Organ Donation and Transplantation in Hong Kong

Introduction

Organ transplantation is a very effective medical intervention that improves and saves the lives of patients who are suffering from end-stage organ failure. This process is a surgical procedure where failing and damaged organs of the human body are replaced with functioning ones, which are usually donated. In most cases, cadaveric organ donation (removing organs from recently deceased individuals) and living organ donation are majorly practiced. Organ transplantation can also be done using animal and artificial organs.

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Health is a fundamental human right for all individuals irrespective of their race, origin, gender and even economic and social status. It should be on the frontline of both the national and foreign policies that states establish to ensure a healthy and viable population. Therefore, it is essential for governments and relevant stakeholders to formulate sound health policies in regards to organ donation and transplantation due to the increase in the number of individuals suffering from organ failure. Countries have adopted various methods, practices, and legislation regarding organ donation. The two most dominant policies in line with organ donation include the opt-in policy and the opt-out organ donation system which will be comprehensively discussed further in the paper.

Public Opinion on Organ Donation in Hong Kong

According to the International Registry of Organ donation and Transplantation, organ donation in Hong Kong is among the lowest in the world. In 2015, 5.8 out of every million people in Hong Kong were organ donors which is indeed a minimal number considering the increase of the number of people with end-stage organ failure in the country (Legislative Council Authority, 2016). In 2015 alone there were more than 1941 patients on the waiting list for kidney transplants with an average waiting period of 51 months. Poor organ donation rates in the country have had a devastating impact on both the affected and their family members since it has led to tremendous suffering and loss of life.

The challenges experienced in organ donation are indeed immense, and the country needs to take drastic measures to ensure that some of them are mitigated. One of the most significant challenges is the opinion of the public in regards to organ donation. Cultural beliefs and practices are one of the greatest hindrances regarding growth in the number of organ donors. Traditional Chinese beliefs consider post-mortem organ removal as desecrating a corpse, and this has held back so many people from turning up to donate organs. Some of the individuals who want to register as organ donors are skeptical of their family consent and support on the matter. Most of the family members especially those who are deeply rooted in cultural beliefs oppose organ donation because it will mean that their loved ones will not have dignified funerals since they will not be buried with their body as one (Contat, 2015).

Someone who may desire to become a donor may be afraid of introducing and discussing their prior wish and desire to do so because they feel that their family members might actively oppose them. In Hong Kong, the government has adopted the opt-in donation system where individuals voluntarily decide to donate their organs upon death and family consent should be sought to proceed when the donor dies. This has led to the shortage of organ transplant since many families decline to allow for the procedure to take place. This implies that as much as an individual has the willingness of becoming a donor the family's opinion upon death is what will matter.

Other residents of Hong Kong are doubtful about being donors because they feel that doctors may not try very hard to save their lives if they register as organ donors. This fear has indeed been a significant impediment for more people to turn up to register as donors. On another note, some residents of Hong Kong claim that they may be willing to become donors but have absolutely no idea of how to do so. The relevant stakeholders should direct effort towards ensuring that the information on organ donation is readily and easily accessible to the public so that more people may be registered to donate.

Challenges Facing Hong Kong in Organ Donation

Information is a potent tool for changing a nation. Therefore the relevant authorities and actors of the health sector in Hong Kong should invest in public knowledge and awareness of the process of organ donation, its impact, and advantages and how people can contribute positively towards the society by doing so. Given that culture is a great barrier in Hong Kong to the success of increase in the rates of organ donation, the information passed should be very clear and concise but at the same time have a high consideration of the culture of the target population. The Department of Health and Hospital Authority in Hong Kong in partnership with non-governmental organizations have implemented promotional measures of donation which include public education and campaigns through exhibitions, talks, seminars, and media. However, this has not efficiently boosted donor rates because most of the messages are focused on enhancing public understanding on donation but fail to address the unique concerns of potential donors of different age groups in the society (Legislative Council Authority, 2016).

Many of the countries in Europe and America have established specific authorities which may be independent or working in collaboration with the government on matters related to organ donation. Hong Kong may learn from Spain and Australia which both have designated national authorities which coordinate issues related to organ donation and transplantation. Some of the functions of these national donation authorities or organizations include early identification of potential donors and preparing lists of donors and recipients, coordination of funds and budget allocations to organ donation and transplantation, in-depth training of medical staff and specialists on the process of organ donation and promoting efforts to enhance public understanding and awareness of matters related to organ donation (Legislative Council Authority, 2016).

