New pictures in my webshots album. I wrote this policy briefer for the Philippine Legislators Committee on Population and Development a few months ago: Economic Sabotage – The extent and impact of smuggling in the Philippines
There is a raging debate in Singapore today: Should the government legalize the organ trade? Should Singapore endorse transplant tourism? The debate began last month when two young Indonesians were jailed for trying to sell their kidneys to a wealthy businessman in Singapore. The Human Organ Transplant Act of Singapore prohibits the supply of any organ or blood for monetary transaction.
Singapore is fifth highest in the world in terms of incidence of kidney failure. According to a news report, at least 3,500 people in Singapore have kidney failure; 600 are on transplant lists. But they have to wait up to nine years for an organ from a deceased donor. This explains why many Singaporeans are seeking kidney transplants in other countries.
The people are divided on the issue of buying and selling organs. Some are in favor of it in order to save lives. Others oppose it because it involves the exploitation of the poor. The Singapore Medical Association, to the surprise of some doctors, voted against the legalization of the organ trade. The group cited the short-term and long-term medical complications arising from kidney transplants.
As expected, Catholic groups are criticizing the organ trade. They ask: “A donated organ can save a life but at whose expense? Will the organ trade lead to an economic allocation of resources where only those who can pay will stand a better chance of survival in receiving an organ transplant? Will an organ be treated like a commodity?”
One Catholic blogger wrote that the organ trade reflects the widespread commercialization in society and insisted that the relationship between the organ donor and the recipient has no altruistic meaning, but is purely a commercial transaction.
But lawyers Jennifer Yeo and Madan Mohan support the organ trade on the grounds that it can help both the poor and the kidney patient. They wrote:
“Is it fair to criminalize such social relationships where no third party is harmed? When a social relationship is forged which gives a new lease of life to both the stakeholders, then law ought not to step in to criminalize and punish such relationships.
“Organ donation, even if it involves valuable consideration, may make life better for both parties who find no way out of problems of health or poverty. If the state – and the altruists – cannot help the poor in overcoming their problems, it ought not to raise more barriers for them.”
The government of Singapore seems to be in favor of a limited organ trade. The minister of health recently hinted that a certain procedure allowing trade in organs will be tested soon. Singapore is reviewing the practice in Spain and Norway, which allow the use of cadaveric kidneys from persons above 60 years old. Singapore does not accept kidney donations from the elderly.
Iran is often mentioned in the organ trade debate because it is the only country in the world which has legalized the selling of kidneys since 1997. (Iranians call it “organ sharing.”) By 2006, more than 16,000 Iranians had sold a kidney. Singapore officials are now studying the Iranian model.
A live-donor registry is also being proposed in Singapore, which would facilitate the matching of donors to patients. It would also be used to monitor the health and financial conditions of donors after organ transplants. Charity groups would be tapped as well to help in the post-transplant needs of donors and their families.
The proposed live-donor registry, aside from being the first of its kind in the world, would address the common problems encountered by organ donors after transplants. A study published on the World Health Organization Web site enumerates some of these problems: In Egypt, 78 percent of donors reported deterioration in their health status; 78 percent spent the money within five months of their donation; and 73 percent reported a weakened ability to perform labor-intensive jobs. In Iran, 60 percent reported negative effects on their physical activities; and 65 percent reported negative effects on their employment status. Singapore policymakers should be guided by the disturbing results of this study.
The organ trade debate in Singapore is interesting and essential because the issue is being discussed from the point of view of an organ-importing country. In other countries like India and the Philippines, the organ trade issue is often linked to the issue of poverty. Discussions are focused on how to stop rich patients, especially foreigners, from exploiting the poor in these countries.
Singapore can discuss the issue dispassionately. It can take the lead in setting the legal, medical and ethical framework for an organ trade that respects the rights of both the organ donors and recipients. It can set an example by delineating the role of the state in ensuring that a fair, safe and rational system of organ transactions is in place.
Singapore should also not forget that the bigger issue today is not the organ trade but holistic medical care given to the poor. Prevention of kidney failure and other chronic illnesses should be a higher priority. Singapore should re-examine its healthcare budget and investigate if proper medical attention is being given to its citizens, especially the poor. As much as possible, organ transplants should be discouraged. They should be the final option for those who are sick.