Masterclass 13 - Donation Transplant Service - New Approach in Hospital Authority

Donation after circulatory death (DCD) offers an additional opportunity for organ donation. It allows the retrieval of organs from individuals who do not meet the criteria for donation after brain death. However, DCD raises ethical concerns due to challenges in the quality of end-of-life care, the determination of death, and potential conflicts of interest between organ procurement and the care of terminally ill patients. Standard DCD guidelines and protocols should be established to gain public and social acceptance and trust in organ donation, as well as to ensure the viability and quality of donor organs.

Donor organ shortages is a recurrent theme in transplantation. Conventionally, marginal donor organs would be discarded. The use of marginal or extended criteria organs is one way to increase the donor pool.


Machine perfusion enable the safer use of selected extended criteria organs after assessment.


Organ Care System (OCS) is one type of organ machine perfusion. The OCS has perfusion systems for heart, lung, and liver.


For the heart, the OCS enable the use of extended criteria organs in mainly 3 possible ways:


1) Perfusing warm oxygenated blood to the donor organ, decreasing ischemic injury;
2) Providing functional assessment of the donor organ, allowing further information for decision;
3) Optimization the donor organ, by having the ability of therapeutic intervention such as infusing medications


Our heart transplant team were the first in Asia to use the OCS machine perfusion to successfully transplant an extended criteria donor heart in April 2020. Since it's introduction, we have been able to successfully transplant 3 marginal donor hearts which would otherwise have been discarded.

The development of specific desensitization regimens has significantly improved the outcome of ABO incompatible (ABOi) living donor kidney transplantation in many well-established centres across the world. In July 2023, we accomplished a milestone in the field of pediatric kidney transplant by successfully performing the first blood group incompatible transplant in an adolescent boy with hereditary cystic kidney diseases who has been on dialysis for 4 years. The donor was the mother (Blood group AB) , and the recipient was her son (Blood group A ) . 


To overcome this immunological barrier, we employed the new technology of immunoadsorption instead of conventional plasma exchange, for the first time in Hong Kong. Immunoadsorption allowed more selective removal of anti-B antibodies from the recipient's blood prior to transplant, and thereby enabled the transplant to proceed with minimized risk of rejection secondary to the blood group incompatibility. The patient enjoys excellent graft function and has been clinically well.


The success of this pioneering initiative was a real- life illustration of how collaborations within and beyond Hospital Authority, and from local to international levels, help translating into clinical services to support patients in need. The feasibility of blood group incompatible transplant serves as a critical stepping stone towards increasing the availability of compatible donor organs. We are hopeful that this groundbreaking approach will pave the way for further advancements in kidney transplant, fostering a brighter future for pediatric patients in Hong Kong and beyond.