In this issue of Hong Kong Medical Journal, Teoh et al1 examine passive-positive organ donors in Hong Kong and potential means of engaging them. As the authors note, there is a significant mismatch between organ donors and patients awaiting transplant. In Hong Kong, more than 2000 dialysis patients are awaiting a kidney transplant, but there are fewer than 100 kidney transplants performed each year. Rather than investigating the reasons for refusing consent to donate deceased organs, the authors adopted another approach and instead surveyed passive-positive donors. These passive-positive donors refer to members of the public who support organ donation but have not registered as potential donors. The authors explored the reasons that these individuals gave for not registering. A key finding from the survey is that almost two thirds of people who are willing to donate their organs after death have not registered on the Centralised Organ Donation Register.1 The percentage of local passive-positive donors is even higher than that in the United States.

Why is the act of registration an important step to look into? A crucial aspect of facilitating behaviour change is making use of the commitment and consistency principle. If you want to lose weight, for instance, you should sign a contract with yourself (if not a contract with the fitness centre). Once you commit to a goal or an idea, you are much more inclined to follow through and achieve the goal and honour your commitment. As simple a step as it might seem, signing up as a donor turns out to be an important one.

Is the step of signing up as a donor going to make a huge difference? The answer is obviously ‘yes’, but it is not the only step. After you commit to a contract verbally or in writing, you should go one step further. Make the contract public, for all others to know, or else we you might simply back out of the deal. Unsurprisingly, human beings strive for consistency in our commitments, but more so when we are being watched. The most effective stamp to seal a contract is to share the contract on your social media platforms, and let others know, not only your next of kin. This is one of the best ways to enlist your friends and followers to hold you accountable. At the same time, this is a tool for someone who has signed up as an organ donor to encourage his or her followers to do the same.

How can social media help? The power of social media is immense. Social media platforms such as Facebook and Twitter have developed tools and public advocacy campaigns that can be used to engage and facilitate organ donation.2 For example, on the first day of launching the Facebook organ donor initiative (when members are allowed to specify ‘Organ Donor’ as part of their profile), there was a 21.1-fold increase in online organ donor registration rate in the United States.3

Is social media the only solution? Peer influence from social media on the donor registration rate is not the ultimate goal. Boosting the number of registered or prospective donors is insufficient, although the figures are easily measurable. Equally important is the value of being an organ donor. While the act of registration is the first step, that does not necessarily materialise as a donation if we cannot create a state of mind that donating organs can save lives. Organ donation will not happen if we cannot engage the prospective donor’s family members who might veto the donation plan. Additional interventions are needed to improve the public trust and foster belief in the meaningful act of donating organs.

What is the take-away message? We should heed the lesson from the study by Teoh et al1 regarding how to become a registered donor. However, continued efforts should be made to promote why people should to donate to save a life. We need a social movement to encourage the people of Hong Kong to talk about organ donation and end of life care matters, to share their view with their family, both informally via casual conversation, or better still, formally via registration. The expressed wish of a potential donor is very important in helping a family to agree to organ donation in a distressing time of a loved one who will sadly be passing away soon. It is difficult for the family to comprehend or to accept the situation. May they be comforted with knowing not all is lost. It is not only the end of one life, but the beginning of a new life for many recipients waiting for organ transplantation.

All authors contributed to the concept or design of the study, and critical revision of the manuscript for important intellectual content. KM Chow drafted the manuscript. All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.

All authors have disclosed no conflicts of interest.

This editorial received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

1. Teoh JY, Lau BS, Far NY, et al. Attitudes, acceptance, and registration in relation to organ donation in Hong Kong: a cross-sectional study. Hong Kong Med J 2020;26:192-200. Crossref

2. McCarthy M. Facebook and Twitter join US effort to attract a million new organ donor registrations. BMJ 2016;353:i3369. Crossref

3. Cameron AM, Massie AB, Alexander CE, et al. Social media and organ donor registration: the Facebook effect. Am J Transplant 2013;13:2059-65. Crossref