Friday, January 19, 2007

Organ trading? What next?! Is there nothing sacrosanct?

Ban on organ trading entirely irrational
ST Forum 16 Jan 07

IN THE Review article, 'To receive, S'poreans must learn to give' (ST, Jan 11), Ms Salma Khalik argued that the Human Organ Transplant Act, which states that specified organs taken from deceased persons can be given only to Singaporeans or permanent residents, is selfish.

This is because if no Singapore citizen or permanent resident is waiting for an organ, it cannot be harvested, even if there are foreigners who need it urgently.

A Ministry of Health (MOH) spokesman responded by saying that 'We don't want to be seen as doing a tourist trade in organs. We don't want to see a waiting list of foreign patients.'

Ms Khalik had earlier pointed out that Singaporeans have no qualms getting organs from abroad. I would go further.

The MOH spokesman's explanation is politically correct. Organ trading is frowned upon and usually not allowed in countries where political correctness reigns. However, it is entirely irrational and medically incorrect.

No one is harmed by harvesting an organ for transplant into a foreigner needing it desperately when there is no potential local recipient.

On the contrary, a life is likely to be saved. Whether money changes hands is irrelevant. If a person needing an organ transplant is willing to pay for it, what is wrong in us allowing this, so long as Singaporeans and permanent residents take priority over foreigners?

To go further, our law which prohibits live-donor organ transplant whenever there is a contract or arrangement is irrational.

Healthy people can live with one kidney or after having part of their liver removed. If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?
(read on)

My comments:

Dear friends,

Medical ethics is increasingly cloudy and in muddy waters.

It seems that anything and everything is possible now in the name of modernity!

In the name of advancement, keep Ashley as a baby with hormones and surgery.

What's an organ?

After all, what’s an organ? Just some combination of proteins and connective tissues, performing various biochemical and physiological functions. Just like so many pipes and gadgets that you see under the hood of a car.

The brain- just so many zillion cells passing thoughts and emotions in the form of neuro-transmitters. Perhaps, “Love” is just some imbalance of one of these neat equations, as is anger, loneliness and what-not.

So if man is just a lump of meat strung together by so many hinges, then go ahead. Having two kidneys is a waste of good space, some say. Even more unforgivable than being redundant, it is a depreciating asset that could have been turned into cold hard cash. The extra bean-shaped commodity in the loins is the poor man’s stairways to heaven.

Or is it?

Insatiable demand

The demand for organs is insatiable. The demand for kidneys is the aggregate sum of patients with end-stage renal failure in the whole wide world. Think “globalised” world , factor in Singapore’s reputation as a centre of medical excellence, the benefit for tourism and healthcare dollars must be astronomical. But is this what this is all about? Dollars and cents? But of course the patient benefits too.

In the short-run, it may seem common-sensical, even noble.

In the long-run, what happens?

Long-run effects of demand

As demand is insatiable, or infinite, suppliers will find a way to meet this demand ala Adam Smith’s supply-demand “invisible hand” equilibrium ( yadda, yadda, yiddi).

Supplies initially come from well-meaning people who donate for free (LOL), followed by desperate poor folks who want the good life that the recipient has. Since normal supply is unlikely to meet this insatiable demand, what will likely happen next?

Strange bedfellows

Crooked doctors (yes there are such despicable creatures, but not in Singapore), corrupt prison wardens and executioners working in collusion with officials (like in some ahem.. North Asian country), and the black market with all those colourful “mafia” characters get into the act. Don’t blame them, they are just as inevitable as flies around rubbish.. they serve a function, fill a void.

Before we know it, horror stories (which I still find hard to believe) will surface, of people waking up after a night out at a Mohamed Sultan pub with a long scar in the sides? Far fetched?

The good professor

I agree with Professor Alistair Campbell, head of the Centre for Biomedical Ethics at the National University of Singapore ( I wonder where he is going next?) who said that the ban on organ trading must stay as:

Such trade inevitably involves exploitation of the worse-off in society”

“Every operation carries a risk. Since the poor will be the main sellers, their compromised health will be further jeopardized”

“Treating the body as a saleable asset is regarded by many people as morally wrong in principle”

Hear! Hear! Prof!


Dr.Huang Shoou Chyuan

Link:1 Another forum letter on organ trading
2. and Another letter


Anonymous said...

In Singapore money speaks sense in a languange everyone understands. Perhaps one day it is legal to trade your wives for financial gain if you need money. Of course, you have to sign an option form approved by the esablishment.

Anonymous said...

If our government can legalise casino, and screw our workers (Read Mr Wang says so) trading in organs will be an easy act to pass in parliament.

Anonymous said...

When something like this gets to be mentioned in MSM, does it mean that the government will eventually reject or accept the proposition totally. We have seen this type of stuff before and what it can become. Testing the water again...

Gerald said...

Hi Dr Huang,

The scenarios you painted are certainly scary. But what if there are laws that are enacted to prevent the free-for-all trading of organs?

I'm interested to know what your views are on the benefits of organ trading for those in dire need of a transplant. Won't it enlarge the donor pool? Yes, we can hold a position that human organs are sacrosanct, but if I had a child that would die without a kidney transplant, I think I'd rather pay huge sums of money to get a "donor" kidney than to see my child die waiting for a free one.

btw - your blog doesn't display in Firefox.

