Last year the mother of a fourteen-year-old boy involved in a fatal accident chose to donate his organs to people needing transplants. That selfless act made headlines in local papers, and received a few mentions in the international press. While such a gift is rare, even more unusual in our city is people consenting to organ donation either while they’re still alive or after death.
Hong Kong is a big city – we have a population of 6.9 million and one would think it not too difficult to find people to donate their organs – at least after they die – to those in need. But the Hong Kong Medical Association (HKMA) has a long list of patients waiting for transplants and lots of difficulty finding donors to match. It seems we are all too keen to give our heart romantically but are in no hurry to give the real thing – or any other of our organs – even though we may no longer have any use for it. Are we really so attached to our bodily bits and pieces that the thought of losing some part of them even after death is too terrifying, or is there some other reason the HKMA’s Organ Donation Register is not more universally popular?
It may have something to do with the ancient Chinese belief that a healthy and happy afterlife is impossible unless the body is kept complete – but this belief is being steadily eroded by modern ideas more in accord with the disintegration of flesh and blood. Even the government recognizes the benefits of organ donation and launched a new campaign to persuade us to bequeath our inner treasures in mid-December last year. The campaign continues with posters and TV slots later this month as well as travelling exhibitions and a training scheme for young people and secondary school students who will, the organizers hope, take the message home to their friends and families.
And the medical association has made it even easier to put our names on the register set up for the very reason of encouraging people to open their (metaphorical) hearts to others whose organs are failing. Originally those who registered were issued an organ donation card which they always had to carry with them but after the association’s computer system got a sophisticated upgrade, benefactors have merely had to fill in a form and technology does the rest. So far 35,195 good souls out of Hong Kong’s nearly seven million have filled in the donor forms. Which may seem a lot, but it is only 0.5% of the population and in terms of the numbers of stricken patients, not nearly enough.
Our organ miserliness seems even more strange when you consider that in Hong Kong heart disease is the second most common cause of death after cancer. Believe in karma, and you could think the closed-fistedness around our organs has resulted in the shut down of our real hearts. Not that everyone who has heart disease will need a transplant – some won’t even realize they have a heart problem before the organ of love and life has had enough and suddenly seizes up. It is the others who are given ample warning by their lurching hearts that may find themselves on the Hong Kong Medical Association transplant waiting list. Of course therapies like drugs and mechanics will offer some relief but often they can’t be relied on to keep the inevitable at bay for very long. Then a heart transplant becomes a matter of urgency while the donees are generally housebound and must often avoid walking anywhere with even the slightest gradient.
We often refer to Hong Kong as the place where the east and west touch base, but in matters of the heart and its malfunctions, the two have been at some variance. Dr Clement Chiu, a cardio-thoracic surgeon and one of the city’s heart transplant pioneers, explains: “In western countries many patients need heart transplants because of coronary heart disease, however in Hong Kong most patients tend to have cardiomyopathy problems such as an enlargement of ventricles – in that they balloon up and therefore don’t pump blood correctly – and heart valve problems.”
Yet difficulties around coronary heart disease are on the rise in Hong Kong. “We were doing only 100 operations [to correct coronary disease problems] a year in the ’80s, but now we’re doing more than 300 a year,” says Dr Chiu.
And why is that? Well, the causes of coronary heart disease are many but two of the love organ’s biggest enemies are cholesterol and stress, both of which we have plenty of in Hong Kong. Hong Kongers are known for ever-speedier adrenaline-charged lifestyles, which in one way may seem to define us as electric individuals but actually puts a lot of pressure on our internal functionings, especially those of our central organ. Which will only take so much of that kind of treatment. We also tend to love sitting down to plates piled with foods which have become richer, more salty and fattier over the years – (Mention a few common ones favoured in Hong Kong) – and which form the low density lipoproteins commonly known as ‘bad cholesterol’. This type of cholesterol collects as fatty deposits in the arteries, closing them up and limiting oxygen and nutrients to the heart. Disease almost certainly follows and, if a blood clot closes one of those arteries, a heart attack and probable death will result.
Heart transplants, in comparison to cornea and kidney transplants, are relatively new to Hong Kong. The first was conducted in December 1992 at the Grantham Hospital in Aberdeen which now specializes in cardio-thoracic transplants. More than 70 hearts have been transplanted since that first successful operation 15 years ago: indeed the recipient of that heart is still alive today.
Which says a lot for the advance of modern medicine. Although the world’s first human-to-human heart-transplant patient only lasted 19 days after the operation, his death was due to septicaemia not heart failure or rejection of the organ by the body. Since then, life expectancy after a heart transplant has steadily increased – although 15 years is uncommon, Dr Chiu says that people can live 10 years or more. The success rate after surgery is now usually 90%: it is rare for bodies to reject new hearts right away. However, Dr Chiu does say it is possible for bodies to spurn hearts even after receiving drugs, sometimes the blood-pumping organs are more prone to rejection than kidneys or livers because of their very nature. Hearts are not solid like those two body-purifying organs, they survive for less time without blood flowing through them, and so the longer they are left unattached to a body, the more problems can occur.
Nor does rejection only occur physically: Dr Chiu mentions a case in which the recipient couldn’t come to terms with the new organ psychologically. “He might not have been able to accept someone else’s heart in his body,” he says. “He was not ready, so he committed suicide.”
And that is why people are now carefully screened before being allowed on the transplant waiting list. Not only must they be physically and mentally fit but after the operation they will have to keep up a strictly-defined lifestyle, including constantly taking medication. For the rest of their lives. So the list tends to be quite small – at the moment only around 20 people are waiting for another heart.
Yet, returning to Hong Kong’s organ donation reluctance, the list is primarily small because of a lack of donors. A patient with an average height and weight usually has to wait six months or more before being called to go under the knife for a fresh heart, while those who are heavier and taller are less lucky: a heart suitable for their body configuration could take much longer to materialize.
So, if we healthy bodies are going to continue to huddle protectively over our biological structure, decomposing or not, perhaps we need a more forceful reminder to give of ourselves after death. In Spain, Belgium and other European countries the organ donation rate is very high because it is generally assumed everyone is a donor unless they specifically instruct otherwise. Which also creates more jobs for the living – in those European countries dedicated teams employed to coordinate transplants at hospitals are common. In Hong Kong hospitals, such teams are rare, nor are most of the general staff trained to recognize what makes a potential donor.
Apparently such a system has been discussed in Hong Kong in the past but got tangled in thorny ethical issues. For instance, if a person hasn’t opted out, are doctors free to take their organs without telling their relatives? You can almost hear that traditional Chinese belief system about the hereafter bristling down the centuries at the suggestion. Spain runs what may be a fuzzier option – relatives are still consulted and really have the final say whether their dear departed will become a donor or not. Such a system may be the one Hong Kong finally votes for.
And those more concerned about their money than their body parts once they have passed from this earthly existence can rest assured their estate won’t have to pay anything for their organs to continue working in someone else’s body. The Hospital Authority absorbs all costs of organ transplants including surgery and any additional expenses. Dr Chiu says the cost is roughly $600,000 per transplant and, while this may seem expensive, it’s 40% lower than what it was when the programme initially started, primarily due to falls in price and increase in effectiveness of medications.
Whether the government’s campaign will be effective in solving Hong Kong’s concerns around organ donation has yet to be seen, but if we as citizens of this supposedly modern and cosmopolitan city continue to be shy about really giving our hearts to those in need, what can we expect when it comes to our turn? Which of us can say we will never end up with a
heart broken by disease, hoping against hope some kind fellow Hong Konger put their name down for us on the Organ Donation Register? |
