Hot Topics: Why Hong Kong officials want to discuss cross-border organ donation plan with Beijing

Hong Kong will discuss establishing a cross-border organ donation scheme with Beijing and is willing to propose legislative amendments to make the initiative possible, the city’s health minister has said.

Secretary for Health Lo Chung-mau also cited the success of a cross-border organ donation that saved a four-month-old girl last month. He said it had set a “very good example” of what such cooperation could achieve.

Cleo Lai Tsz-hei had earlier suffered from heart failure. On December 17, she underwent an organ transplant at Hong Kong Children’s Hospital after doctors received a heart from a child across the border who had died from a head injury the day before.

“Although Hong Kong and mainland China have different regulations under ‘one country, two systems’, the medical field has a standard on how organs are donated, allocated and transplanted,” Lo said.

The health minister said he believed there were no discrepancies between Hong Kong and mainland China on medical standards for organ transplants.

Hong Kong and the mainland have maintained separate networks for matching organ donors to patients, but city residents could receive organ donations across the border under certain circumstances.

In his blog on December 18, Lo appealed for organ donations. He said transplant numbers in the past three years experienced a downward trend because of Covid-19. At the end of last September, close to 3,000 patients were awaiting an organ transplant in the city, Lo said.

The Hong Kong government made a special request to the central authorities in Cleo Lai’s case. The importation of the organ must comply with the Human Organ Transplant Ordinance and the related Human Organ Transplant Regulation in the city. All imported organs must be accompanied by certificates which contain a statement that all applicable laws were complied with in obtaining the organ. The certificates must also be approved by the Human Organ Transplant Board.
Staff writers

Question prompts:

• Why does Hong Kong need a cross-border organ donation scheme with mainland China? Explain using Context.

• How was Cleo Lai’s organ transplant arranged to ensure that the imported organ met Hong Kong’s standards?

Hong Kong baby’s heart transplant sparks hope for long-term cross-border plan

Question prompts:

• Describe ONE trend shown in the chart about heart donations in Hong Kong.

• What information from Context could explain the trend shown in the chart?

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• The transplant was Hong Kong’s first such arrangement

• Cleo Lai was suffering from a disease that caused the walls of her heart to thin and stretch

A four-month-old baby girl suffering from heart failure underwent a transplant in Hong Kong with a donated organ from mainland China in the first arrangement of its kind in the city.

Cleo Lai Tsz-hei underwent the operation in December at Hong Kong Children’s Hospital after the Human Organ Transplant Board, a statutory body under the Department of Health, approved the donation, authorities said.

Cleo suffered from dilated cardiomyopathy, a disease that caused the walls of her heart to thin and stretch, enlarging the organ and making it difficult to pump blood around her body. She underwent an operation last October, but when her condition did not improve, her mother and the doctors treating her made an urgent public appeal for a donor.

The medical team explained the need for a replacement organ was urgent, and a donor could be of any blood type, but had to weigh between 4.5kg and 13kg.

“Finding a suitable donor is the hardest part of this entire process,” Dr Lun Kin-shing, the head of paediatric cardiology at the Kowloon-based hospital, said. “It is difficult to find a fit in Hong Kong, where the child mortality rate is low. By widening the criteria, we hope to give Cleo the greatest chance of finding a suitable donor.”

With time running out, the Hospital Authority contacted the National Health Commission, which found a heart belonging to a child in the mainland who succumbed to a severe head injury.

“This is a special case because it is very difficult to identify a suitable heart to be transplanted into a four-month-old girl in Hong Kong,” said Simon Tang Yiu-hang, the authority’s director for cluster services. “And so that is why out of goodwill, the National Health Commission used their robust mechanism and helped to identify the right organ for our four-month-old child.”

Dr Robin Chen, who leads surgeries at Children’s Hospital, described the operation as smooth and said Cleo’s new heart was functioning well for now, although she would remain in the intensive care unit.

“Cleo has been in a critical stage and recently her condition has been worsening,” he said. “Without a heart transplant, it could have been life-threatening at any time.”
Staff writers

Question prompts:

• Why was it difficult to find a suitable heart for Cleo Lai? Explain using News and your own knowledge.