Gerald said...

Hi Dr Huang,

The scenarios you painted are certainly scary. But what if there are laws that are enacted to prevent the free-for-all trading of organs?

I'm interested to know what your views are on the benefits of organ trading for those in dire need of a transplant. Won't it enlarge the donor pool? Yes, we can hold a position that human organs are sacrosanct, but if I had a child that would die without a kidney transplant, I think I'd rather pay huge sums of money to get a "donor" kidney than to see my child die waiting for a free one.

btw - your blog doesn't display in Firefox.

Rowen said...

Dear Doctor,

No offense meant, just based on this topic.

If your own child or close relative needs an kidney transplant in order to live and there is a kidney for sale, Would you pay the price(which you can afford) for the kidney? or would you stand aside and see your loved one die?

I feel that organ trading is wrong too as it will exploit the poor.

However, if faced with a situation as stated above, i believe many would not want their loved one to die.
I faced such a situation once which was my grandma (she was 76) and i had to let go coz of something she said.

"When your time is up, no use struggling coz in the end it will hurt more."

Faced with such a situation, what would you do?

Just my 2 cents worth

nofearSingapore said...

Hi all,

Anonymous (all): If you believe in conspiracy, then all this sudden surge of interest is just “kite-flying” before the real push for organ-trading by the govt. I don’t know what to believe anymore. I want to think that all this singing from the same hymn-book is just a coincidence.

Gerald: I apologise that after I inserted GooglesAds ( as an experiment ) that Firefox doesn’t show my blog anymore. Ironic as Firefox is marketed by GoogleAds. If anyone has any bright ideas let me know. I am still working at it. Sorry

Gerald & Rowen:

Heading: Cost to humanity/society of Organ trading – slippery slope scenario

For discussion sake, I exclude organ donation between family/loved ones as it is not commercial and is sacrificial (but not without its controversy).

Just because there is willing buyer-seller scenario, it is not true that nobody loses. Humanity loses, as this will be just the top of a slippery slope where the worth of a human life will then only be measured in terms of dollars & cents.

Once we accept that this is so, we can even go as far as to say that even if he donates both kidneys and dies, it is acceptable, as long as the compensation is mutually agreeable. The difference between one kidney and two kidneys ( plus death) is now just more X dollars. The sanctity of life is not anywhere in the equation, so you can just ignore it?

Now we go one more small step, since it is all about money, as the Queen of England ( or some VIP like that) needs a kidney, as without her the whole UK would be without a monarch ( or some stupid excuse like that), so why not just take a homeless hobo’s organ ( or both) and transplant them into her. Dispense with the farce of paying him ( or his estate) as no one will notice his absence.

Society as a whole would benefit more from the normal renal function of the Queen than of that hobo ?!

Is there anything to stop us getting to the latest (hobo) scenario? Since value of life has now been pared down to mere dollars, and everything is possible, even taking away a life ? Déjà vu, Hitler’s Germany?

If you are conversant with Sg’s Organ Transplantation regulations, one can already feel the slipperiness of the slope.

We started with organ transplant from dead donor (voluntary opt-in) -->dead donor (opt-out ie if you did not opt-out, your kidneys/cornea etc) will be taken on your death ( if suitable) --> Life donor from related kin only --> life donor from unrelated (but no monetary exchange) -->next step … organ trading for money -->next.. limited only by imagination of authorities…

About your various personal scenarios (child/grandma), we do only what we can, with whatever we have, be it dialysis, or long term medications ( expensive tho it may be). Sometimes, we have to accept the inevitable.

We are opening a Pandora’s box. Call me a sanctimonious prig if you want, but we are one small step away from where we shouldn’t be.

I am not good with words and the above may sound contradictory and philosophically unsound or even naïve, but that’s me.

When MSM starts firing, try to read between the lines.


PS: The link to Dr. Lee's letter has expired. Does anyone have a copy of the letter, so that I can edit into the main post?

Anonymous said...

Yes, Dr H, I'm worried too about that slippery slope. Your Queen of England example can be transplanted to somewhere nearer where rumours are counting the days for an old man to kick the bucket soon.

Gerald said...

I'm glad I can read your blog again on Firefox! :)

Like you, I too don't like these cost-benefit analyses when it comes to people's lives.

I'm interested to know your views on stem cell research (embryonic and adult) as it is along the same lines as organ trading.

aliendoc said...

I commented on this in my entry dated Nov 25, 2006. And today's paper had letter from a patient's perspective.

Touch call to make...ethically, it may be despicable; but if I were to walk in the patient's shoes, my view may change.

Anonymous said...

Why not commercialise blood donation. I have donated 30+ times and not received a single cent for my efforts.

Singapore's position in altruistic blood donations is in line with WHO's stand which is it is a safer system for donors and recipients. The same arguments for altruistic blood donations should apply to kidney donations.

Anyway, I have decided to stop donating blood since it's "free" and has zero dollar value (to me).

Majullah $ingapore.


nofearSingapore said...


