Implementing "Opt-out" Policy to Increase Organ Donation Rate?

Like other places around the world, there are many patients in Hong Kong waiting for organ donations for various reasons. According to the Research Brief issued by Hong Kong Legislative Council Secretariat (2016), Hong Kong’s organ donation rate was among the lowest in the world at 5.8 donors per million people in 2015, representing only a seventh of high-donation places like Spain at 39.7 donors per million people. The Hong Kong Government will consider introducing an “opt-out” legislation to further promote organ donation in Hong Kong. Under this “opt-out” system, all individuals are donors unless they specifically state otherwise. However, there should be a formal public consultation on this proposal, according to Dr. KO Wing-man, the former Secretary for Food and Health of Hong Kong. This is a controversial topic that may promote a lot of public discussion. The following is an interview with Dr. Leung Lai Yin John, a senior radiologist who had served as an official in different government offices, to discuss the issue of organ donation in Hong Kong.

Apart from some Chinese values and other religious beliefs against organ donation, our aging population is one of the major causes of the low organ donation rate in Hong Kong, said Dr. Leung. According to the Hong Kong Census and Statistics Department (2016), the population of the elderly in Hong Kong was close to 1.2 million in 2016, accounting for 16% of the total population - about one sixth. The uneven age distribution would reduce the amount of suitable organs. Meanwhile, Hong Kong has a small number of accidental deaths compared to other countries which also lowers the amount of deceased organs. Both are the major causes of the low organ donation rate in Hong Kong.

As a misconception that some doctors may not try as hard to save patients who are potential donors of organs to secure supply, Dr. Leung pointed out that some patients may mistrust their doctors due to such misconception. The relationship between doctors and patients has been changing in the last 10 years, and doctors are no longer as authoritative as before. With the public getting more aware of their own interests and the occasional reports on medical malpractices, patients are more concerned with their legal rights and medical process than they used to be. For example, doctors need to explain the provisions more clearly and clarify the legal liability of both parties before their signing of any consent. In recent years, there is an increase in litigation cases on medical malpractices. And therefore, Dr. Leung said doctors tend to practise defensive medicine, and to adopt medical approaches that are unlikely to be blamed or sued by patients. Dr. Leung states that doctors now have to pay hefty sum for professional indemnity insurance. This shows the changes in the demand for social justice and the relationship between patients and doctors. However, he believes that most of us have trust in the medical system in Hong Kong and the professionalism of all our doctors and other medical professionals.

Being asked whether government would implement the “Opt-out” legislation, Dr. Leung said organ donation is not an urgent issue as there are others that require urgent solutions by the Hong Kong Government. Public consultation is absolutely necessary on such a controversial issue in the society and Dr. Leung considers that it is not likely that the Government will implement the “Opt-out” policy for the time being.

Compared to organ donation, medical funding by the Government is another issue that needs to be addressed. To quote from the Government Budget 2016/2017, the recurrent expenditure on healthcare was $57 billion, or 16.5% of the government recurrent expenditure, which is a more than 90% growth compared to 10 years ago. With the increasing aging population, the expenditure on healthcare is expected to grow. Government allocation is always insufficient to meet the growing demand. The lack of medical funding would affect the medical resources, human resources and prolong the waiting time of medical treatments. Years of resources shortage in the public health care system would further worsen the situation. In the face of such a dilemma, organ donation in Hong Kong is not a prime concern. The controversial "opt-out" proposal will arouse a lot of public discussions and responses. It is very hard for it to pass the legislative process, and therefore, Dr. Leung believes the government would not bring up the proposal at this moment.

Facing the lack of government resources, Dr. Leung considers that by promoting more about the "heroic donors" in mass media, the general public would become more aware of the need for organ donations and be more actively involved in the promotional campaign.

Furthermore, organ donation needs community support. Together with other supporting organizations, Dr. Leung tried to distribute promotional material at the Mass Transit Railway stations. Unfortunately, the results were very disappointing. He was told by some University students that they were not interested at all in organ donation. He felt so helpless at these results. In fact, the blood donation rate in Hong Kong is not favourable despite its long history in Hong Kong, Dr. Leung admitted.

In face of the difficulties in implementing the opt-out proposal, and the insufficient allocation of government resources to the medical sector, it is believed that the Government tends to maintain the status quo. It seems there is still a long way for Hong Kong to go to improve the organ donation rate, and to catch up with the European countries.

Reference

• 立法會祕書處(2016)。〈香港的器官捐贈情況〉。《研究簡報》，第五期。
• 政府財政預算案(2016)。〈投資醫療〉。《2016/2017財政年度 政府財政預算案》。
• 香港統計處(2016)。《香港二零一六年中期人口統計》。