The chances of finding a donor kidney in Hong Kong is less than 5%. So as to say that if none of your family or friends have the same blood type compatibility, the chances of you surviving is close to none. However, Hong Kong’s Hospital Authority has been looking into ‘paired donor exchange systems’ to tackle this blood type incompatibility. Especially in Asia, deceased donor transplants are unpopular. This has resulted to live donors insisting on saving their loved ones, even with ABO incompatibility, usually with unsuccessful outcomes.

The first donor exchange systems were set up in 1980s in attempt to find 2 pairs of incompatible donor-recipient to do a ‘across the pair swap,’ allowing both recipients to benefit from this scheme. So to break it down, for pair 1, donor has blood type A but recipient has blood type B. And for pair 2, donor has blood type B but recipient has blood type A. Here is the tricky part. From a medical standpoint, if donors from both pairs were to help ‘across the pair,’ many lives could be saved. But let’s say if you were in the exact situation right now, would you donate your organ to a complete stranger? With no guarantee that they will be saved, and as a matter of fact , that your friend/family would be saved by the other donor either.

There are so many ethical and legal logistics to be discussed and considered before agreeing to a procedure like this. Dr Chau Ka-foon, chief of service and consultant nephrologist in the department of medicine at Queen Elizabeth Hospital, explained that under the HK law, strangers could not make live donations to each other.

In my opinion, the ethics of such exchanges are incredibly complicated and can lead to plenty of controversy. The temptation to exploit a situation like this could really question one’s character and morality. I feel that the initial agreement to be a part of this ‘pair scheme’ should be with the genuine intent to save someone’s life out of pure goodwill. So once the operations have begun, the survival of one recipient should not be compromised by the other.

There has been instances of operations that did not happen simultaneously, resulting to sudden emotional conflict and abrupt decisions by the second donor to back out. Undoubtedly, this feeling would be amplified if the first exchange was an unsuccessful one. If your loved one did not make it out alive, just imagine how hard it would be to continue as a donor. Other health complications from the donors could also make this ‘stranger swap’ so much more challenging.

Hong Kong has had a case of liver exchange a while ago but a lot of preparation and a well planned procedure was required to handle this medically complex situation. The concept could potentially be a great one, as patients who find matches through this scheme would benefit significan Wtly. But in order for this to happen, citizens of Hong Kong must not abuse the system, put their trust in each other, and think about the bigger picture.

Vera Wong
(The view of the author does not represent the position of the Society)