Page 174 - Hospital Authority Convention 2017

Masterclasses Masterclasses
HOSPITAL AUTHORITY CONVENTION 2017

M11.1 Renal Medicine 10:45 Room 221

To P or Not to P: Ethics and the Kidney
Li PKT
Central Renal Committee, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Nephrologists are generally regarded as clinicians with a holistic approach to manage patients. We have specialised skills
by making use of high technology procedures, and adopt a general physician approach towards multi-system problems of
patients, while taking into account their psycho-social needs as well.

At the same time, the ethical challenges to nephrologists can never be understated. In the principles of biomedical ethics,
respect of autonomy, non-maleficence, beneficence and justice are four major areas. The dilemma for clinicians choosing
unrestricted advocacy of patients or bedside rationing of healthcare is always real. There has been proposal of “administrative
gatekeeping” as a means to strike a balance.

To P or not to P represents two elaborated concepts of P: Personalise and Prioritise.
To personalise or not to personalise involves the discussion of whether there is a totally free patient choice on dialysis
modality using public resources. The concept of peritoneal dialysis first policy in Hong Kong, and how this can benefit the
largest number of patients with the most cost effective and quality dialysis modality serves as a model and an example for
discussion.

To prioritise or not to prioritise involves the discussion of kidney allocation system in the donation and transplantation field.
The scarcity of cadaveric kidney donations and the need to allocate according to a fair and open system is a prerequisite.
The allocation of kidneys in different sectors with different backgrounds, medical and social and other factors can bring in
dilemmas that the medical community needs to provide input on the final system.

M11.2 Renal Medicine 10:45 Room 221

Paired Kidney Exchange in Renal Transplantation
Kwok J
Department of Pathology and Clinical Biochemistry, Queen Mary Hospital, Hong Kong

Kidney transplantation is the best therapy for end-stage renal failure. Similar to the global counterparts, Hong Kong is facing
Wednesday, 17 May There are less than 100 kidney transplants each year for the past five years in Hong Kong and the average waiting time for a
the challenge of severe shortage in kidney donation. Despite tremendous efforts to promote organ donation, the number of
donated transplantable kidneys remain disappointingly low. As a result, a progressive increase in the number of patients on
the waiting list.

deceased kidney graft is more than six years. The statistics show a significant gap between the number of kidneys donated
and the number of patients on the wait list.
Amid the difficulty to secure sufficient number of deceased kidneys, one of the strategies running successfully worldwide is
to expand the living donor pool. With the sophisticated advancement in medical skills and technology, living donor donation
is a safe and mature procedure. However, the major obstacles of living kidney donation are ABO incompatibility and positive
cross-match between potential donor and recipient.

Will the Paired Kidney Exchange (PKE) Programme offer an additional transplant option for the donor-recipient pairs?
The PKE Programme aims to increase the chance of finding a compatible living donated kidney by exchange between
incompatible pairs.

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