In Hong Kong policy matters related to human organ donation lack a designated authority and instead fall under the general purview of the Food and Health Bureau which is also entrusted with formulating policies and allocating of resources for running many other health services in Hong Kong. This has had a negative impact on the process of organ donation due to the multiple functions performed by the bureau thus allocating insufficient resources and time on organ donation and transplantation. Successes in countries like Spain and Australia may serve as an example to Hong Kong on how competent designated authorities on organ donation can be.In 1989, Spain established the National Transplant Organization and in 2009 Australia founded the Organ and Tissue Authority which implement nationally consistent and coordinated efforts to organ donation and transplantation that has seen a rise in the donation rates of the two countries. In 2015, Spain increased from 14 donors per million in 1989 to 39.7 donors per million (Cheung, 2016).Therefore it is clear that having a specific authority in the health sector assigned to organ donation functions may boost organ donation rates.

Inadequate funding and insufficient budget allocations to organ donations and transplant functions in hospitals have slowed down the rate of organ donation in Hong Kong. Organ donation and transplant programs are very costly and thus need considerable funds to operate; they may require sophisticated infrastructure, additional costs and even extra staffing in hospitals. The government in Hong Kong doesn't fund such programs adequately, and this has impeded great success rates in the area of organ donation. Another major challenge in Hong Kong is insufficient staffing in organ donation and transplantation departments. This has led to work overload for the few staff in place. In 2015 there were only nine coordinators in Hong Kong who were covering all the 41 public hospitals in matters of organ donation and transplantation (Cheung, 2016). Indeed, this painted a vivid picture of how poorly organized the health sector for the task at hand. Sufficient well- trained medical personnel are one of the keys to achieving not only national health but also global health goals. Thus the government needs to focus efforts on increasing medical staff in organ transplantation areas. Such a strong team will be beneficial in early identification of potential donors and encourage smooth running of transplantation procedures. It is vital to note that these specialists should be trained on how to discuss donation issues with the families of the potential donors as this will foster greater comprehension of the health and social benefits of donations as the immense and irreplaceable impacts it has on saving another person's life are emphasized.

The Opt-in Organ Donation Policy of Hong Kong

As stated in the introductory part the opt-in and opt-out are the two major health policies adopted by many countries when it comes to organ donation. The low rate of organ donation amid the increase in the number of patients in Hong Kong has raised an intense debate and discussion on whether the state needs a change in policy direction. Hong Kong has adopted an opt-in policy of organ donation which is based on the voluntary decision of individuals to donate and family consent to donation after the death of the individuals. The opt-out system, on the other hand, is whereby individuals with the proper state of mind are regarded as donors unless they officially opt-out from the list of donors. Most countries in Europe have adopted the opt-out policy, and some believe that this has been the cause of great success when it comes to organ donation. Some of the critics of Hong Kong opt-in policy advocate for change towards hard-line opt-out policies to improve the numbers of organ donations.However, adopting opt-out measures solely do not necessarily guarantee the increase in rates of organ donation.

Since the opt-in system is voluntary, many people in Hong Kong feel that it is not such a crucial issue unless they are affected. Such perceptions should be focused on to eliminate stereotype thinking. Most of the young people feel like organ donation is irrelevant to them, and if education resources and programs are encouraged in schools and universities concerning organ donation, then the attitude might change. The government may introduce sensitization programs even in secondary schools to provide a better foundational base for the more profound understanding of organ donation since it cross-cuts all generations. Young people should understand that conditions related to organ failure not only affect the old but can affect them too. If this is done even with opt-in policies, then the number of organ donations may increase due to the better understanding of the young population which is the future of the nation.

Singapore and Austria are among the countries with hard opt-out systems whereby organs can be transplanted from anyone whether they have registered as donors or not and family approval is not necessary. In 1987, Singapore implemented the Human Organ Transplant Act where all Singaporeans aged 21 and above and of stable mental health can have their organs donated to those in need of transplants (Legislative Council Authority, 2016). In one way the hard-line opt-out policies may be successful in ensuring that patients in need of organ transplants are attended to on time and thus prevent death or further suffering. However, on the other hand, it may be perceived as a violation of the rights of the donors and their family...