2023-05-25 03:43:58
- Ye Jingsi
- BBC Chinese correspondent reports from Hong Kong
image source,Getty Images
The number of people waiting for organ transplants in Hong Kong far exceeds the number of donors.
Over the past six months, taking a baby girl’s cross-border heart transplant as an opportunity, mainland China and the Hong Kong SAR have been speeding up discussions on a mutual aid and cooperation mechanism for cross-border human organ donation. Now this discussion is also involved in China’s national security issues.
The Hong Kong SAR government stated that it has received more than 5,700 applications for cancellation of post-mortem organ donation registration in the past few months, which is “unusual”.
Pro-Beijing media in Hong Kong said some people were urging others to unregister on online social platforms. This immediately aroused public speculation that the National Security Police might intervene. The Hong Kong police confirmed to the BBC in Chinese that the Police Network Security and Technology Crime Investigation Bureau “is aware of the incident”, but did not deny the possibility of the national security department intervening.
However, the Secretary for Justice of the Hong Kong Special Administrative Region, Lam Ting-kwok, SC, later said that it was “too early to say” whether it was illegal, and urged everyone not to forget the original intention of organ donation: “to develop and promote the spirit of great love for mankind.”
Why did the debate on organ donation in Hong Kong take a turn?
Discussions about human organ donation in Hong Kong have become heated recently, which is related to a press release from the SAR government.
May 22ndan unnamed government spokesperson commented on “recent public concerns about the cross-border organ transplant mutual aid mechanism and the central organ donation register”. During the first month, 5,785 applications for cancellation of registration were received, “far higher than the previous figures”, but 2,905 of them had never been registered, accounting for more than half of the number of applications for cancellation of registration; “The registration rate reached 74%.
The statement said, “The Department of Health has noticed that the number of deregistrations on the Central Register website has been unusual recently.”
“The government calls on the public to continue to support the life-saving act of organ donation, and not to be provoked by a few people with ulterior motives to destroy the hard-won organ donation atmosphere that has been established over the years in Hong Kong.”
image source,NurPhoto via Getty Images
Hong Kong residents who intend to donate their organs after death, in addition to registering with the Hong Kong Central Register, can still obtain and sign an organ donation certificate by themselves and carry it with them.
The following day, Hong Kong Chief Executive Lee Ka-chao was asked about it during a routine meeting with reporters before presiding over the executive meeting.
“If a person is canceled without registering, it is very suspicious and disruptive to the entire system,” Lee said.
“I strongly condemn attempts to undermine such a noble organ donation program to save lives. Anyone who disrupts the system, we should be severely condemned, it is a shameful act. I have asked the police to investigate whether these cases Violations, whether there is any illegal behavior.”
Lin Zhiyu, chairman of Hong Kong Patient Policy Connection (HKPV) who has been engaged in patient rights advocacy work for nearly 20 years, is puzzled by Li Jiachao’s statement, because participating in the donation plan will not receive any compensation, and withdrawing will not receive any benefits. He believes that citizens want to know what actual behaviors law enforcement agencies are investigating that may be suspected of breaking the law.
Lin Zhihuang, who is a lawyer by profession, told the BBC Chinese reporter: “Because if you say in a nutshell, ‘a large number of people have withdrawn now, and some people have not registered at all’, if you want to investigate, then do you want to send the 5,000 Many people have to check it? Such a large number of investigations will also consume a lot of police manpower.”
Hong Kong Secretary of Justice Lam Ting-kwok was questioned by reporters on May 23 why the cancellation of registration was illegal. Lin Dingguo said: “We really hope to understand the reasons for the whole incident. Of course, we are only at the understanding stage. After understanding the situation, whether the relevant behavior is inappropriate or even serious enough to touch the law, It is too early to say, and there is not enough data to make a judgment.”
The government statement, dated May 22, did not mention common phrases such as “response to media inquiries,” and appeared to be the government’s own initiative. Why such a pretentious posting is unknown to the outside world.
However, the “cross-border organ transplantation mutual assistance mechanism” mentioned in the introduction probably came into the public view of Hong Kong because of an operation on December 17, 2022: a four-month-old baby girl who needed a heart transplant was missing. However, after asking Beijing for help from Hong Kong, the China Computer System for Human Organ Distribution and Sharing (COTRS) successfully donated a heart to her matching deceased child, and the operation was completed at the Hong Kong Children’s Hospital.
image source,China News Service
Hong Kong medical authorities seek to establish a constant mutual assistance mechanism with the China Human Organ Distribution and Computer Sharing System (COTRS).
