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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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