Deceased organ donation in Hong Kong (1995-2014)

Abstract

Background: Organ shortage is one of the greatest challenges to organ transplantation worldwide. In Hong Kong, many initiatives have been introduced to increase organ donation rates, including transplantation legislation, publicity campaigns, establishment of Centralised Organ Donation Register, and appointment of organ transplant coordinators. Yet, the organ donation rate in Hong Kong remains low when compared with other developed countries. As a result of organ shortage, nearly 70% of current kidney transplant recipients in Hong Kong had their kidney transplants done overseas. Overseas kidney transplantation is not only associated with ethical issues such as transplant tourism, but also poses problems in the care of kidney transplant recipients as the donor information and details about peri-operative care is often lacking.

Study objectives: This study aimed to assess the temporal trend of deceased organ donation in Hong Kong over the past 20 years. Demographic information about the deceased organ donors over successive years was also examined. The impact of socioeconomic development, and organ donation promotion publicity campaigns on deceased organ donation rates in Hong Kong has been analyzed with the novel application of an age-period-cohort (APC) model.

Methods: All deceased organ donors between 1995 and 2014 retrieved from the Hong Kong Hospital Authority Organ Procurement System were included. To assess the temporal trend of deceased organ donation, the deceased organ donation rate over successive transplant years in terms of donors per million population (pmp) and donors per 1000 deaths were determined. Comparisons of the deceased donor profile between different transplant years were performed. I modeled deceased organ donation rate (per million population and per 1000 deaths) using an APC model to decompose the deceased organ donation rate into the effects of chronological age, donation period and donor birth cohort.

Results: The deceased organ donation rate increased from 3.7 donors pmp in 1995 to 5.4 donors pmp in 2014. The donation rate per 1000 deaths was 0.7 and 0.8 donors per 1000 deaths in 1995 and 2014 respectively. Older donors (p<0.001), hypertensive donors (p=0.05), and expanded criteria donors (p=0.01) increased over the past 20 years. The APC models showed an increase in deceased organ donation rate pmp and a decrease in deceased organ donation per 1000 deaths with age. Increasing donation rates were observed in successive generations, particularly for the first generation to reach adulthood in relatively developed Hong Kong (1930s birth cohort). Period effects were however not evident.

Conclusion: There was a modest increase in the deceased organ donation rate over the last 20 years, which was driven in part by increased donations from older and expanded criteria donors. Socioeconomic change in the last century may have contributed to attitude changes among successive generations. Organ donation promotion strategies based on publicity may not have sufficient population-wide impact (period effect) to bring about an increase in the deceased organ donation rate. More targeted policies based on analysis of evolving factors may be required.