Symposium 8 - Cultural Transformation for Organ Donation

The HOPE Team pilot project at the New Territories West Cluster (NTWC) represents a transformative initiative aimed at enhancing organ donation rates through collaborative clinical practice. This presentation will outline the establishment and operational framework of the HOPE Team, which consists of physicians from Anaesthesia and Intensive Care Units (ICU) working closely with nurse organ donation coordinators. Together, they engage daily in donor detection, follow-up on identified potential donors, and facilitate comprehensive donor evaluation processes.


Preliminary outcomes indicate a notable increase in the number of consented donors, rising from 3 in 2023 to 8 in 2024. This increase, while encouraging, underscores the need for ongoing efforts to further elevate donor rates and enhance community awareness about organ donation. The team has collaborated with experts from the Donation and Transplantation Institute (DTI) to critically evaluate the project's processes and establish a comprehensive clinical governance framework. This framework is essential for guiding future initiatives, ensuring sustained clinical effectiveness, and fostering a culture of organ donation within the healthcare system. 


The presentation will also discuss the strategies implemented to improve communication and collaboration among healthcare professionals, as well as the educational initiatives aimed at increasing awareness among both staff and the public. Challenges encountered during the project's implementation will be addressed, alongside the lessons learned that can inform future practices.


By sharing insights and experiences from the HOPE Team's journey, we aim to inspire further advancements in organ donation practices across the region, ultimately contributing to a cultural transformation that prioritizes and normalizes organ donation in healthcare.

The management of end-of-life care in critical care units is a pivotal component in enhancing the quality of healthcare delivery, ensuring that patient dignity and comfort are prioritized during the final stages of life. Beyond providing compassionate care, end-of-life practices present a unique opportunity to facilitate organ donation, thereby saving lives and expanding the donor pool. This lecture will explore the integral role of end-of-life care in optimizing outcomes for critically ill patients and their families, emphasizing how structured protocols and ethical considerations can improve decision-making processes.
A key focus will be on Donation after Circulatory Determination of Death (DCD), a vital pathway that allows for organ retrieval following the irreversible cessation of circulatory and respiratory functions. DCD has gained prominence worldwide as a means to increase organ availability, especially in regions facing shortages. We will examine the current global landscape of DCD, highlighting variations in implementation, ethical debates, and the impact on transplantation success rates. Countries such as Spain, the United Kingdom, and Australia have pioneered DCD programs, demonstrating significant contributions to their respective organ donation systems.
Furthermore, the lecture will address the challenges and opportunities associated with integrating DCD into routine critical care practice, including the importance of clear protocols, multidisciplinary collaboration, and public awareness. By aligning end-of-life care with organ donation strategies, healthcare providers can improve the quality of death for patients and maximize the potential for life-saving transplants. Ultimately, fostering a culture of respectful, ethical, and well-coordinated end-of-life care can transform critical care units into centers of both compassionate support and organ donation excellence, benefiting society as a whole.

Kidney transplantation offers children with end-stage renal disease (ESRD) significantly longer survival and better quality of life compared to dialysis. In the past decade, pediatric kidney transplantation (pKTx) has developed rapidly in mainland China, driven by development of the new national organ donation and transplantation program, utilization of small pediatric deceased donor kidneys, and a pivotal national allocation policy prioritizing pediatric organs for pediatric recipients ("P to P" policy). These achievements are also inseparable from the dedicated OPO professionals and altruistic donor families. Pediatric donor kidneys are preferentially allocated to pediatric patients nationwide through the China Organ Transplant Response System (COTRS), resulting in accomplishment of 761 pKTx in 2024. This demonstrates transparency and equity in organ allocation. Pediatric donor kidneys with minimal chronic damage have longer expected functional lifespan. Pediatric-to-pediatric transplantation offers advantages in anatomical compatibility-including age, body weight, and kidney size-although it requires high-level technical skills in organ procurement, bench surgery, and vascular anastomosis. Standard extraperitoneal approaches of implantation simplifies surgery and avoids intraperitoneal approaches and perfusion-related complications commonly seen in pKTx from adult kidneys. Due to better size matching, pediatric donor kidneys allow small ESRD children with body weight of 5-10Kg to receive KTx when necessary. Surgical complications increase with younger donor and recipient age. The "P to P" policy ensures such technically demanding cases are allocated to experienced transplant centers, improving transplant outcomes and supporting the development of centralized pKTx programs. Our center performs 60–80 pKTx annually, with a median donor age of 30 months and body weight of 12.1 kg. About 20% of recipients are under 5 years old, with the youngest being 8 months and 5.4 kg. We will optimize utilization of small pediatric donor kidneys to further improve graft survival. Strengthening regional collaboration is strongly advocated to better support ESRD children in the Greater Bay Area.