After this disclosure, discussions on the establishment of a regular cross-border mechanism between Hong Kong and the mainland have progressed rapidly: in January 2023, some members of the Legislative Council urged the SAR government to speed up the introduction of a cross-border organ matching mechanism, and at the same time proposed to change voluntary organ donation to Donation is “default and tacit”, and Professor Lu Chongmao, director of the SAR Medical and Health Bureau, who is himself a liver transplant expert, went to Beijing in March to discuss and formulate a preliminary plan with the National Health Commission of China.
In April, Lu Chongmao led a delegation to Guangzhou, Guangdong to observe the operation of COTRS. On May 20, it was the turn of a delegation of transplant doctors from the Hong Kong Hospital Authority to visit Guangzhou.
Dr. Zhong Jianhua, a social policy scholar in Hong Kong who lives in the UK, believes that promoting the discussion of the “cross-border organ transplant mutual assistance mechanism” on the regularization of land ports has reminded some Hong Kong citizens of various negative rumors about the organ transplant mechanism in mainland China, such as “organ trading”. Given the strong stance of the SAR government, Hong Kong people may not even pay attention to the government’s organ donation propaganda.
Zhong Jianhua told the BBC Chinese reporter: “I have always supported organ donation by default, but you must first make people trust your system. To implement such a system in other places, you must first protect the medical rights of donors before death.”
“So at the end of last year, Lu Chongmao said that he wanted to implement this mechanism, so I said that I would also consider tearing up my organ donation card… I will no longer support the promotion of default acquiescence.”
Lin Zhiyu said: “The number of recent withdrawals is quite high, which is a warning sign. But if there are so many people quitting, plus the government’s remarks these days, will it make people feel that even if they quit, there is no great love. , and even face criminal investigations…it doesn’t do much good to promote the donation program.”
He believes that the SAR government needs to release more information for citizens to consider, whether it is the investigation on the withdrawal of the donation plan or the cross-border donation mechanism.
“Encouraging citizens to join the donation program itself is not an easy task … I am concerned that if the handling of this incident is not corrected, the withdrawal situation may be even worse in the future.”
image source,China News Service
Li Jiachao described it as a “disgrace” that the Central Register of Organ Donations had what the authorities considered anomalous deregistration applications.
Is the organ donation situation in Hong Kong bad?
On the afternoon of the day when Li Jiachao asked the police to investigate the issue of the donation register, the Hospital Authority of Hong Kong happened to give a lecture to media reporters. The reporters asked the speaker Professor Li Jintao’s views on the situation of organ donation in Hong Kong. Li Jintao is a consultant doctor of the Department of Internal Medicine and Therapeutics of the Prince of Wales Hospital and an honorary professor of the Department of Internal Medicine and Therapeutics of the Faculty of Medicine of the Chinese University of Hong Kong. He is good at nephrology.
“In the past few years, Hong Kong’s figures on cadaveric organ donation have been disappointing,” said Lee Kam Tao.
“I have been a doctor for 30 to 40 years. In the past few years, I have been a little worried that Hong Kong people’s love is declining. This includes organ donation and blood donation.”
The Hong Kong Central Organ Donation Register was launched in 2008. According to its webpage, as of April 30, 2023, there are currently 357,668 people in Hong Kong registered on the central register.
This does not include the number of people who requested and signed the “Organ Donation Certificate” by themselves. In April 2016, Gao Yongwen, the former director of the Food and Health Bureau of the Special Administrative Region (now the Medical and Health Bureau), answered questions from Legislative Council members: “Because citizens who sign organ donation certificates do not need to report to the Department of Health, we do not have new organ donation certificates.” The citizen data of the donation card.”
Figures from the Hong Kong Hospital Authority, also from the official website of the Central Register, show that as of the end of March 2023, 2,973 people in Hong Kong are waiting for organ transplants, of which 81.8% are waiting for kidney transplants.
Currently, deceased and living organ or human tissue donations that Hong Kong can handle include kidney, liver, heart, lung, cornea, bone and skin. Statistics from the Hospital Authority show that since 2012, the annual number of kidney and liver donations has been hovering in double digits, the number of heart and lung donations has been below 20, and only the number of corneal donations has been in triple digits.
Zhong Jianhua pointed out that the number of organ donation registrations in Hong Kong has been growing slowly for a long time. Lin Zhiyu believes that compared with mainland China, the situation in Hong Kong is not bad.
