1. What is organ donation? Why should I donate organs?

For patients with organ failure, organ transplantation is the only way to help them recover. Not only can organ donation grant those patients a new lease of life, but it will also improve their quality of living. There are over 2000 patients with organ failure waiting desperately every day for organ transplants in Hong Kong. However, the organ donation rate has been low. There were only 3.9 deceased organ donors per million people (pmp) in 2019, lower than 6.7 pmp in 2018, and far below those in the western countries1. As a result, many patients waiting for organ transplants passed away before a suitable organ was available.

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Reference: (1) The International Registry of Organ Donation and Transplantation; (2) Department of Health

 

2. What organs can be donated? Where do they come from?

Organs that can be donated include heart, lung, liver and kidney. Other than organs, some tissues can also be donated. They include bone, skin and cornea.

There are two sources of organ donation: living and cadaveric donation. Organs suitable for living and cadaveric donation are different:

  • Living donation: Kidney and liver are organs suitable for living donation. Healthy adults who wish to donate a kidney or part of his/her liver have to pass through a series of psychological and medical assessment before transplantation of organ takes place.
  • Cadaveric donation: Kidney, liver, heart, lung, cornea, skin and bone are suitable for cadaveric donation. Brain-dead patients can donate their organs and tissues to patients suffering from organ failure hence enabling the later to extend their life.

 

3. What is the Centralised Organ Donation Register?

The Department of Health established the Centralised Organ Donation Register in 2008 to create a more convenient means for prospective donors to voluntarily register their wish to donate organs after death, and for such wish to be more reliably recorded.  The Register will enable medical staff and bereaved families to acknowledge the wish upon the patients’ death to facilitate the arrangement of transplantation.

 

4. Is there any age limit to register as an organ donor?

 There is no age limit for registration at the Centralised Organ Donation Register (CODR). However, make sure that you tell your family about your wish to donate organs.

 

5. Is there an age limit to donate organs?

 There is no strict age limit for cadaveric donation. In general, organs may be donated by someone as young as a newborn or as old as 75. As for tissue donation, the age limits are below 80 for corneas, between 16 and 60 for long bones and 10 or above for skin.

For living donation, according to the “Human Organ Transplant Ordinance”, organ donors must reach the age of 18 years in order to perform living donation.

Reference: Department of Health

 

6. How do I sign up as an organ donor?

  1. Register online via www.codr.gov.hk

OR

  1. Complete the registration form in the organ donation promotional leaflet and send it by post or fax to the CODR System Administrator, Department of Health.

 

  • By post to: CODR System Administrator, Department of Health, 21/F, Wu Chung House, 213 Queen’s Road East, Wan Chai, Hong Kong;or
  • By fax to 2127 4926

Tips:

  1. When registering, you can choose to donate all or some of the organs and tissues (kidney, liver, heart, lung, cornea, skin and bone) according to your preference.
  2. Upon receiving your organ donation form, the Department of Health will contact you by telephone to verify your personal particulars. 
  3. Prospective donors who have successfully registered with the CODR do not need to carry the organ donation card with them

Reference: Department of Health

 

7. How does the organ donation process work?

Currently, brain death is the criterion for cadaveric donation in Hong Kong. When there are potential brain death cases, the following procedures would be initiated:

  1. Two senior independent doctors who are not related to any organ donation matters will conduct two separate assessments to confirm brain death of a patient.
  2. Medical team informs organ donation coordinator who will communicate with bereaved family to render care and counselling.
  3. The medical team assesses the suitability for organ donation and maintains the function of the deceased’s organs.
  4. The organ donation coordinator obtains consent from the bereaved family for transplantation.
  5. The medical team conducts relevant examinations and matchings to identify suitable organs for donation.
  6. Arrange organ/tissue removal and transplantation.
  7. The body is sent back to the ward.
  8. The coordinator accompanies family members to bereave the donor.

 

8. After I donate the organ, do I/my family have to bear the medical charges arising from organ donation?

– Cadaveric donation: Fees and charges arising from organ donation after the death of donors are not to be borne by their family.

