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Non-Communicable Diseases WatchNovember 2015
Liver Donors - Anonymous Heroes Who Save Lives
This publication is produced by the Surveillance and Epidemiology Branch, Centre for Health Protection of the Department of Health
18/F Wu Chung House, 213 Queen’s Road East, Wan Chai, Hong Kong http://www.chp.gov.hk All rights reserved
Key Messages
Liver transplantation is a life-saving procedure for adults and children with end-stage liver diseases.
Liver grafts can come either from a deceased donor or living donor.
Globally, there were 25 050 liver transplantations performed in 2013. Among them, 18.3% of livers
were from living donors.
Hong Kong had its first deceased donor liver transplantation, first paediatric living donor liver
transplantation, and first adult living donor liver transplantation in 1991, 1993 and 1994
respectively. Between 1991 and 2014, there were a total of 1 148 liver transplantations performed
at the Queen Mary Hospital (QMH). Among them, 646 used living donor grafts and 502 used
deceased donor grafts.
As the demand for liver grafts continually outstrips supply, it would be hard to reduce the proportion
and number of living donor liver transplantations without an increase in donated livers from
deceased donors.
To support organ donation after death, members of the public may indicate their wish to
donate organs after death by registering in the Centralised Organ Donation Register (CODR) at
https://www.codr.gov.hk/codr/Internet.do and informing family and relatives about this wish.
To have the gift of hope continue to snowball, prospective donors can also encourage family,
relatives and friends to do likewise.
Liver Donors - Anonymous Heroes Who Save Lives
Page 2
Liver transplantation is a surgery to remove a
diseased or injured liver and replace it with a whole
or partial healthy liver from a donor. Liver grafts can
come either from a deceased donor or living
donor (usually a healthy family member). In a living
donor scenario, the operation in the donor involves
taking out the required segments while ensuring
that the remnant liver is sufficient for living donor to
maintain normal body functions. In fact, the
development of living donor liver transplantation is
to compensate the critical shortage of deceased organ
donations for increasing number of patients waiting
for liver transplantation.1, 2
There are many diseases of liver which may need
transplantation eventually. Common indications for
liver transplantation include cirrhosis from chronic
iver diseases, acute liver failure, liver malignancies,
metabolic liver diseases and other irreversible liver
diseases (Figure 1).2, 3 Nevertheless, some patients
ma y not be appropriate candidates for liver
ransplantation, for example, patients with active
alcohol intake or substance abuse, active infection or
uncontrolled sepsis.2
l
t
Non-Communicable Diseases Watch November 2015
Figure 1: Common indications for liver transplantation
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Non-Communicable Diseases Watch November 2015
Global Perspective
From Deceased Donors From Living Donors
Source: International Registry in Organ Donation and Transplantation.
0.3
1.1
1.8
3.7
5.3
7.4
8.2
10.9
12.9
13.66
18.9
19.2
21.9
22.7
23.0
26.5
0 10 20 30
Japan
Russia
Saudi Arabia
Turkey
Hong Kong
South Korea
Netherlands
Australia
Switzerland
United Kingdom
France
United States of America
Portugal
Spain
Belgium
Croatia
Rate per million population
0.04
0.12
0.2
0.23
0.29
0.49
0.53
0.6
0.7
0.8
2.9
3.8
4.0
4.7
12.8
16.1
0 10 20 30
Australia
Netherlands
France
Croatia
Portugal
Spain
United Kingdom
Switzerland
United States of America
Russia
Japan
Belgium
Saudi Arabia
Hong Kong
Turkey
South Korea
Rate per million population
Since the first successful liver transplantation
from deceased donor was performed in 19673,
liver transplantation has evolved and become a
highly successful life-saving procedure for many
adults and children with end-stage liver diseases.
Survival after liver transplantation has also
progressively improved with 1-year and 5-year
survival rates exceeding 85% and 70% respectively.4
Liver is the second most common solid organ to
be transplanted worldwide after kidney. The Inter-
national Registry in Organ Donation and Trans-
plantation of Global Observatory on Donation and
Transplantation (http://www.irodat.org/) estimated
that there were 25 050 liver transplantations
performed globally in 2013. Among them, 18.3% of livers were from living donors.5 While use of liver from deceased donor predominates in the Western countries, use of living donor liver transplantation is more popular in Asian countries. The relatively slow progress of deceased donor liver transplantation in Asia is mainly due to the cultural and religious barriers of organ donation.6, 7 As Figure 2 shows, Croatia had the highest rate of liver transplantation from deceased donors of 26.5 per million population in 2013, whereas South Korea had the highest rate of liver transplanatation from living donors of 16.1 per million population.8
Figure 2: Rate (per million population) of liver transplantation from deceased and living donors
in 2013
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Non-Communicable Diseases Watch November 2015
Source: Department of Surgery, The University of Hong Kong.
