Monday, September 29, 2008

Organ transplant law to include reimbursing donor

Sep 29, 2008

It's not unethical to pay costs incurred by donor, notes Health Minister
By Salma Khalik

CHANGES to the Human Organ Transplant Act (Hota), expected early next year, will include compensation to those who donate their kidneys to save the lives of people they do not know.

Health Minister Khaw Boon Wan said this yesterday when he sought to refine the ethical debate over organ trading to placate those who are against money changing hands for body parts.

Ethicists are against commercialisation, he noted, but even ethicists in the United States with its 'highly ethical framework' think that altruistic donors should be reimbursed.

'Ethicists have no problems with reimbursing the donor provided that...he or she is fully informed of the risks, possibility of complications and what will happen to him for the rest of his life.'

Mr Khaw, who was in Manila last week to meet organ donors, said he returned home even more convinced that something had to be done to regulate organ trading, in particular, to cut out the middlemen.

The donors he met had no clue what they were getting themselves into. 'We cannot leave this problem to the black market,' he said.

His remarks following the opening of Woodlands Polyclinic are a sea change from his earlier stance a few months ago which had seemed to preclude any kind of organ trading whatsoever.

But Mr Khaw has been shifting his stance gradually, as debate grew following a high-profile court case involving retailer Tang Wee Sung's attempt to buy a kidney from an Indonesian.

The problem is acute, with over 1,000 more people each year suffering from kidney failure and needing transplants. Last year, 46 people received a cadaveric kidney - after a wait of almost nine years.

Desperation is driving some to illegal methods, despite the risks of running foul of the law and health complications. Every year, 20 to 30 Singaporeans go abroad for an illegal kidney transplant.

Hota, which allows for cadaveric and living-related organ transplants, will be amended early next year to lift the current 60 age cap.

It will also allow for paired matching, where relatives of patients who are not good matches can donate their organs to another patient who also has a family member who is willing to donate a kidney.

The minister drew a distinction between inducement - 'You're poor, I'm rich, I'll give you $1 million for your kidney' - and reimbursement.

'I think if we stick to the reimbursement side of the equation, we'll remain ethical,' he said.

Central to Mr Khaw's plan is the welfare of the donor. The Filipinos he met had been 'short-changed', he said, with just $3,000 to $4,000 paid to them for a kidney.

But what about follow-up treatment and checkups? What if their own kidney failed? The money would scarcely see them into the future.

He said he has asked his ministry officials to compute what additional medical expenses donors might incur as a result of giving up one kidney.

'Putting a dollar value to that is not unethical,' he said, suggesting that the amount would likely be in the tens of thousands of dollars, since it has to last the donor the rest of his life.

Mr Khaw said that there will be roles for various parties. He sees hospitals taking on the job of making sure that donors know the risk they face.

The ministry will audit to ensure that there is no 'hanky-panky', and also to link donors with recipients.

Those able to afford it should reimburse the donors themselves, since they are the beneficiaries. Voluntary welfare organisations like the National Kidney Foundation (NKF) could help poorer recipients raise funds for such reimbursements.

The minister has already met with NKF officials regarding a possible role for the charity.

Mrs Eunice Tay, NKF's chief executive officer, said that details are still sketchy, but the foundation is likely to set up a fund to pay for post-operative treatments for poor donors.

Mr Khaw made it clear that this proposal is but a complement to the living related and cadaveric transplants.

But prevention or the management of diabetes is still the best safeguard. Diabetes causes over half of the almost 1,000 or so kidney failures here a year.

He said: 'Once kidneys fail, the options are all lousy, whether it is dialysis or transplant.'

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