TOC: Human Organ Transplant Act - optimism despite concerns

[Porfirio Rubirosa]

Human Organ Transplant Act - optimism despite concerns
Tuesday, 31 March 2009, 6:03 pm | 326 views
Anthony Yeo / Consultant Therapist, Counselling and Care Centre.

The amendment to the Human Organ Transplant Act (HOTA) allowing for reimbursement of living kidney donors was passed in Parliament with heated debate recently.

It generated such heat that MPs from the ruling party were given authorisation to vote in accordance to their religious or moral convictions.

The obvious objection seems to centre on the possible abuse from those donors who may do so for profit as well as how ethics committees can discharge duties responsibly.

Whatever the objections or concerns may be, it does seem that the primary focus is on the donor rather than the recipient. In this sense, would it not be expedient to discuss this issue from a systemic perspective, taking into consideration the needs of recipients, consequences for donors as well as the larger health system.

It is certainly beyond the health system to meet demands for kidney transplants. The fact that there is such a long waiting list for kidneys, must definitely spur us to think of the burden of our health system to ensure that kidney patients do not need to experience undue suffering.


There is also the need to consider ways to ease the burden of having to deny those in grave danger not only from further incapacitation or death. If laws are too stringent and kidney donation becomes restrictive, one wonders if our health system would have the reputation in being an illness system.

If our health system is to provide healing and enhancement of health, then the onus is on the administrators of the system to explore every avenue to ensure that this is made available to all in need.

It is always tragic to learn of those who have to endure extended suffering from kidney failure, far worse to witness those who die prematurely due to lack of access to kidney donors.

We only need to recall the very heart-rending experience some years ago of the family of the Indian woman who experienced severe pain and suffering till her death because her life could not be saved due to restrictions prevailing at that time.

Her family was traumatised and the health of her mother and sister were so badly affected that within a year or two, they too met their death. The surviving sister needed help with her trauma that took a while to heal.

Such an experience should not be repeated if we could consider the needs of kidney patients. If we value life, then surely saving lives must take precedence over laws and procedures. And if easing the restrictions and making donation more readily available can be a way to promote living, then laws would need to be amended to make this possible.

If we were to have this expanded perspective, then it is a little easier to uphold the need to consider how best to make donation more accessible. This is where the amendment to provide for reimbursement can make sense.

There must be a place for care of the donor as well. For one, we are aware of the risks involved. Donors have encountered complications to their physical well-being including deaths, although the latter has been infrequent.

As the Health Minister asserted in Parliament, suffering from financial consequences is a major risk involved. Furthermore, during the recovery from the procedure, disruption to work and life, as well as the need to live with the loss of an internal organ are other risks that have often been overlooked.

To this extent, the amendment to allow for reimbursement can pave the way for reluctant donors to offer their kidneys.

Of course there will be possible risk of abuse of the system but that should not deter us from a very humanitarian approach to this matter. Likewise, those who are concerned about the administration of reimbursement and procedures to be put in place to prevent abuse can be assured that these are operational matters that can be dealt with responsibly.

This confidence comes from the way our government has been functioning, ever cautious and prudent. Sometimes they tended to be unduly vigilant to the point of stifling possibilities for change. If they continue to function as they probably would, then we can be hopeful that measures would be put in place to prevent abuse.

There are already ethics committees in place for approving organ transplants and we can rest assure that fine-tuning will be executed accordingly.

Hence, there should be optimism despite concerns expressed; support for greater flexibility in the midst of existing laws and public support for making kidney donation more readily available.

Hopefully our health system will be life-enhancing, life-preserving and life-extending with this amendment passed in Parliament.

 

[Porfirio Rubirosa]

3) WEC on March 31st, 2009 9.10 pm 1. The law does not have the oversight to root out possible sale of Kidney from someone who is desperate of money; opens up the door to abuse

2. The law does cannot stop a genuine donor from selling his kidney as oppose to giving it to someone who cannot pay for it; opens up the door for the unprivileged to be marginalized.

This is a bad law. All the MPs including our health minister were against it until a Lee Wei Ling came along and supported this decision.. you go figure.

4) eternalhap on March 31st, 2009 9.44 pm I don’t get the thrust of this article. Is the writer in agreement with the recent HOTA amendments, or is he implying more should be done?

Personally I believe the amendments to HOTA are insuffiicent if we were to increase supply of kidneys or other organs to match the demand. A legalised and regulated organ trading market will likely provide a sharp rise in kidneys to match the demand.

5) SZ on March 31st, 2009 10.28 pm “That our poor in the midst is not left out such that only the rich and wealthy are given the opportunity of a kidney transplant.”

just like only the rich will survive and the poor are left to die?