Local Situation
2 1 2 5 9 10 914 12
7
1824
16 18 21 23 24 23
43 41
3040 37 35
12
2 24
4 6
210
2 2
2 34
14
1
9 1532
36
36
34
5639
49 41 43
41
53
44
33
34
27
0
25
50
75
100
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Deceased donor Deceased donor split Living donor
Number
of
liver
trans-
plantations
Year
Hong Kong had its first deceased donor liver
transplantation at QMH in 1991, whereas the first
paediatric living donor liver transplantation and
the first adult living donor liver transplantation was
done in 1993 and 1994 respectively.9 In children, the
most common indication for liver transplantation is
biliary atresia.10 Among adults, the most common
indication for liver transplantation is liver failure
secondary to hepatitis B infection.11 In mid-2003,
QMH became the only liver transplantation centre
in Hong Kong.
A review of a total of 1 148 liver transplantations
(including 134 paediatric recipients) performed at
QMH between 1991 and 2014 revealed that 646
used living donor grafts and 502 used deceased
donor grafts (Figure 3). The overall 1-year, 3-year
and 5-year survival rates were 92.9%, 88.2%
and 85.8% respectively. For paediatric recipients,
the corresponding rates were 93.6%, 91.0% and
91.0%. For adult recipients, they were 92.8%, 87.9%
a nd 85.1% respectively.12
Figure 3: Liver transplantations performed at Queen Mary Hospital, 1991 to 2014
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Non-Communicable Diseases Watch November 2015
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Promotion and Support of Organ Donation
Liver transplantation techniques in Hong Kong
have advanced greatly with a low hospital mortality
(< 2% in 2012) and high long-term survival.9
However, such life-saving practice is hindered
by the shortage of liver grafts.6, 13 Although living
donors can provide certain proportion of organs,
liver transplantation in living donors is technically
more demanding and involves complicated man-
power and logistical issues such as donor selection
and safety.7 Furthermore, there are small but real
risks (such as infection and biliary complication)
for living liver donors. 14 As the demand for liver
g rafts continually outstrips supply, it would be hard
to reduce the proportion and number of living donor
li ver transplantations without an increase in donated
livers from deceased donors.5 While organ donation
is a charitable act, many of us are in fact potential
organ donors after death (Box 1).
Box 1: Criteria for Deceased Organ and Tissue Donation15
General Criteria
There is no age limit in general
Brain death donors can donate both organs and tissue
When cardiac death occurs, the deceased can mostly donate tissue only, such as corneas, skin and bones
The organ has adequate function
Potential donor has no severe or systematic infection, such as HIV
Cancers are contraindicated in organs, skin and bone donation, except primary brain tumours. However,
the deceased cancer patients may donate cornea provided that they do not have lymphoma, leukaemia,
myeloma, malignant tumours of ocular or peri-ocular area
Criteria for Deceased Liver Donor
Deceased liver donor should meet the general criteria for organ donor
There is no age limit for a brain death donor
Deceased liver donor has normal liver function
Deceased liver donor has no history of chronic liver disease
Hepatitis carrier is not suitable for donation
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Non-Communicable Diseases Watch November 2015
To facilitate prospective voluntary donors to
express their wish to donate organs after death,
the Government launched the CODR on 24
November 2008. As at 31 October 2015, there were
over 179 000 registrations.16 To become an organ
donor after death, members of the public can
register in the CODR (Box 2). The CODR provides
multiple channels (including internet, email or fax)
for the public to register their wish to donate organs
after death more conveniently. It also enables
their wish to be readily accessible to Organ
Donation Coordinators of the Hospital Authority
at the critical moment so that the latter can
a pproach the family members as soon as possible
to seek consent to carry out relevant examinations
a nd operations in order to save patients in urgent
need of organ transplantation. In Hong Kong,
expressed consent from relatives of a prospective
donor is required prior to organ and tissue retrieval.
So it is of utmost importance that prospective donors
tell their family and relatives about their wish to
dona te organs and tissues after death. Otherwise,
the family or relatives may prohibit organ and tissue
ha rvesting if they are unaware of their loved ones’
honor able wish.
Box 2:
For those prospective organ donors who wish to register their wish in the CODR, they can:
1. Register online at https://www.codr.gov.hk/codr/Internet.do ; or
2. Download and complete the organ donation registration form, and send it to the CODR System
Administrator by post or fax.
