For more than 40 weeks, 11-year-old Kai-Him Tang had to rely on mechanical life support to keep his heart beating following a diagnosis of heart failure in December 2014. He was subsequently put on the heart transplant list in May 2016. However, due to Hong Kong’s low rates of organ donations, he was only eligible for surgery on 12 June this year.

A record-long wait for a suitable donor and subsequently a heart transplant surgery

The surgery was not an easy one citing Tang’s age and the duration at which he had relied on the mechanical pump. “As there were lots of scars and dense adhesions around the heart, the operation was more difficult than usual,” remarked Dr Timmy Wing-Kuk Au, chief of cardiothoracic surgery at Queen Mary Hospital.

Even so, Tang successfully underwent the lifesaving surgery after having relied on an external mechanical pump for 282 days. Prior to Tang, the longest anyone had ever been put on an external mechanical pump in Asia-Pacific was 250 days. While this may be a new record, it also speaks volumes about the low rates of live organ donation rates in Hong Kong.

Hong Kong has just 5.8 organ donors for every one million citizens in 2015, which means situations such as Tang’s will only be more common if the landscape persists.

Nevertheless, Tang’s mother remains to be extremely grateful for the success of her son’s surgery stating, “I’m really thankful for the support from everyone... and glad to see my son has regained [his health]. Not to mention, fearing for her son’s condition prior to his transplant surgery as she recalled, “Every time he was pushed into the operating theatre, I worried about whether he could defeat death.” Post-surgery, Tang is currently recovering in at the hospital and is expected to be discharged in a few weeks.

While it may be natural to assume that children should never be forced to face such rigors so early in life – the case is not always true. This is best demonstrated by the story of Joe Skerrat, a three-year-old boy from the United Kingdom who had to wait 251 days for a heart transplant. Just like Tang, Joe had to rely on a mechanical pump to serve in place of his failing heart prior to surgery. With a device designed only to be put in place for several weeks, Joe ended up going for several months before a suitable donor was found and a successful transplant was completed. Similar to the situation in Hong Kong, the United Kingdom is also suffering from a chronic shortage of organ donors with several children still awaiting a transplant.

Hong Kong’s heart transplant surgeries have come a long way over the past 30 years

The first heart transplant ever performed in Asia was by Dr Juro Wada from Tokyo, Japan in 1968. Due to cultural and religious issues, heart transplantation was hardly carried out in the Asian continent, until the year 1987 where it began to pick up rapidly.

By 1992, Hong Kong has carried out its first successful heart transplant surgery at the Grantham hospital. Over the course of the next two decades, the number of heart transplant surgeries in Asia continued to steadily increase alongside the survival rate associated with the surgery. By the early 2000s, the result and survival rates of heart transplant in Asia had reached standards comparable to the rest of the world.

In the first 15 years since it was introduced in Hong Kong, the total number of patient who have undergone heart transplant surgeries totaled to 77 with another two having undergone heart and lung transplantation. For all of these patients, the surgery was life changing with a majority (80%) of the patients surviving more than five year post-surgery. Moreover, all heart transplant patients were able to return to their everyday lives and jobs, including strenuous activities such as working as a policeman of fireman.

Unlike the West, the major cause for heart transplant are problems involving the muscular wall or valves of heart. Meanwhile, the most common complications as a result of the surgery are rejection and infection. Fortunately, there are well-established medications to treat both forms of complications. As a whole, the Hong Kong healthcare sector is very well armed to tackle heart transplantation surgeries with the only underlying issue being the number of organ donors.

It has been nearly six decades since the first heart transplant surgery was carried out in Asia. Since then, the techniques and equipment have improved tremendously. Today, Hong Kong stands at the cusp of organ transplant surgeries with success rates equaling the rest of world with similarly impressive survival rates.

Yet, the low rate of organ donors remains as the challenge especially in regards to child organ donors. This issue is one that the Hong Kong population, as a whole, will need to work together to resolve lest another case like Kai-Him Tang were to repeat itself. MIMS

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