• Using information from Chart and News, explain why the Hospital Authority made special arrangements for Cleo Lai’s case.

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• An international transplant organisation says organ donations from the mainland should not be accepted

• Beijing banned the practice of harvesting organs from executed prisoners in 2015

While organs are regularly transported across borders around the world, in the European Union for example, Hong Kong and the mainland have until now maintained separate networks for matching patients with donors.

Dr Chau Ka-foon, honorary president of the Hong Kong Transplant Sports Association, said the city only had an overseas organ donation mechanism for bone and corneas. That means the Human Organ Transplant Board does not need to approve the importation of these organs.

“For now, every single import of other organs, like hearts, lungs, kidneys and livers, requires the approval of the Human Organ Transplant Board,” Chau said. “To facilitate a cross-border donation mechanism, a law amendment may be needed to include these organs. Otherwise, the authorities would need to make special arrangements every single time.”

She added Hong Kong and the mainland would need to reach a consensus on a code of practice, including the suitability of organs, eligibility of donors and recipients, transport procedures and more, to establish confidence.

“The mainland has an accreditation system for hospitals conducting organ transplants. And their techniques are surely more advanced, as they are doing far more organ transplant surgeries than Hong Kong hospitals,” she said.

The International Society for Heart and Lung Transplantation, an organisation that represents more than 3,700 medical practitioners from over 45 countries, issued a statement last April saying organ donations from the mainland should not be accepted. This was in response to accusations by human rights groups that central authorities had harvested organs from prison inmates, including political detainees.

Beijing introduced the China Organ Transplant Response System (COTRS) in 2013 to regulate the donation process and banned the practice of harvesting organs from executed prisoners two years later.

Some Hong Kong doctors, speaking anonymously, said they were concerned the scheme could trigger an international backlash against the medical sector.

But Secretary for Health Lo Chung-mau said such views did not represent the entire sector.
Staff writers

Question prompts:

• What are THREE concerns regarding a potential cross-border organ donation scheme? Explain using Issue and Glossary.

• What is the government’s view on the potential cross-border donation initiative? Use Context, News and Issue to explain.

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Context:

• Why does Hong Kong need a cross-border organ donation scheme with mainland China? Explain using Context. The number of patients waiting for an organ far exceeds the number of donations in the city. Thus, the scheme is needed to provide more suitable organs for donation.

• How was Cleo Lai’s organ transplant arranged to ensure that the imported organ met Hong Kong’s standards? All imported organs must be accompanied by imported organ certificates which contain a statement that all applicable laws were complied with in obtaining the organ. The certificates must also be approved by the Human Organ Transplant Board. The importation of the organ must comply with the Human Organ Transplant Ordinance and the related Human Organ Transplant Regulation in the city.

Chart:

• Describe ONE trend shown in the chart about heart donations in Hong Kong. The number of heart donations has been dropping since 2018.

• What information from Context could explain the trend shown in the chart? According to the secretary for health, transplant numbers experienced a downward trend over the past three years because of Covid-19.

News:

• Why was it difficult to find a suitable heart for Cleo Lai? Explain using News and your own knowledge. Hong Kong’s child mortality rate is low, making it tough to find a heart that matches Cleo Lai. There are also certain procedures that must be followed after a child’s death before an organ can be donated.

• Using information from Chart and News, explain why the Hospital Authority made special arrangements for Cleo Lai’s case. Hong Kong’s number of heart donations is much lower than the number of patients who are awaiting transplants. However, Cleo’s case is quite urgent so they need to seek help from every source available.

Issue:

• What are THREE concerns regarding a potential cross-border organ donation scheme? Explain using Issue and Glossary. Hong Kong would need to amend the current law to include other organs / Hong Kong medical practitioners worry that importing organs from mainland China would cause international backlash / The International Society for Heart and Lung Transplantation issued a statement last April saying organ donations from the mainland should not be accepted / Human rights groups have accused central authorities of harvesting organs from prisoners (any three)

• What is the government’s view on the potential cross-border donation initiative? Use Context, News and Issue to explain. The government is quite positive about the possible scheme, especially after the success of Cleo Lai’s case. The secretary for health even said the city would be willing to propose legislative amendments to make the initiative possible. He said concerns from some doctors did not represent the whole local medical sector.