Replies to LegCo questions
LCQ7: Liver Transplant Central Registry
Following is a question by the Hon Alan Leong and a written reply by the
Secretary for Food and Health, Dr York Chow, in the Legislative Council today
(July 8):
Question:
The Coroner's Court recently held an inquest on the death of a patient of the
Queen Mary Hospital who died as a result of not receiving liver transplant in
time. The jury of the inquest considered that the Queen Mary Hospital had not
clearly informed the patient of the arrangements for liver transplant and the
details in respect of the waiting time for liver transplant. The jury and the
Coroner have separately made a number of recommendations. In this connection,
will the Government inform this Council whether it knows:
(a) if the Queen Mary Hospital will provide more information to patients about
such operations, including a flowchart which illustrates the different stages
relating to liver transplant, such as the screening tests for determining
whether the patient is suitable for receiving liver transplant, the patient
being listed on the Central Registry for Liver Transplants (the Central
Registry), and the patient receiving the liver transplant, as well as the
detailed criteria for listing patients on the Central Registry and allotting
donated cadaveric livers, with a view to enhancing patients' understanding about
liver transplants; if it will not, of the reasons for that;
(b) if the Queen Mary Hospital will issue to patients written or other forms of
confirmation that they have been listed on the Central Registry; if it will not,
of the reasons for that; and
(c) given that the relative priority of patients to receive liver transplant is
determined according to their scores under the Model for End-Stage Liver
Disease, whether the Queen Mary Hospital will consider informing the patients
listed on the Central Registry of their relevant scores, so that they will
better understand the situation in respect of the waiting time; if it will not,
of the reasons for that?
Reply:
President,
(a) - (c) At present, the Hospital Authority (HA) distributes an information
leaflet on "Liver Transplant Central Registry" to patients who are referred for
liver transplant so as to enhance their knowledge about the Liver Transplant
Central Registry (the Central Registry) and to help them understand the details
and arrangements of liver transplant.
The Central Registry determines the priority of allocation of cadaveric livers
among patients based on objective clinical parameters to ensure that donated
livers are allocated to patients with the most urgent needs. The Central
Registry adopts the internationally-recognised MELD (Model for End-Stage Liver
Disease) and PELD (Pediatric End-stage Liver Disease) scoring systems to compute
the mortality risk score of patients (i.e. the probability of pre-transplant
death), known as the MELD/PELD score, using objective clinical data such as the
level of serum bilirubin, serum creatinine and the international normalised
ratio of prothrombin time. As a higher MELD/PELD score indicates more urgent
conditions, priority will be given to the patient with the highest score in the
allocation of livers. When there is a potential cadaveric liver, the Liver
Transplant Coordinator would check through the list of patients on the Central
Registry with the same blood group as the cadaveric liver donor and identify,
among them, the patient with the highest MELD/PELD score. The Liver Transplant
Coordinator will then inform this patient that he or she may undergo the
transplant operation.
On the other hand, HA has an established internal audit mechanism to ensure that
every donated liver is allocated to the patient with the most urgent needs
according to their ranking on the Central Registry. Where a cadaveric liver is
not allocated to the first patient on the waiting list under exceptional
circumstances, the doctors concerned must provide a full explanation in writing.
Example of these circumstances include the patient having opted for not
receiving the transplant at the time or being unsuitable for undergoing the
transplant due to his or her clinical conditions at the time. This is to ensure
that the process of liver allocation is conducted in a fair and objective
manner. The aforesaid criteria for determining the ranking of patients on the
waiting list and the criteria for allocation of donated organs are detailed in
the information leaflet on "Liver Transplant Central Registry".
Patients referred for liver transplant will be listed on the Central Registry if
they have gone through clinical assessment and are assessed to require liver
transplant. Their ranking on the Central Registry is subject to constant changes
due to changes in their own medical conditions or other patients' medical
conditions, inclusion of new patients on the Central Registry or removal of
existing patients from the Central Registry etc. Moreover, patients may be
removed from the Central Registry due to improvement in their own medical
conditions. For these reasons, hospitals will not issue written or other forms
of confirmation to patients on their listing on the Central Registry.
Nevertheless, doctors will maintain communication with their patients and keep
them informed of their updated approximate ranking on the Central Registry.
Patients may also contact the Liver Transplant Coordinator directly to enquire
about their up-to-date ranking and their MELD/PELD scores.
After considering various recommendations made by the Coroner's Court, including
the provision of a flow chart illustrating the stages from screening to listing
patients on the Central Registry and the conduct of the liver transplant
operation, detailed criteria for listing patients on the Central Registry and
for allocation of donated cadaveric livers, as well as the enquiry channels, HA
and Queen Mary Hospital will provide a liver transplantation flow chart (see
Annex) to patients and further strengthen the efforts in providing relevant
information to patients with a view to enhancing patients' understanding about
the arrangements for liver transplant.
Ends/Wednesday, July 8, 2009
Issued at HKT 12:50
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