By Christopher Cheng & Ng Lay Guat
EVER-LENGTHENING waiting lists for kidneys is an old problem not unique to Singapore. Almost every country in the world has a waiting list that is growing longer faster than the number of transplants done per year. The solution to this problem is of course to increase the number of transplants performed. Singapore is on the right track in encouraging live donor transplants, and the opt-out system of the Human Organ Transplant Act will increase the number of deceased donor transplants. Other measures such as raising the donor age limit and paired donor transplants can help shorten the waiting list to an extent.
Compensating donors is another means the authorities have suggested to shorten the waiting list. We feel that this would be an overly zealous measure.
We do not object to reimbursing altruistic donors so they do not suffer from having only one kidney. As transplant surgeons, we have come across many families with several potential donors. The ones who finally come forward tend to fit a certain profile. We have seen many instances of sister-to-brother, wife-to- husband and sister-to-sister donations. This is not because women are more generous than men, but rather because they tend not to be the sole breadwinners in their families.
For example, we recall a young patient with end-stage renal failure who had nine siblings. We couldn't help but remark that she was, in a way, luckier than many patients with smaller families. However, the only sibling who came forward to donate was an older sister. When we examined the matter, we realised that the donor was single, whereas all the other siblings were married and were breadwinners.
The worry that their own families may suffer if they chalk up large medical bills years after donating a kidney is valid. But giving such donors a lump sum may not be the answer to their worries. Not all are shrewd fund managers. Assurance of help in the event of future medical problems relating to the donation would probably be more helpful.
Another potential problem with compensating donors is that it may turn away truly altruistic donors. Already, we are seeing potential donors delaying their decision because of pending legislation on this matter. The feeling is: 'If the patient can get a kidney by paying for it, why should I run the risks of donating my kidney?' People may also refrain from offering to donate a kidney for fear of being called greedy.
The most unacceptable effect of compensating donors is that such compensation may slip into organ trading. Some have argued that the poor have the right to decide what they can do with their bodies, and if they choose to 'commodify' their bodies so that they and their families can benefit financially, so be it!
Only people driven to desperation will consider parting with parts of their bodies. They are either in desperate need of money or in great debt. The money they might save from the organ sale may be very meagre indeed.
The Government should consider giving donors medical coverage so their fears of possible medical problems later in life might be allayed. The cost of such coverage is potentially high, but we suspect it would be affordable. This is because the criteria for selecting donors are stringent, and the people who qualify to be kidney donors tend to be fit. The possibility of their developing end-stage renal failure is very low.
A rich person with end-stage renal failure should not have the automatic right to buy spare parts from another person just because he can afford to do so. This would amount to causing bodily harm to another, not unlike in slavery.
Performing kidney transplants is a joy. Watching an end-stage renal patient recover from surgery and seeing a happy family leave the hospital is a blessing no money can buy. Legalising organ trading in Singapore will just degrade this wonderful experience into a purely commercial transaction.
Differences in opinion on this matter depend on one's point of view. For someone suffering from renal failure, almost any means to obtain a kidney would appear permissible. For those desperate enough to sell their body parts as the only available means of clearing their debts or bettering their lives, organ trading may also be considered permissible. However, from a society's standpoint, we must examine the moral implications of the new rules we are considering. We should as a community put rules in place to protect the poor, the weak or the otherwise underprivileged.
The rich already enjoy many privileges in our society. Allowing them to purchase an organ legally would be crossing a dangerous line. We are sure our system will ensure that there is an equitable, innovative and highly regulated set-
up such that the donors will be protected. However, as Dr Lee Wei Ling, who is in favour of legalising organ trading, has acknowledged in these pages, it will not be the rich who will come forward to donate their organs. It will be the poor and the desperate. We have always championed the underprivileged in Singapore. Selling organs, whether the sellers be Singaporean or foreign, should not be the means to a better life.
How much is life worth? Transplanting kidneys is relatively safe but it has definite risks. While it may be acceptable to run the risks for a relatively young person to undergo a transplant from a relatively healthy donor, it will be difficult to justify a rich, aged individual suffering from renal failure (and possibly other illnesses) getting a kidney from a young individual just because both parties are willing. It will be even more difficult to extend the argument for kidney trading to live liver or cornea trading. Should we allow someone to buy a face? It is now medically possible to do face transplants. This is a slippery slope; we should not place ourselves on this slope.
Yes, Singapore has dared to blaze its own trail in many areas, as Dr Lee pointed out. Medisave, Newater and HDB - these have all proved to be the right things to do. However, organ trading is fundamentally wrong. It should not be legalised because it empowers the already powerful and exploits the vulnerable. It will not lead to a more moral, sustainable society.
The writers are consultant kidney transplant surgeons at a public general hospital in Singapore. The views expressed here are personal.