on time, and young people in their teens are significantly less aware of the concept of organ donation, making it harder to have specific views or make donation decisions. The government can organize roving lectures in schools, hospitals, and long-term service organizations such as social welfare organizations, nursing homes, elderly centers, and Ningshan Service organizations that are chaired by medical staff and other professionals to respond in detail to public questions and dispel misunderstandings about the scheme. Promoting organ donation requires concerted efforts by community partners from different sectors of the community, including the business sector, the labor sector, the healthcare sector and other professional bodies, to create an organ donation culture.

Recently, Hospital Authority has established an agency-based network to invite public bodies, non-governmental organizations and private companies to promote organ donation, and has encouraged employees to register through the Central Register, encouraging more than 300 incoming supports, including charities, railway companies, insurance companies and private hospitals. Cooperation with these organizations can be further enhanced in the future to bring the organ donation message to various sectors and strata. Rotary 3450 A Rotary Organ Donation Octopus has been launched in 2013 and other organizations will continue to follow suit and use various platforms to promote the organ donation message.

Organ donation can also be related to the three liberal education modules at secondary schools, modern China and public health, which enable students to think critically in the roles of patients, family members and medical workers from different perspectives. The Education Office will promote and fund schools to produce materials relating to education in the area of life and death. Teaching material should specifically call on students to take care of their health, to develop good living habits, to reduce the risk of disease and organ failure and to highlight organ donation and dedication. In the past, school life education has tended to focus more on the growth of individuals, interpersonal relations and sex education of students but has often not included such things as donating organs. Life training should be encouraged in the future to enable students to think about life's meaning.

Food and Health Bureau and Hospital Authority can work with secondary schools to design teaching materials and curricula for organ donation to facilitate the integration of teachers into the relevant classrooms and send medical staff to secondary schools to hold 'interactive theatres' to explain to students the system, significance and impact of organ donation through lively and interesting forms, and to distribute relevant information to students on the spot. A leaflet and an invitation to students who wish to participate in organ donation are invited to participate in the organ donation program. In addition, the hospital authority can enhance the use of social media networks, including Facebook, Instagram and Youtube, as a distributing medium for organ donations and also design games. Short films, movies or other new media data. Increase interest in the information donated by young personnel.

Establish a dedicated HA department for the coordination of donations of organs. Train healthcare professionals as early as possible to identify potential donors.

There is no comprehensive coordination of the organ donation system in Hong Kong, the evaluation criteria are no uniform, and the performance of each hospital varies considerably to directly affect the overall efficacy of organ donation. Foreign experience, like Spain, the US, Australia and other countries generally established independent organ donation agencies for coordinating the work of liaison officers, providing professional guidance and training, setting targets and evaluating the performance of individuals.

The HA should establish a dedicated department whose members are staff members who know organ donation and are responsible for the united management of all phases of organ donation, including the distribution of staff, the management and coordination of roles of all the organ transplant liaison officers. At the same time the HA needs the differences between hospitals in donations to be observed and analyzed and to find ways to improve their economic efficiency. HaHa, should also further enhance the employment of organ transplantation liaison personnel to mitigate the current labor shortage and to provide sufficient medical support to improve the organ transplant team's service capacity.

One strategy for increasing organ donation is to identify potential donors and to keep their internal bodies in good shape early. As the number of liaison officers for the transplantation of organ is limited, the role of other health workers has become even more important, especially those who have regular contact with terminally ill patients. Hong Kong can refer to the Spanish practice of providing basic professional training to doctors and nurses, intensive care departments and relevant medical staff to enable them to acquire knowledge of brain stem death and organ donation, and to deploy resources and manpower appropriately to assist them in identifying and assessing potential organ donors and making timely notifications, To enable the Organ Transplant Liaison Officer to provide counseling to the family as soon as possible and to give appropriate care before the patient is convicted of brain stem death.