ST June 29, 2008Organ trading presents a host of sensitive issues. At this point in time, I haven't yet considered all the finer points.
Should sale of organs be allowed?
Doctors and MPs give their take on organ transactions
By Shuli Sudderuddin
Organ selling should be allowed in a properly controlled system, and in fact this is long overdue, Associate Professor Lee Wei Ling, director of the National Neuroscience Institute, said yesterday.
'People are dying of organ failure. And there are people who are healthy enough to donate their organs. It is ironical that the law at present punishes the very victims it is supposed to protect,' she said.
She made this call when asked for her views on the first-ever kidneys-for-sale case, which came up in court last Friday.
Dr Lee has been championing organ selling since last year when she wrote in to The Straits Times Forum page.
She said yesterday that in Singapore, it is possible to ensure the donor is healthy enough to donate his organ without adverse medical consequences, and there is fair remuneration. Checks can be made to ensure the donor does not carry any diseases that can be transmitted to the patient through the transplanted organ.
'In other countries, the donors are at a disadvantage without knowing it, and can get exploited. Singapore is the one place that can ensure that the donor is taken care of.
'We should be proud of it. There are existing rules and regulations that are outdated and irrelevant to the current situation in Singapore. We should set out to change them and do what is right.
'Every one of us has a duty as human beings to help others. People who may potentially be saved are dying, yet we still bury our heads in the sand and allow the suffering to go on? Of course, we should not break the law. But we should change the laws when they have become irrelevant. We should ensure that the person who is selling his organs is protected, and eliminate the middleman.'
She noted the existing market for organs mediated by a middleman.
'We should set up a proper, competent system to ensure the safety of the donor and that the donor receives a fair sum of the money in exchange for his organ.'
Echoing her sentiments was Dr Lee Keen Whye, a consultant obstetrician and gynaecologist at Gleneagles Medical Centre.
'As long as there is a willing buyer and seller, why not? If the seller does not feel exploited, who are we to judge? It's more important to save lives first,' he said.
Other doctors and MPs interviewed, however, disagreed. Dr Pwee Hock Swee, renal medicine specialist at Mount Elizabeth Hospital, felt that organ transactions should be purely altruistic.
Dr Lily Neo, an MP for Jalan Besar GRC, said that kidney transplants are 'a big life- and-death operation and people should not be induced to part with a part of themselves for a financial reward'.
Dr Fatimah Lateef, an MP for Marine Parade GRC, feels that it is more important to raise the number of donors available. A price tag should not be put on human organs.
Ms Halimah Yacob, head of the Government Parliamentary Committee (GPC) for Health, was also not in favour of organ trading 'because the poor and the weak will be the ones who have to give up their organs and this will lead to them being intimidated and harassed'.
But from a broader perspective, I can roughly see how a system of new legal rules can be built to deal with the main ethical concerns. Thus I am inclined to agree with Dr Lee Wei Ling (who happens to be Lee Kuan Yew's daughter) that it is possible, and desirable, to legalise organ trading.
The key ethical objection is that human organ trading may lead to the exploitation of the poor and of socially disadvantaged donors who are unable to make an informed choice.
For instance, a poor, lowly-educated person may be persuaded to sell his organ to a rich patient who needs such an organ. The poor, lowly-educated person doesn't understand the health risks that he is exposing himself to. In exchange for the kidney, the rich patient pays a sum which is peanuts to him, but which seems like a lot to the poor person.
This is the paradigmatic situation that the legal rules would have to deal with, for human organ trading to be legalised in Singapore. How? These are the features of a possible legal framework that I can envisage:
1. Organ sellers should be Singaporean citizens or permanent residents. This eliminates the potential problem of ill Singaporeans regularly sourcing for organs from desperately poor people in neighbouring countries such as Indonesia and Thailand. In the long run, this avoids major diplomatic disputes from arising between Singapore and its neighbours.Two key considerations should be kept in mind. Firstly, more organ transplants ultimately means that more human lives will be saved - this is the noble intention of the system.
2. The government needs to act as a middleman. Seller and buyer should not be allowed to know each other's identities beforehand, if at all. If Y wants to sell a kidney, Y will inform the relevant government authority. If accepted for sale, Y's kidney will be transplanted to a patient selected by the hospital according to its own priority list. This avoids the ethically difficult situation where the patient directly locates his own poor, desperate person, and exercises his own undue influence to persuade or coerce the poor person to sell his kidney.
3. In addition to medical check-ups, the potential organ seller should be given the relevant counselling and medical advice. This is to ensure that he fully understands the medical risks he will be undergoing.
4. If there is any medical reason to believe that the potential organ seller's health will be unduly affected, his sale proposal should be rejected. A panel of independent doctors will have to assess each case.
5. Organ prices should be fixed by law. The price should not be subject to any kind of bidding system, nor any system whereby richer patients can gain priority by offering to pay a higher price. The Health Ministry can regularly review and revise the applicable organ prices, if necessary.
Secondly, we are talking about the types of organ transplants where the seller will have every reasonable expectation of being able to live normally after the organ is removed. (For example, a healthy person is typically able to donate one of his two kidneys and continue to live a normal life).