– Living donation: Except for private hospital services, charges arising from the pre-operative examination, operation, the follow-up as well as treatment arising from organ removal are not to be borne by the living organ donors.

Reference: (1) Department of Health; (2) Hospital Authority 

 

9. Who should I contact if I have questions on organ donation or the process of registration?

– For more information on organ donation, you may visit the Organ Donation website of the Department of Health ;

– If you have any questions about the process of registration, you may contact CODR Administrator at 2961 8441 or by email at codr@dh.gov.hk.

– You are also welcome to call HKOTF at 3595 8555 or click HERE to contact us.

1.Will organs be donated after death for all registered donors?

Organ may not be donated after death even if you are a registered donor. Firstly, the donor must be certified as brain death before their organs can be used for donation. Secondly, under the system of organ donation in Hong Kong, the final decision of organ donation rest with the family, regardless of whether the deceased had expressed his/her wish when alive. Organ transplant will only be conducted when family consent has been obtained for a brain death donor, and the other donation criteria are matched (e.g. blood group matching).

 

2. What is brain death?

In Hong Kong, only organs from brain death donors are accepted for donation. When cardiac death occurs, the deceased is only suitable for tissue donation, such as corneas and skin.

Brain death is the complete and irreversible loss of all brain function, including the brainstem. Two senior independent doctors who are not related to any organ donation matters will conduct two separate assessments to confirm brain death of a patient.

After confirming that the brainstem has no response and the patient has completely lost the ability to breathe independently, brain death will be officially declared. The heartbeat of the deceased donor will be maintained by life-support medical equipment so as to facilitate transplantation of organs within a short period of time.

 

3. What’s the difference between brain death and vegetative state?

Although both of them are in a coma stage, brain death is not equivalent to a vegetative state. People in a vegetative state do not have cognitive function but they can breathe independently. On the contrary, brain dead patient does not have the ability to breathe independently and there is no chance of survival regardless of any medical intervention.

 

4. If I have already registered in the body donation program, can I still become an organ donor?

Yes, there is no conflict between them. If you are a registered body and organ donor, medical staff will first remove suitable organs for transplantation after death. Except for a few individual cases, after organ donation, the body can still be donated to the Medical Schools which you have registered at for the purposes of medical education and research.

 

5. Will the removal of organs affect the appearance of the body?

During the transplantation, medical staff removes the organs with full respect for the body of the deceased. The removal does not disfigure the body as the incisions will be properly stitched up and be covered by burial clothing.

 

6. How to decide the priority of allocating an organ to recipient?

Organ allocation mechanism – scoring system

There is a designated centralized organ transplantation register and scoring mechanism for each type of organ. Patients qualified for inclusion into the respective register will be accorded priority of receiving organ based on a scoring system. Patients with the highest score have the highest priority. Factors taken into consideration in the scoring system include:

  • The seriousness of the illness (higher score for more serious illness)
  • Age of the patient (higher score for younger age)
  • Waiting time on the register (higher score for those who waited longer)
  • Compatibility (higher score for higher compatibility)
  • Health condition (lower score for poor general health condition)
  • Comorbidity (lower score for those with complication of diseases)

1.I have already signed an organ donation card, why do I still need to register at the Centralised Organ Donation Register?

The Government has introduced organ donation card since 1982. People who wish to donate organs after death may sign the card but the Government does not have any proper record of those who had signed. Thus, you need to carry the card all the time so that your wish is known to medical staff.

With the establishment of the Centralised Organ Donation Register (CODR) by the Department of Health in 2008, a person’s wish to donate after death can be recorded reliably and safely so that medical staff can find out the wish of the deceased more efficiently and make arrangement accordingly. At the same time, the bereaved family will be able to find out the deceased’s wish more readily. In this case, people who have successfully registered with the CODR will not need to carry the organ donation card with them.

For people who have signed an organ donation card in the early years, we suggest them registering at the CODR so that their wish to donate can be recorded properly.