6) CA on April 1st, 2009 2.10 am I don’t get the thrust of this article either.

The wealthy get better healthcare. They receive better educations. They get better jobs. They have it better, not just in the case of kidney transplants, but in EVERYTHING. This is a fact of life and there is nothing anybody can do about it. The sooner we accept this and move on, the better.

The poor will always be desperate to make ends meet. They will sell their labor out of desperation, they will sell their bodies, and they will sell their organs. Again, this is the tragedy of the human condition, and the sooner we realize that it’s not going to go away, the better. These conditions will not arise because of this Act; they exist and will continue to exist despite it.

Restricting the supply of kidneys because of concerns that the rich will benefit from and that the poor will be marginalized by this program is, though well-intentioned, ultimately short-sighted. At the end of the day, we are still restricting the supply of kidneys… which means we are denying suffering patients a chance for treatment.

7) lobo76 on April 1st, 2009 9.11 am WEC,

Lee Wei Ling supported the decision to have compensation for donors. I myself supported this ‘decision’. However, the flawed model of compensation comes solely from the ministry.
8) MC Harding on April 1st, 2009 1.36 pm This is Organs for Sale? it’s outrageous. In other words, rich people can have organ transplants, and the poor may well have to supply organs, for cash?

it’s all about THE MONEY.

Go see the Movie- Solyent Green.

Singapore govt is entering into unchartered waters. Truly Wacko!

10) Dumb and dumber on April 1st, 2009 2.01 pm Anyone will be desperate to save their own life, and their kins. They will buy any hope out of desperation, ethical or not, to save their own lifes and the ones they love.

Human Organ Transplant is not about buying or selling; in reality, it’s somebody’s loss vs somebody’s gain; and hence, it should never associate with demand or supply. It’s about pro-longing life or some said, to delay death at the expense of another. The very act of compensation to justify the new act will have far reaching impact and consequences.

“The poor will always be desperate to make ends meet. They will sell their labor out of desperation, they will sell their bodies, and they will sell their organs.”

The very act of exploiting the poor or desperate is unethical in nature. Why does the medical profession needs to swear an oath to serve and be ethical? My thinking is that the answer is in the act to minimise abuse and exploitation by the enforcer.

I am wondering whether the medical technology has advance to the stage that by giving up one kidney, are we absolutely sure that there is no side-effect at all? Can someone with medical background able to confirm this? If there are any side-effects, does that equate to trading health to obtain some monetary gain.

Lastly, if anyone have a love one desperately in need of a kidney, I bet they will support the law to enable this. On the other side of the coin, If you are a parent, would you allow your children to donate his kidney for monetary gain?

11) CA on April 1st, 2009 2.53 pm Exploitation implies some form of manipulation or coercion. Having an OPTION to sell your organ for monetary gain is no different than having the OPTION to sell your body to strangers for money or the OPTION to donate your blood for money or the OPTION to accept a low-paying job to make ends meet.

On the flip side, if we enforce a ban on these (or any similar) options, are we not denying possible means by which the poor can make ends meet? How is this a ethically justified stance? Who are we to restrict or limit opportunities based on our “ethical” or “moral” persuasions?

Look, I’m not saying that this is fair or right. Poverty has always been with us and will continue to be with us. It is part of the human condition. However, CONFLATING this issue with the issue of organ donation/sale is a mistake that will ultimately lead to MORE SUFFERING for those on the kidney waitlists.

All I am suggesting is that when “moral” or “ethical” objections– in quotations because everyone has differing opinions– directly results in pain, suffering, and death of those on the waitlist, we had better take a close look at our reasoning.

Besides, all this can be sidestepped. Just offer monetary compensation for cadaver organs. Structure the program such that if someone opts to have their organs harvested upon death, their loved ones/survivors will receive the monetary benefit/gain. “Ethical” coercion issues sidestepped, more available organs, more chances at successful transplants, less kidney related deaths, case closed.

 

[mscitw]

Another cheap spin by Mouthpiece to soften e ground for organ sales, where the rich will no doubtly reap the most benefits with the regime's hospitals making some nice profits. Win win.

Do peasants know why Merchant Tang got off with a light sentence.

Deemed to important to die, Merchant Tang employs many peasants and foreign talents who will crowd the 'Meet the Peasants Sessions' with their collective sob stories. The regime had to keep him alive but to show Peasantpore's law is bagus, it decided to punish the middleman and incidental donor.

In peasantpore, a sham republic riddled with dynastic successions, when you are rich and influential, you can get away with crimes and all kinds of heartless deals.