According to tracking statistics from the International Organ Donation and Transplantation Registry (IRODaT) headquartered in Barcelona, Spain, the number of posthumous organ donations per million people in Hong Kong will drop from 7.5 in 2009 to 4.66 in 2022. As of the end of 2022, Hong Kong’s population will be 7.33 million.
Also in 2022, in Mainland China with a population of 1.4 billion, the number of organ donations per 1 million people after death is 3.63; the donation rate ranks first in the world in Spain, reaching 46.03; the United States ranks second, with a donation rate of 44.5; the UK donation rate It is 21.08, ranking 10th in the world.
Wang Songlian, a senior researcher at the China Department of Human Rights Watch, commented on the latest developments in Hong Kong on Twitter, pointing out that the cause of organ donation has long encountered great resistance in East Asia. Lin Zhihuang agrees that traditional funeral concepts such as “there is a whole body after death” still influence the work of organ donation in Hong Kong.
Lin Zhihuang explained to the BBC in Chinese that there are donors who have registered before their death and those who have not. They may not have the willingness to confess to their relatives, and whether they have confessed or not, the family members may object. “So in fact, the family members are the last gatekeepers “.
He also believes that young people are generally not opposed to organ donation, so it is important to educate them. But at the same time, considering many factors such as the blood type in organ matching, whether the donor has certain diseases, and the suspicious death of the donor who needs to undergo a forensic examination (autopsy), there is still a certain element of luck in the success of the donation .
Zhong Jianhua believes that considering the current political and social atmosphere in Hong Kong, coupled with the discussion on the establishment of a regular interoperability mechanism between mainland and Hong Kong, it is difficult to make new breakthroughs in organ donation in Hong Kong.
Hong Kong government officials and experts have emphasized that even if the permanent mechanism is opened, it will not lead to organ donations from Hong Kong people being given priority to be sent to the mainland for transplantation, or even abused. The SAR government’s statement on May 22 emphasized that the “China Computer System for Human Organ Allocation and Sharing” (COTRS) was “highly recognized by the World Health Organization and the World Organ Transplantation Society.”
Hong Kong Medical and Health Secretary Lu Chongmao said on May 12, “We will not divide into two teams. The entire organ transplantation and distribution system is open and transparent, and there is an existing mechanism. Therefore, we still use the Hong Kong team and donate locally. organs will be distributed locally.”
“If there are organs in the Mainland that belong to what we call the ‘second tier’, that is, they cannot be distributed in the Mainland, but enter Hong Kong, we will distribute them to patients in need according to Hong Kong’s mechanism and the Hong Kong team. This allows more patients to benefit according to existing mechanisms.”
The discussion of the so-called “two teams” may have originated from Lu Chongmao’s proposal in a media interview in March that after the establishment of the exchange mechanism, Hong Kong people will have a “second team” waiting for organs from the mainland, which will mean The organs of Hong Kong can also “go north”.
Chen Zhiren, a professor of the School of Clinical Medicine of the University of Hong Kong and director of the Liver Transplant Department of Queen Mary Hospital, who participated in the Hospital Authority’s exchange trip to Guangzhou in late May, said in an interview with Hong Kong Commercial Radio on the 24th that the staff of the organ transplant coordinating authority in mainland China must abide by certain regulations. Standardize, carefully input the data of organ donors into the system, and if any unusual data is found, the public security system will be contacted immediately to prevent organ trafficking.
Officials link deregistration of organ donation to sabotage, surely?
image source,South China Morning Post via Getty Images
Despite continuous publicity, the rate of organ donation in Hong Kong is still low.
Regarding the Chief Executive’s request for a thorough investigation, the Public Relations Department of the Hong Kong Police told BBC Chinese on the evening of May 23: “The Cyber Security and Technology Crime Investigation Bureau is aware of the incident.”
The statement said: “The police will continue to watch out for possible criminal activities on the Internet and take corresponding law enforcement actions. If any illegal activities are found, the police will definitely follow up seriously… The police remind the public that the Internet world is not a virtual world that cannot be followed. world.”
According to the “Ming Pao” report, the Hong Kong police will first collect evidence at this stage, and then formulate the direction of investigation.
However, after Li Jiachao’s remarks were published, the Hong Kong media checked how the central register website accepts registration and cancellation of registration, and found that they could only fill in the relevant forms and wait for the staff of the SAR Department of Health to call for verification. If you want to check whether you are registered, you can call the dedicated hotline, or fill out the personal information request form following the procedures of privacy laws and regulations. Some media reporters actually tested the hotline, and no one answered it for an hour.
