Replies to LegCo questions
LCQ16: Liver transplant centre
Following is a question by the Hon Li Kwok-ying and a written reply by the
Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council
today (March 16):
Question:
It was reported that Queen Mary Hospital (QMH), the only liver transplant centre
in Hong Kong, had aborted liver separation operations on a number of occasions
due to inadequate resources, resulting in not only a waste of livers, but also
reduced chances for patients to undergo liver transplants. In this connection,
will the Government inform this Council whether it knows:
(a) the number of liver separation operations aborted at QMH since 2003 and the
reasons for the abortion;
(b) if the Hospital Authority (HA) has reviewed the incidents in which liver
separation operations were aborted due to inadequate resources or manpower; if
so, of the review findings; if not, the reasons for that;
(c) if HA has assessed whether the closure of the liver transplant centre at
Prince of Wales Hospital and performing all liver transplants at QMH is more
cost-effective than the arrangement in the past; and
(d) if HA will review the current operation of the liver transplant centre?
Reply:
Madam President,
A liver separation operation is to divide a liver donated for human transplant
purposes into two halves, which can then be transplanted into two separate
patients simultaneously. Generally speaking, whenever Queen Mary Hospital
receives a donated liver, it will try to arrange for a liver separation
operation as far as practicable, so as to enable two patients to benefit from
the same donated liver.
The performance of a liver separation followed by two simultaneous transplants
requires the mobilisation of a significant amount of manpower resources, which
include a minimum of two teams of transplant surgeons, anaesthetists, nurses and
other professionals, the use of three operation theatres and a whole host of
medical equipment. Whether or not such a complex operation can be successfully
arranged also depends on some external factors, such as whether there are other
patients at the hospital with urgent clinical needs at the same time.
(a) Since becoming the only liver transplant centre in Hong Kong in mid-2003,
Queen Mary Hospital has not aborted any liver separation operation due to
insufficient resources or manpower.
(b) The Hospital Authority (HA) has been closely monitoring and evaluating the
service level, the resources and manpower needs of its liver transplant centre,
so as to ensure that the centre receives the appropriate support for its
development and that the needs of liver transplant patients are met. In
addition, Queen Mary Hospital has strengthened the organisation and
co-ordination of its liver transplant services. It has also introduced a system
for mobilising the relevant staff at any time of the day or night. This is to
ensure that no matter when a donated liver may become available, the hospital
would be able to mobilise the transplant teams and sufficient manpower to
perform a liver separation operation as far as practicable, and to enable two
patients to benefit at the same time where possible.
(c) Given the existing number of donated livers available for human transplant
in Hong Kong each year, the current arrangement of designating Queen Mary
Hospital as the only liver transplant centre in Hong Kong is certainly the most
cost effective.
It is widely recognised internationally that in respect of major surgical
operations such as liver transplants, there is a positive relationship between
the number of operations conducted in a dedicated surgical centre and the
clinical outcome of the operations. Furthermore, to perform living liver
transplants, both the transplant centre and the surgical teams must possess the
relevant experience. The clinical outcome of the operations is subject to
independent reviews as well.
Since Queen Mary Hospital became the only liver transplant centre in Hong Kong,
the HA was able to consolidate its relevant resources and expertise at a single
location. This has not only facilitated the co-ordination and performance of
liver transplants, but also allowed the transplant teams to accumulate valuable
experience at a faster pace. Queen Mary Hospital has already completed over 100
liver transplants since it became the only centre for such operations. At
present, the patient survival rate at one year post transplant is 91 per cent,
which is at a top-tier level internationally. Before Queen Mary Hospital became
the only liver transplant centre, the overall survival rate of HA's liver
transplant patients at one year post transplant was 83 per cent. Hence, it can
be seen that substantial improvements on the effectiveness of liver transplant
operations have been brought about by the current arrangement.
(d) The Central Co-ordinating Committee on Surgical Services of the HA reviews
the operation of the liver transplant centre from time to time. It also monitors
the arrangement for liver transplant operations and its effectiveness.
Ends/Wednesday, March 16, 2005
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