DOI: 10.12809/hkmj187371
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
LETTERS TO THE EDITOR
In search of the best organ donation legislative system
for Hong Kong: further research is needed
Khaled Tafran, MEc (Health Policy)
Department of Administrative Studies and Politics,
Faculty of Economics and Administration, University of Malaya, Kuala
Lumpur 50603, Malaysia
Corresponding author: Mr Khaled Tafran (khaled@um.edu.my)
To the Editor—Transplantation is advancing
rapidly to such an extent that in the foreseeable future we may witness
the first head transplantation.1
Low donation rates will be one of the main global barriers undermining
transplantation.
I read with interest the article by Cheung et al2 and I would like to highlight a
few issues concerning this research. Although the article analysed the
willingness of potential donors under three systems (opt-out, opt-in, and
opt-in with allocation priority), it did not consider an opt-out system
with allocation priority. Previous research showed that an opt-out system
with allocation priority may result in a higher willingness to donate than
other systems.3 4 Cheung et al2
found that the difference in willingness between the opt-in and opt-out
systems was not significant; therefore, it is highly possible that an
opt-out system with allocation priority would result in a similar, or
perhaps better, willingness to an opt-in system with allocation priority.
Moreover, the opinion of health care professionals on donation legislative
systems is critical in this context, as they play a vital role in
facilitating the process of donation and transplantation.5
Although the findings of Cheung et al2 are imperative, more accurate policy recommendations in
this context require further studies to investigate willingness to donate
under an opt-out system with allocation priority as well as health care
professionals’ opinion of donation legislative systems in Hong Kong.
Declaration
The author has no conflicts of interest to
disclose. The author had full access to the data, contributed to the
study, approved the final version for publication, and take responsibility
for its accuracy and integrity.
References
1. Tafran K. Religious barriers to head
transplantation: an Islamic viewpoint. Int J Surg 2017;43:92-3. CrossRef
2. Cheung TK, Cheng TC, Wong LY.
Willingness for deceased organ donation under different legislative
systems in Hong Kong: population-based cross-sectional survey. Hong Kong
Med J 2018;24:119-27. CrossRef
3. Tumin M, Tafran K, Mutalib MA, et al.
Demographic and socioeconomic factors influencing public attitudes toward
a presumed consent system for organ donation without and with a priority
allocation scheme. Medicine (Baltimore) 2015;94:e1713. CrossRef
4. Li D, Hawley Z, Schnier K. Increasing
organ donation via changes in the default choice or allocation rule. J
Health Econ 2013;32:1117-29. CrossRef
5. Tumin M, Tafran K, Satar NM, et al.
Factors associated with healthcare professionals’ attitude towards the
presumed consent system. Exp Clin Transplant. In press.
Authors’ reply
TK Cheung, BSc; TC Cheng, BSc; LY Wong, MPH, PhD
The Jockey Club School of Public Health and Primary Care, The Chinese
University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
Corresponding author: Prof LY Wong (lywong@cuhk.edu.hk)
To the Editor—We would like to thank Dr
Tafran for his valuable comments on our article.1
First, in Spain, where the opt-out system is implemented, the deceased
donor rate of 39.7 per million population (pmp) in 2015 (thanks for
letting us know the typo of 34.0 reported in the Introduction)2 increased to 46.9 pmp in 2017. On the contrary, in Hong
Kong, where an opt-in system is adopted, the deceased donor rate has
remained at around 6 pmp over the same period of time. The gap between
Hong Kong and Spain is large, and the gap is widening.
Second, as current participation in the opt-in
system of deceased organ donation is low, our initial plan was to estimate
the willingness rate under three proposed legislative options that have
been adopted in other jurisdictions: “opt-out system”, “opt-out system
with allocation priority”, and “opt-in system with allocation priority”.
Nonetheless our pilot study revealed that the majority of participants
experienced difficulty in distinguishing between “the opt-out system with
allocation priority” and the other two options as they were confused about
the concepts inherent in these legislative options with similar
definitions. Considering the length of the questionnaire and the limited
interview time and feasibility, we decided to only examine the “opt-out
system” and the “opt-in system with allocation priority” in the final
study design. The media has subsequently reported these two proposed
options and have since generated public debate regarding this issue. We
suggest that the next survey can include more legislative options using
examples from other jurisdictions as well as suggestions from interviewed
participants.
To summarise the key messages of our paper, it is
crucial to understand and explore various stakeholders’ perspective with
respect to different legislative options for deceased organ donation.
These stakeholders shall include health policy-makers (eg, The Food and
Health Bureau), and a variety of health care professionals and patient
groups (eg, The Hong Kong Alliance of Patients’ Organizations).
Declaration
The authors have no conflicts of interest to
disclose. The authors had full access to the data, contributed to the
study, approved the final version for publication, and take responsibility
for its accuracy and integrity.
References
1. Cheung TK, Cheng TC, Wong LY.
Willingness for deceased organ donation under different legislative
systems in Hong Kong: population-based cross-sectional survey. Hong Kong
Med J 2018;24:119-27. Crossref
2. International Registry in Organ Donation
and Transplantation. 2018. Available from: http://www.irodat.org/.
Accessed 23 Dec 2018.