Hong Kong’s low organ donation rate was largely down to “conservative” attitudes rather than “abnormal” withdrawals from a donors’ register, a leading doctor has said.

Lui Sing-leung, the chair of the Hospital Authority’s central renal committee, spoke to RTHK’s English-language radio show on Monday morning to discuss the trend following the city’s Organ Donation Day on Saturday.

Organ Donation Centralised Organ Donation Register
Centralised Organ Donation Register. Photo: Kelly Ho/HKFP.

In 2022, Hong Kong had just 4.7 organ donors per million people – significantly below Spain, which, with 46 donors per million people, had among the highest donation rates in the world.

A total of 42 kidneys were donated in the city in the first nine months of 2023, while more than 2,340 late-stage kidney failure patients were waiting for organs as of September.

“People in Hong Kong, compared to the Western countries, are relatively more conservative in terms of the idea of preserving the body after death,” Lui told RTHK. “Often, the potential donor’s relatives are not sure about the wish of the potential donor and therefore they decide to not donate the organs.”

Surveys conducted by the Census and Statistics Department have found that most people unwilling to donate organs after death said their reluctance came from wanting “to keep [the] body intact.”

hospital authority logo (3)
The Hospital Authority logo. Photo: Tom Grundy/HKFP.

Lui also said that the city’s low organ rate had little to do with a recent spate of applications to withdraw from its opt-in organ registry.

‘Invalid’ organ registry withdrawals

Earlier this year, the city saw a spike in “invalid” withdrawals from its opt-in system for organ donations after the government proposed integrating Hong Kong hospitals with the China Organ Transplant Response System, to allow organs from Hong Kong to be donated to recipients in mainland China, and vice versa.

The withdrawals included those who had not registered in the first place or who had not completed the identity verification process, the Department of Health later said.

Chief Executive John Lee meets the press at Hong Kong's Central Government Offices, on June 6, 2023. Photo: HKFP.
Chief Executive John Lee meets the press at Hong Kong’s Central Government Offices, on June 6, 2023. Photo: HKFP.

In June, Chief Executive John Lee drew comparisons between the activity and the “black riots” in 2019, after four people were arrested over alleged “access to computer with dishonest intent” in relation to the registry cancellations.

“The means… used are very similar to those used in the 2019 black riots and Hong Kong version of the colour revolution,” Lee said, referring to the protests and unrest sparked by a controversial extradition bill that year. The demonstrations escalated into sometimes violent displays of dissent against police behaviour, amid calls for democracy and anger over Beijing’s encroachment.

Lee added that repeated registrations and withdrawals from the opt-in organ registry were “abnormal,” and had created an “illusion” of cancellations by “individual shameless people.”

Two men were charged with criminal damage to property over their alleged disruption to the organ donation system last Thursday.

Acting Secretary for Health Libby Lee (third from right) attends Organ Donation Day 2023, on November 11, 2023. Photo: GovHK.
Acting Secretary for Health Libby Lee (third from right) attends Organ Donation Day 2023, on November 11, 2023. Photo: GovHK.

Organ Donation Day was established in 2016 amid efforts to promote organ donations in Hong Kong.

“Despite rapid advancements in healthcare technologies, organ transplant remains the only hope for many patients with organ failure to live on,” Acting Secretary for Health Libby Lee said at an event to mark the occasion on Saturday.

“Currently, more than 2,000 patients are waiting for organ transplants in Hong Kong. To shorten patients’ waiting time for organ transplants and to bring new life to them, active support for organ donations by members of the public is critically important,” she continued.

The health official encouraged Hongkongers to join the Centralised Organ Donation Register, which currently has more than 363,000 members, to offer hope to patients waiting for organs.

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Mercedes is a British journalist who has been based in Hong Kong since 2012. At Hong Kong Free Press, she has covered a number of local environmental issues, including climate inequality and marine biodiversity, and explored how Hong Kong's arts scene reflects a changing city. She has contributed to the Guardian and BBC Travel, and previously worked at the South China Morning Post, where she wrote a weekly column about the social and environmental impact of tourism in Asia.