Growing capacity of medical service for transplant

Back in 1958, Dr Edward Donnall Thomas, an American hematologist, successfully performed the first publicised case of bone marrow transplant in human history. He helped a leukaemia patient transplant bone marrow from his twin brother.

 

Opening up the hematology field for treating and saving lives, the father of bone marrow transplant won a Nobel Prize in 1990.

 

In Hong Kong, the Queen Mary Hospital is the only hospital doing and coordinating allogeneic haematopoietic stem cell transplantation (HSCT) for all ages, while the Prince of Wales Hospital’s paediatrics unit performs transplants for patients under 20 years old.

 

On the other hand, autologous transplants, which treat blood diseases such as lymphoma and myeloma, are done by both of these hospitals and other five hospitals under the Hospital Authority. They perform approximately 120 cases each year.

 

“About 30-40% unrelated transplants were performed with overseas donors, among them about 70% are from Chinese communities including China and Taiwan,” Dr Sim said of allogeneic transplant at the Queen Mary Hospital.

 

In the Queen Mary Hospital, the bone marrow transplant centre is expanded, increasing isolation rooms from ten to 18 since 2013. Each room has an independent bed, bathroom, television, telephone and other equipment for long-term in-patient services.

 

The haematology team is responsible for the HSCT unit patients. At any one time, one physician and three resident specialists look after 18 transplant patients.

 

Dr Sim said, “In addition to nurses and other health care workers, pharmacists, dietitians, clinical psychologists…It takes a team to do something like this.”

 

It is still in progress in increasing medical staff, wards, clinics and other facilities for blood cancer patients.

 

The Prince of Wales Hospital performs about 20 to 30 cases of paediatric bone marrow transplant each year. The patients are from one to 20 years old, and their average age is about eight. About half of them suffer from leukaemia and about 60% of the transplants are from unrelated donors.

 

The hospital has four dedicated inpatient beds, and two doctors and nine nurses in the team.

 

In 2018, paediatric oncology service will be centrally provided at the Hong Kong Children’s Hospital, and service re‐organisation is being worked out, according to Vivian To, Manager of Communications & Community relations in the Prince of Wales Hospital.

 

Dr Leung Ka-lau, legislator for medical constituency, said the support on haematology in Hong Kong is relatively sufficient and two universities in Hong Kong provide good education and resources.

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However, Kitty Leung Ka-yee, President of the Hong Kong Bone Marrow Transplant Patients’ Association (BMTPA), is concerned if the service is sufficient.

 

“If the government is to organise [promotion] activities, I will prefer them to enhance the medical facilities and service instead, especially for bone marrow recipients,” said Ms Leung, who was afflicted with leukaemia and received new bone marrow.

 

She suggested the increase of wards, including intensive care unit (ICU) and isolation rooms.

 

“We understand many sectors do not have enough resources, so government should provide more funds and the public have to accept the growth of medical expense,” said Ms Leung.

 

Promotion and education as important strategy

Leukaemia patients and donors see a weak atmosphere of bone marrow donation in Hong Kong, as the public lacks consciousness and have various misconceptions. They believe promotion and education as the means.

 

In Hong Kong, bone marrow promotion mainly collaborates with blood donation under the Hong Kong Red Cross Blood Transfusion Service. In fact, there are 167,794 blood donors in 2015, in which a third of them do not register bone marrow donation, and the number of first-time-register blood donor is in declining rate, which is 4.2% decrease compared to 2014.

 

HKBMDR organised a Bone Marrow Donor Award Ceremony every two year. Last year, 71 bone marrow donors received the recognition. “A bone marrow donor-recipient pair met each other for the first time and shared their experiences,” said Mr Man. “The warm hearts in our city to help the needy are touched together.”

 

“What we are working well is to provide excellent services and convenient ways to facilitate people to register as bone marrow donors,” Mr Man said one of the main jobs of the new donor centre at West Kowloon this year is to recruit bone marrow donors.

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Apart from promoting in mobile blood drives, HKBMDR are conducting continuous education campaigns to enhance public understandings. The tools include roving exhibitions, websites, leaflets, public talks and social platforms, said Mr Man.

 

“We are thinking and working at all times on other sustainable PR initiatives and campaigns to encourage citizens to register,” Mr Man said the number of volunteers to register at the Registry has been increasing with their continuous promotional programmes.

 

“It sounds like the promotion for bone marrow transplant are not as high profile as other solid organ donation campaigns,” Dr Sim said, “but the HKBMDR has been utilizing their limited resources to strategically target their efforts on regular blood donors, especially the young and healthy subpopulation.“

 

On the other hand, the Queen Mary Hospital does not take initiative to promote bone marrow donation.

 

Dr Sim said she have no concrete plans to promote unrelated stem cell donor recruitment. “I believe this probably falls within the jurisdiction of the HKBMDR.”

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But she believes any promotional and educational activities should be organised towards "targeted population” and the younger generation.

 

“Education, especially targeting younger generation in school, is the utmost important,” Dr Dim continued. “Via them, hopefully the correct perception can penetrate local families and rectify any misconception among their parents.”

 

To enhance public understanding and acceptability of bone marrow donation, Dr Sim suggested public education activities such as exhibitions and seminars, regular and consistent propaganda with the involvement of media on television, radio and the Internet.

 

“Hong Kong could learn from other countries in terms of their promotional strategies,” said Dr Sim, citing an example of setting up a donation Facebook Fan Page to encourage participation among the younger population.

 

She said their support is mainly on patients and their family, not donors, who get normal after a few days of rest without impact on health.

 

BMTPA is also working on bone marrow promotion. “We are organising several upcoming activities, including hiking and fun fair,” said Ms Leung.

 

BMTPA is one of the participating and support organisations of the Island Scout Trail Walk on 20 March, when they would distribute promotional materials and leaflets. They will also hold their first fun fair with booth games to gather bone marrow recipients and donors, and medical staff on 14 May.

 

Though BMTPA assists the Red Cross on bone marrow promotion, Ms Leung said, “We think promotion through blood donation is not enough. [Bone marrow donation] should be promoted more and separately.”

 

In fact, HKBMDR has its own Facebook page since 2005 with 1,282 likes and become active in promotion the recent years.

 

BMTPA, a non-profit patient support organisation established since 1993, aims to give support to patients before and after bone marrow transplant. They currently have two to three hundred members.

 

“We have organised numerous activities, visits, family conferences, gatherings, sharing sessions and talks,” said Ms Leung, President of the BMTPA.

But Mr Man believes it is not meaningful to separate the promotion as blood and bone marrow are related and can be promoted in a basket.

 

While HKBMDR has no worries on the promotion budget, BMTPA, financially supported by government funds and donation, encounters difficulties in manpower and resources.

 

Since all the BMTPA volunteers, about 30 to 40 of them, are recovered patients, Ms Leung said it would be great if young people can help.

 

“We hope to put the education on teenagers,” added Ms Leung. Therefore, they started to cooperate with the Scout Association.

 

They hope more people will volunteer, and to gain more government concern.

 

Legislator Dr Leung said market promotion is an important way to raise public awareness on bone marrow donation.

 

“The society is not focusing on this matter, so people do not give concern,” he thinks the media plays a significant role to bring public attention on certain matter.

 

He admitted that the government takes responsibility on medical service and promotion activities.

 

“We will continue to exercise every effort in facilitating members of the public to support our mission,” said Mr Man, but it still needs time to encourage the public.