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Tuesday, November 8, 2016, 09:13

Who will grant the gift of life?

By Shadow Li

A little boy lies near death in a Hong Kong hospital awaiting a heart transplant. But his prospects are bleak, since the SAR has one of the lowest organ donation rates in the world. Shadow Li reports.

Who will grant the gift of life?

We’ve all heard that snarky, sardonic saying “no good deed goes unpunished”, but don’t try that on Wu Man-ming, whose kindness decades ago saved his life a few weeks back. Today, the 60-year-old retiree is alive thanks to people who stepped forward to offer their help because Wu had been good to them.

Wu, the retired head of the SKH Holy Trinity Church Secondary School in Ho Man Tin, was dying of acute liver disease. He heard the fatal pronouncement from his doctor not so many weeks ago that he had days to live. There was but one hope, a liver transplant.

Wu’s wife, Stella Chu Lai-yee, began a desperate effort to save him. She contacted the media appealing to the people of Hong Kong to save the life of a good man.

People started coming forward. Within 24 hours of Chu’s appeal, more than a dozen subordinates, colleagues, former students and even their wives and friends had volunteered to take the tests to find out if they could be the match.

The match was Cynthia Ip, who met Wu several times through the years, but really hardly knew him. She got a call in the middle of the night telling her that she was the one. Her connection was through her husband Lui Wai-chung, a young man Wu had hand-picked two decades ago, mentored through the years, and helped him to rise to become vice-principal at the school. Lui thought of Wu as a father figure and life’s coach.

Ip donated two-thirds of the right lobe of her liver that saved Wu’s life.

Wu was lucky, and in his good fortune everyone may rejoice.

Long waiting lists

Ten-year-old Tang Kai-him may not be as lucky. He’s been waiting for a heart transplant since May when he was diagnosed with heart failure. His heart is functioning at only 1 percent and he’s being kept alive with a device implanted in his heart. Tang needs a donor with A-positive blood, about the same size as he is. What hope is there for a tiny fellow who’s only 131 centimeters, who needs a new heart in a city with one of the worst organ donation records in the world – 5.8 per million?

The organ donation rate in Spain and Croatia, which are in the top bracket when it comes to that kind of human compassion, is seven times greater than Hong Kong’s.

“The bar is high to effectuate an organ donation,” said Hong Kong Society of Transplantation Council President Chak Wai-leung. Deceased organ donors need to be certified brain dead, though their hearts still may be beating with supporting machines hooked up. Even then, their organs need to be examined to ensure they are clear of disease or infection, said Chak. In 2015, Hong Kong has 80 to 120 brain dead cases among 46,757 deaths in total.

By the end of June this year, there were over 2,511 people on the list waiting for organ donations, including 1,983 for kidney transplants, and another 98 awaiting liver donations. In cases involving kidneys or liver, the remedy can be living donors. But that’s not possible with conditions affecting heart and lungs.

In the first half of this year, there were a meager 30 kidney donations. Last year there were 81 kidney donations from both deceased and live donors. In 2012, there were 99. The numbers seem to be going down.

“It might strike some as odd, simply looking at the numbers that there aren’t many people waiting for heart and lung transplants. That’s because people died before they got a transplant,” said Chak.

Patients with kidney failure can last for years, even decades with dialysis. That explains why the queue of people waiting for kidney transplants snowballed to around 2,000, he added.

Specialized teams needed

Last year, 19-year-old Jamella Lo died while awaiting a double-lung transplant. Her case aroused a lot of public sympathy and it got people discussing the possibility of a so-called “opt-out system” to increase organ donations in the city.

An opt-out system means that when someone dies his or her organs are considered available for transplant, unless the deceased person has signed a declaration earlier, opting out of the program.

It’s a program widely used in Europe. Even Singapore, Hong Kong’s most vigorous competitor, adopted it in 1987, where even non-permanent residents are included.

There are two possible approaches to an opt-out system, Chak says. The hardline approach harvests organs from the dead when there is no evidence of an opt-out declaration, even though surviving family members may object. Chak favors the other, more flexible, softer approach, where surviving family members get the final word. That’s much the way things operate today, where the final say rests with family members even when the deceased person has signed a donor card.

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