 

2. Why do I need to tell my family about my wish to donate organs after death?

Registering at the Centralised Organ Donation Register and signing an organ donation card are ways of expressing your wish to donate organs after death. The two mechanisms do not have legal effect. Family members of the deceased have the final decision on whether organs would be donated. According to “Behavioural Risk Factor Survey” conducted in 2015 by the Department of Health, 96.4% of the respondents would endorse the wish to donate organ of the deceased family members if the deceased had expressed his/her wish before death. The Survey shows the importance of telling your family your wish to donate organ.

Reference: Department of Health

 

3. Given that over 40,000 people die in Hong Kong each year, why is the organ donation rate so low?

Firstly, only individuals who are certified as brain death can donate organs. Although the annual mortality rate is over 40,000 in Hong Kong, only 0.3% amongst the deceased are brain deaths. Taking the year 2012 to 2016 as an example, the number of brain deaths ranged from 91 to 126 annually; amongst them, only about 40% of family members had given consent to organ donation. Therefore, the transplantable organ is inadequate to meet the demand for organ failure patients.

Reference: (1) The Census and Statistics Department’s  Monthly Digest of Statistics; (2) Hong Kong Legco’s meeting record (2017.05.10)

 

4. Why are more patients on the waiting list for kidney transplants than that of other organs?

Patients of renal failure can receive dialysis treatment to maintain their life. However, similar treatment is not available for patients suffering from heart failure, lung failure, and liver failure.  They may have died before a suitable organ is available. Therefore, the waiting list for kidney transplantation is much longer than the other organs.

1.Organ donation system

There are mainly two organ donation systems: opt-in system and opt-out system. Hong Kong has adopted the ‘opt-in’ system.

  • Opt-in system: under this system, people who wish to donate organ after death need to proactively register as an organ donor.
  • Opt-out system: under this system, people are assumed to be organ donor after death, unless they have clearly registered their intention not to donate organ when alive.

There are two approaches under the opt-out system:

  • Soft approach: Spain has adopted a ‘soft’ opt-out approach, in which family members are able to veto organ donation even if no formal objection has been expressed by the deceased.
  • Hard approach: Singapore has adopted the ‘hard’ opt-out approach, in which the bereaved families do not have legal right to oppose the donation of organs if the deceased has not registered his/her objection to donate when alive.

 

2. Paired donation 

In some cases, a patient who needs an organ transplant has a living related donor who is willing but unable to donate because of an incompatible blood type or tissue type, and the same thing happens to another family. Under a paired donation arrangement, both medically approved incompatible donor-patient pairs donate organs to the other pair so that the patients in both pairs receive compatible organs.

 

3. The law governing organ transplant in Hong Kong

The “Human Organ Transplant Ordinance” was enacted in 1995 mainly to prohibit commercial dealings in human organs intended for transplanting, to restrict the transplanting of human organs between living persons and the transplanting of imported human organ. The Human Organ Transplant Board was established under Section 3 of the Ordinance in 1996.  An approval from the Human Organ Transplant Board is the requisite for performing living organ transplantation between two persons who are in a marital relationship subsisted for less than 3 years or not genetically related.

 

4. Age limit for living organ donor

At present, the “Human Organ Transplant Ordinance” defines that all living donors must reach the age of 18 years.  The law does not allow for discretion by any party, in order to put a stop to organ trafficking, and to protect donors and recipients, as well as to protect minors from being forced to donate organs.

Number of organ/tissue donation & patient waiting for transplantation under Hong Kong Hospital Authority

螢幕截圖 2020-06-16 下午12.21.17

Reference: Hospital Authority

Annual Increase on the Centralised Organ Donation Register 

螢幕截圖 2020-06-16 下午12.22.07

Reference: (1) LegCo Paper No. CB(2)656/17-18(05) ; (2) FHB’s replies to LegCo Questions (FHB(H)-2-e1)

The Number of Living and Deceased Organ Donor in HK

2

Reference: The International Registry on Organ Donation and Transplantation