Fong Bao-kiu, honorary president of the Hong Kong Information Technology Chamber of Commerce, described these as “old-fashioned methods”, but they seem inappropriate today when information security and hacker prevention are valued.
Fang Baoqiao told the BBC Chinese reporter: “It’s like making a will, maybe I regard organ donation as part of the will, but if the current system is like this, then I have to think after filling out the form: If I want to change something , will it be a little troublesome?”
He doesn’t think that the old system will affect citizens’ consideration of whether to pledge to donate organs after death. However, “if the system is better, I can take it out to read at any time, it will be more convenient.” He proposed to take advantage of the narrowing of the “digital divide” in society after the COVID-19 pandemic, and use smart ID cards and supporting mobile applications for identity authentication in the organ donation register, which not only saves manpower and material resources, but also reassures citizens.
It can be seen from the website that the “Smart Convenience” app developed by the SAR government can be used to verify identities when filling in or withdrawing from the roster, but it is not suitable for checking whether or what personal information has been registered.
image source,SOPA Images/LightRocket via Getty Images
The wave of immigration has been cited as one of the possible reasons why organ donors in Hong Kong apply for deregistration.
Lin Zhihuang agrees that a mechanism should be added to facilitate donors, such as allowing them to choose which organs to donate after death, and it may even be similar to the “Body Teacher” and “Silent Teacher” programs in which the medical schools of the University of Hong Kong and the Chinese University donate whole bodies for medical students to study anatomy. combined.
Lin Zhihuang also asked: “During the process of canceling the registration, did the government have any data, that is, what were the reasons for the cancellation?”
In fact, in April, the document submitted by the Medical and Health Bureau to the Finance Committee of the Legislative Council showed that the number of newly registered organ donations throughout the year will continue to decline between 2019 and 2022, and the number of canceled registrations will increase significantly between 2021 and 2022. Discussions at the time still revolved around whether it had anything to do with immigration.
Lin Zhiyu said: “If you didn’t have this process (inquiry about the reason) in the process of canceling the registration, and the government can’t grasp the reason, then we can’t guess. But I don’t rule out that immigration is one of the factors. Another possibility is that the government recently announced the China-Hong Kong swap plan, which is not in line with their willingness to donate, so we should cancel it first.”
Organ donation is also a national security issue in China?
image source,Getty Images
Lam Ting-kwok, Secretary for Justice of the Hong Kong Special Administrative Region, said: The original intention of organ donation is to develop and promote the spirit of great love for mankind; it is “too early to say” whether the cancellation of registration is illegal.
After Chief Executive Li Jiachao requested an investigation, “Sing Tao Daily” reported to the Internet media“Bus News”“If it involves publishing inflammatory articles or words on the Internet, or even inciting citizens to hate the central government and the SAR government, endangering national security, etc., the National Security Department of the police will intervene in the investigation.” As a result, it was handed over to the Cyber Security and Technology Crime Bureau to “understand the incident”.
However, some pro-establishment media directly pointed out that the “unusual” situation described by the chief executive was someone engaged in “soft confrontation and incitement”.Chinese state-owned enterprise Hong Kong Bauhinia Cultural Grouporange newsTang Jiahua, Senior Counsel, a member of the Executive Council of the Special Administrative Region, was quoted as saying that the relevant behavior may commit the crime of sedition under the Crimes Ordinance.
Since the promulgation and implementation of China’s “Hong Kong National Security Law” in June 2020 and the establishment of the National Security Department of the Hong Kong Police, the National Security Department has repeatedly cited different charges of incitement under the Crimes Ordinance to prosecute individuals and groups.
Chief Executive Lee Ka-chao, who was once a policeman, and Tang Bingqiang, Secretary of the Security Bureau, have recently made public speeches one after another, asking the public to pay attention to various acts that endanger China’s national security.
Li Jiachao said on May 16: “Although the current situation in Hong Kong is generally stable, we must not take the risk of national security lightly and be vigilant; and the “black violence” in 2019 and the Hong Kong version of the “color revolution” are ours. A wake-up call.”
“We need to pay attention to the risks in this area for a long time, so everyone should be careful of some potential forces, including some “soft confrontation” and so on.”
Chung Jianhua criticized officials concerned for making increasingly rash accusations of endangering national security, but he was no longer surprised. He believes that it cannot be ruled out that some people go through the cancellation of donation registration procedures in order to express their opinions, but it cannot be ruled out that the cancellation is actually done for any reason.
Lin Zhiyu believes that the current controversy is related to the lack of information disclosure, but it is also a good opportunity to start a meaningful discussion or public consultation.
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