What do you need to know if you want to donate your organ?
Compared to other countries, Singapore has a fairly low combined organ transplant rate
Last year, the Ministry of Health revealed that the national public education campaign on organ donation, “Live On” – which was first launched in 2008 – appeared to have helped raise the number of organ transplant operations from an average of 174 cases per year between 2004 to 2007 to 220 cases per year between 2008 and 2015. While the ministry noted that more patients had benefited from organ transplants, the Republic’s combined organ transplant rate for kidneys from both deceased and living organ donors was 20 per million population (pmp) in 2015 – by comparison, the rate for Australia and the United Kingdom was 40 pmp and 49 pmp respectively.
Living organ donors, in particular, have remained in rather short supply over the years-, with only 58 organ transplants in 2015 – a slight increase from 34 in 2006. With the average wait time for a kidney donation being nine to 10 years, and one to two years for a liver or heart, it begs the question of whether more can be done to encourage living organ donors to step up and help make a difference in another person’s life. In fact, it was only in 2016 that Singapore saw its first altruistic liver donation without a specific donor in mind.
Living organ donors in Singapore are regulated by the Human Organ Transplant Act (HOTA)
Under Singapore law, the legalities of organ transplants are overseen by two laws: the Human Organ Transplant Act (HOTA) and the Medical (Therapy, Education, and Research) Act (MTERA).
The MTERA which was enacted in 1974 legalised the donation an individual’s body upon death if he or, in certain situations, his relatives choose to make a gift of the entirety or parts of his body. The causes of such donation as contemplated under the MTERA include medical or dental education or research, and transplantations for individuals in need.
The HOTA was enacted in 1987, about 14 years after the MTERA. The HOTA introduced what is essentially a compulsory organ transplant scheme, that allows the authorities to remove any organ from a deceased Singaporean or Permanent Resident who has died in a hospital, for the purpose of the transplanting the organ to the body of a living person – so long as the deceased’s organs are suitable for transplant, and there are suitable recipients for the organs. However, this would not apply to persons who are not Singaporean citizens or Permanent Residents, anyone who is under the age of 21, mentally disordered (without prior permission from their parent or legal guardian) or has opted out from the scheme.
The HOTA, at Part IVA of the Act, also makes provisions for living donor organ transplants – making it legal for living donor organ transplants of the kidney and liver, provided that the operation takes place in a hospital with the written authorisation of the hospital’s transplant ethics committee, as well as the direct, and continued consent of the donor to specifically donate the organ in question.
Who is in the “Transplant Ethics Committee”, and what criteria do they look at when deciding if someone is eligible to be a living organ donor?
The transplant ethics committee in a hospital comprises at least three people appointed by the Director of Medical Services. The group should have at least one medical practitioner who is not employed or connected to the hospital in any way; and at least one layperson (or a person who does not have any medical training).
In general, authorisation for a living organ donation will not be given by the transplant ethics committee unless they are satisfied or convinced that:
- The donor has given his/her full and informed consent to the donation;
- The donor is not mentally disordered, and is able to understand the nature and consequences of the medical procedures that the donor has to undergo as a result of the organ donation; and
- The donor’s consent is not part of a contract or agreement where the donor gives up his organ(s) in exchange for monetary remuneration, or, where the donor was coerced, misled or unduly influenced into giving up his organ(s).
If anyone conducts a transplant operation or causes such an operation to take place without the written authorisation of the transplant ethics committee or the donor’s consent, then that person would be guilty of an offence, and liable on conviction to a fine up to S$10,000, or jailed for a maximum of 12 months, or both.
What organs can I donate, and why are living organ donors preferred?
Under the HOTA, only the kidneys and a part of your liver may be donated by living organ donors. The reasons for the inclusion of these organs are:
- the human body has two kidneys, and the body can continue to function with one kidney;
- the liver is the only organ that is capable of regenerating (or rebuilding) itself – this means that even if a part of your liver were donated to another person, both the original liver in the donor and the donated liver in the recipient would grow to a normal size within two months.
Living organ donors are preferred to deceased donors for a number of reasons:
- Shorter waiting period for recipients to find a compatible organ;
- Living donor organs function better and can last longer; and
- Since organ transplant doctors are able to perform more stringent medical tests to assess the suitability and viability of both donor and recipient before performing the organ transplant, it helps to minimise the risk of organ rejection, and therefore increases the chance of a successful surgery;
- Living organ donors also help to increase the pool of organs available for recipients and mitigate the low numbers of deceased donor rates.
Are there any risks to being a living donor?
Given that organ donation is a major operation, there are certain risks that are part of the operation, and it is advisable to speak to your transplant surgeon, transplant coordinator or pre-operation counsellor about your concerns. The main risks would include:
- Likelihood of death: According to the National University Hospital, the risk of mortality is 0.03 per cent for a kidney transplant operation, and 0.2 to 0.5 per cent for a liver transplant operation.
- Post-operative infection;
- Undiagnosed allergic reaction to the anaesthetic; or
- Excessive bleeding/clots
Despite these risks, modern research indicates that organ donation does not affect your life expectancy, nor does it impair the ability to have children, or increase the risk of health problems in the future.
Are there any other financial considerations that I need to be aware of?
While the HOTA criminalises the trade and sale of organs and blood, it does allow for the living organ donor to be reimbursed for the costs and expenses for the operation and pre-operation tests – e.g. health checks, laboratory tests, donation operations, follow-up visits at the hospital etc. In addition, donors are also allowed to receive compensation for any loss of earnings that may be reasonably incurred as a result of organ donation – for example, loss of earnings by self-employed or daily-wage workers.
If you are facing financial constraints, but would still like to donate an organ to a loved one, the National Kidney Foundation (NKF) has a S$10 million “Kidney Live Donor Support Fund” to provide financial assistance to needy live kidney donors. The financial support will only be limited to kidney-related medical welfare and insurance. Additionally, it is only available to Singaporean Citizens and Permanent Residents referred by Restructured Hospitals, and they must meet a means test criteria imposed by NKF.
Other Frequently Asked Questions
Question: If I donated my organ to someone else, would it be likely that insurance companies may charge me a higher premium?
Answer: If you have donated an organ prior to purchase of the insurance, you should declare this to the insurance company as part of your medical history. If you have an existing insurance plan and are contemplating donating an organ, you should check with your insurance company directly on whether the donation could have implications on your coverage or premium, as policies may defer from company to company.
Question: I had previously signed an Advance Medical Directive (AMD). Will this have any effect on the application of the HOTA?
Answer: An AMD is a legal document which an individual signs to convey that he does not want extraordinary life-sustaining treatment if he should suffer from a terminal illness from which there is no reasonable prospect of recovery, and where such extraordinary life-sustaining treatment would only serve to postpone death. The signing of an AMD would not affect the organ donation scheme under the HOTA which, by default, applies to all deceased Singaporeans and Permanent Residents of 21 years of age or above, are mentally sound, and have not opted out of the scheme. This would, of course, be subject to the suitability of any organs for transplant.
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This article is written by Lim Min from Straits Law Practice LLC.
This article does not constitute legal advice or a legal opinion on any matter discussed and, accordingly, it should not be relied upon. It should not be regarded as a comprehensive statement of the law and practice in this area. If you require any advice or information, please speak to a practicing lawyer in your jurisdiction. No individual who is a member, partner, shareholder or consultant of, in or to any constituent part of Interstellar Group Pte. Ltd. accepts or assumes responsibility, or has any liability, to any person in respect of this article.