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SINGAPORE : The proposal to allow reimbursement for altruistic living organ donations was accepted by Parliament on Tuesday - but after a heated debate.
Singapore has tough penalties against organ trading, and it is one of the first countries to successfully prosecute an organ trader. There is slim chance for abuse, but it has to weigh this against saving lives, and fairness to organ donors.
The crux of the matter is that it is currently illegal for someone to receive reimbursement after donating one's organs. The Health Ministry believes this is unfair for the donor who is subjected to health risks.
Countries like the UK and US already have reimbursement schemes in place. With reimbursement for organ donations, how does one determine if the act is altruistic? That duty will fall on the hospital transplant ethics committee.
And for the first time, the Health Ministry spelt out how it will be done. First, all transplant centres must follow guidelines on how to select only healthy donors.
Every donor has to be fully informed about the potential risks, the need for long-term medical follow-up, as well as the cost implications, before consent is obtained.
Every transplant is also subjected to a review by an ethics committee, to ensure the donor is free from any financial inducement or coercion.
The hospitals will be required to submit the relevant data after every transplant, and the Health Ministry will conduct regular audits to ensure the ethics committees fulfil legal requirements in evaluating transplant applications.
Loo Choon Yong, Nominated MP, and chairman of Raffles Medical Group, said: "Exploitation of the poor and vulnerable can be minimised if a proper regime is instituted. The medical profession should not feel the existence of an ethical conflict, as this is a conscious variation from medical ethical rules that the Singapore society makes for the greater benefit of society."
But some feel this may be difficult, as long as the amount is not clarified. Christopher De Souza, MP, Holland-Bukit Timah GRC, said: "Details pertaining to the administration and payment of costs and expenses are central to this entire Bill. Yet, the Bill is devoid of these details."
Sylvia Lim, Non-Constituency MP, said: "We do not believe it is wise for Parliament to approve the current provision and leave the compensation framework details to be worked out later, administratively."
Health Minister Khaw Boon Wan said it is difficult to put the sum in quantitative formula in this primary legislation.
Other countries have also not done so. But the ministry and the ethics committees will come up with guidelines on the sum, in future.
However, the Health Ministry did clarify that a foreigner from a poorer country is subject to a different and much lower reimbursement cap, because the sum is calculated based on the cost of living. To ensure foreigners are not exploited, the transplant ethics committees are well briefed to be mindful of the potential for exploitation.
Since reimbursement will be borne by the patient, it also means those who can afford it, will have a higher place in the queue. Is this fair?
Sam Tan, MP, Tanjong Pagar GRC, said: "To insist that in all matters of health, there is complete equality between the rich and the poor, is specious. There are cancer drugs that cost S$200 a pill. Once you cannot afford this drug, the cancer progresses and you are done for."
Mr Khaw said: "Let us not grudge somebody who is able to secure an altruistic donor because once he is out of the waiting queue, he benefits everybody else."
There are now over 1,000 people waiting for an organ - since the upper age limit of 60 years for patients to be placed on the waiting list was also lifted.
When it came to voting on the amendment Bill, the Whip was lifted to allow MPs to vote according to their conscience. The last time this was done was also for amendments to Human Organ Transplant Act (HOTA), to include Muslims in the law on organ donation in January last year.
In Tuesday's voting, four MPs chose to abstain, while Christopher De Souza voted against the amendment.
Those who abstained were Opposition MP Low Thia Khiang, Non-Constituency MP Sylvia Lim, MP for Jalan Besar GRC Denise Phua, and the Chairperson for the Group Parliamentary Committee for Health, Halimah Yacob.
But it certainly will not be the last time the Bill will be debated.
In the months ahead, the Health Ministry will table a subsidiary legislation detailing guidelines the ethics committee must follow, and explain the compensation mechanism in detail. - CNA/ms
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