By post: CODR System Administrator,
Department of Health, 21/F,
Wu Chung House,
213 Queen’s Road East,
Wan Chai, Hong Kong
By fax: 2127 4962
For enquiries concerning the CODR, please call 2961 8441 or email to codr@dh.gov.hk.
Page 7
To have the gift of hope continue to snowball,
persons who have registered on CODR can also
help by encouraging family, relatives and friends
to do likewise, learn the facts about organ donation
and debunk the myths or misconceptions on organ
donation (e.g. organ donation will NOT make
medical personnel offer less treatment; organ dona-
tion will NOT result in body disfigurement as the
incisions will be properly stitched up; in most cases
they will be covered by burial clothing). To know
more about organ donation, relevant news and
activities in Hong Kong, please visit the designated
website at http://www.organdonation.gov.hk, or the
Facebook fan page “Organ Donation@HK” at
https://www.facebook.com/organdonationhkeng.
References
1. Shukla A, Vadeyar H, Rela M, Shah S. Liver Transplantation:
East versus West. J Clin Exp Hepatol 2013; 3(3):243-53.
2. Varma V, Mehta N, Kumaran V, Nundy S. Indications and
contraindications for liver transplantation. Int J Hepatol 2011;
2011:121862.
3. Song AT, Avelino-Silva VI, Pecora RA, et al. Liver transplanta-
tion: fifty years of experience. World J Gastroenterol 2014;
20(18):5363-74.
4. Lo CM. Transplantation for liver cancer - more than better results.
Nat Rev Gastroenterol Hepatol 2013; 10:74-6.
5. Organ Donation and Transplantation Activities 2013. Barcelona:
Global Observatory on Donation and Transplantation, 2015.
6. Lo CM. Deceased donation in Asia: challenges and opportunities.
Liver Transpl 2012; 18 Suppl 2:S5-7.
7. Ng KK, Lo CM. Liver transplantation in Asia: past, present and
future. Ann Acad Med Singapore 2009; 38(4):322-10.
8. IRODaT Newsletter. International Registry in Organ Donation
and Transplantation. Final Numbers 2013. Barcelona: Global
Observatory on Donation and Transplantation, December 2014.
9. Chan SC, Cheung TT, Chan AC, et al. New insights after the first
1000 liver transplantations at The University of Hong Kong.
Asian J Surg 2015.
10. Chung PHY, Wong KKY, Tam PKH, et al. Split graft liver trans-
plant for paediatric patients in Hong Kong. HK J Paediatr
(new series) 2009; 14:181-5.
11. Chui AKK. Liver transplantation in Hong Kong. Hong Kong
Med J 2002; 8(4):232-3.
12. Hepatobiliary and Pancreatic Surgery and Liver Transplantation.
Hong Kong SAR: Department of Surgery, The University of
Hong Kong. Available at http://www.surgery.hku.hk/hbp.php
[Accessed on 12 August 2015].
13. Chung HY, Chan SC, Lo CM, Fan ST. Strategies for widening
liver donor pool. Asian J Surg 2010; 33(2):63-9.
14. Middleton PF, Duffield M, Lynch SV, et al. Living donor liver
transplantation--adult donor outcomes: a systematic review.
Liver Transpl 2006; 12(1):24-30.
15. Know More about Organ Donation (What is Liver Transplanta-
tion?). Hong Kong SAR: Department of Health. Available at http://
www.organdonation.gov.hk/eng/introduction_liver.html [Accessed
on 11 August 2015].
16. Statistics on Organ/Tissue Donations. Hong Kong SAR:
Hospital Authority.
Non-Communicable Diseases Watch November 2015
Non-Communicable Diseases (NCD) WATCH is dedicated to
promote public’s awareness of and disseminate health information
about non-communicable diseases and related issues, and the
importance of their prevention and control. It is also an indication of
our commitments in responsive risk communication and to address
the growing non-communicable disease threats to the health of our
community. The Editorial Board welcomes your views and comments.
Please send all comments and/or questions to so_dp3@dh.gov.hk.
Editor-in-Chief
Dr Regina CHING
Members
Dr Thomas CHUNG Dr Ruby LEE
Dr Cecilia FAN Mr YH LEE
Dr Anne FUNG Dr Eddy NG
Ms Janice HO Dr Lilian WAN
Dr Rita HO Dr Monica WONG
Dr Winnie LAU Dr Priscilla WONG
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Non-Communicable Diseases Watch November 2015