I confess that I haven't been keeping up to date with the whole stem cell controversy. But a simple googling turns up the issue here ( I know the high-brow academic-types would frown on Wikipedia!) but it makes simple reading ( if you don't assume all is Gospel truth).
Yes, the whole issue by opponents is also based on the "slippery slope" objection.

Stem cell is best from embryos. Less good when from cord blood and adults. Latest finding showed stem cells from amniotic fluid of mother shows great promise.

Beware that the cord-blood collection and the whole hype on this is still very "iffy". I always think (in Sg) that if cord blood is really so good, the govt would have set it up already ( shows I have been brainwashed to think the gahmen is always in the "know").

Many docs are extremely skeptical about the business model of the cord blood thing ( won't say more).

The embryos used are those discarded ( sorry so crude) from IVF and abortus. Yes I know this will stir the whole Roe vs Wade all over again.

Sorry can't make myself say which side I am on cos I don't know.

aliendoc: read your piece on Iran's opening of organ-trading market.
Just don't know why I just feel that taking this first step dehumanises all of us. I don't want Sg to be a pioneer of such a "free market"

anon 1.54: the reason blood donation is not commercialised was that the govt thought that only desperate people would sell their blood and these des ppl are likely to be drug addicts who have HIV and other communicable diseases.

Let us all know that at this moment, MOH is still against organ-trading. It is Dr. Lee who brought out that MOH is "irrational" and that organ-trading should be allowed.

I support the MOH's stand! I hope you would all too!


recruit ong said...

Very chim... I only understand one thing, using demand and supply is not enough the address the whole range of issues,. The market model only recognises money and things not quantifiable by money are ignored. It is demand and supply that is killing sharks the world over for their fins. It is demand and supply that blood are shed in poor africa (see movie blood diamond). When the eating or buying stop, the killing can too.

JC said...

Hi Dr Huang,

your blog is interesting. Personally I'm in my 2nd year in NUS this yr doing medicine and following all the hype on organ trading and had some internal debates with myself.

What you said is true, but what the opposite camp said is also true. Everyone has a point. But personally I would still be for organ trading.

Wad you said about the slippery slope (from dead doners to alive and so on) is true, but I see it as like an effort from every1 to hunt for more organs to help people, and that in essence is a good objective consistent with the spirit of humanity. But you see it in a more sinister light that dehumanises the human body and puts a value to life. It just depends which angle we see it from I guess.

If the trading is allowed, most probably it will be governement controlled. And people wont be able to sell (legitimately) one on one but sell only to the government which den priortises according to patient needs. In that way the rich may not benefit as much becuz the poor will likely end up with poorer prognosis (with whatever disease they have) and will be prioritised higher up.

Also, some scheme would have to be done up to prevent only the rich from assessing the organs, just like MOH did medisave and medifund to make health care affordable for rich and poor alike, they should do up something to make it accessible to everyone.

Lastly, if someone wants to sell his organ, it is still subjected to approval from the doctor. If he cant do without it, he cant sell it even if he wants to. Not only that, he must have a record of being able to maintain his health. (from assesment and health records) so that like for eg if he donates/ sells a kidney, he can still survive with one without a high risk of developing renal failure in that remaining kidney.

You will say that a desperate person will turn to black market. The thing is there will also be bad things with any good thing that comes. And these black organ markets are not new. If they legalise selling organs then people wun turn to black markets for nothing (unless dr dun allow and he really need $ at least people wun receive organs from these markets which may be contaminated with duno wad virus (CMV? HIV?) and end up harming more

And drs should learn to pick up a desperate case that was not allowed to sell and channel it to a financial social worker to sort it out so that he wun turn to black market to trade it for $ and risk his life.

My idea is that it is still good in essence, but many things have to be done, from educating the public, teaching doctors how to do refer to social wkers for desperate organ traders (who are not suitable to sell) and law enforcement. Basically a ton of work for this to work.

nofearSingapore said...

Something I cross-posted into KwayTeowMan's blog:

We don't sell our extra kidney cos deep down inside we don't really believe that the extra -kidney is redundant.
We also don't but the argument that it is safe to have an operation to remove a healthy kidney.
Deep down, we feel that maybe the extra kidney or capacity may come in handy. We know that no surgery is completely 100% safe and without complications.
So, why does a poor person in 4th world country ( exagerration) sell his organ.

Ignorance and desperation.

Ignorance will be exploited by middle men and those who gain from the whole supply chain of organs.

Desperation- we are only providing short-term solution to the poor ( which is without doubt of considerable importance to them now). If they are not desperately poor, they die die also won't sell ( just like you and I). Solution: get them out of poverty trap- I know easier said than done.

Solution for organ recipients- no easy solution. More research on medical technologies so that dialysis is not as expensive and as troublesome.

Sometimes, it is tough to accept that the solutions to solve all human suffering is still a long way off.



nofearSingapore said...

I am posting this comment which is more appropriate here:
Organ harvesting said...
Hi Dr H.,

Not related to this entry but another earlier one that you posted.

Matrix Island entry today Thursday, February 08, 2007 about how SGH enforced Human Organ Transplate Act, with police+hospital staff etc fighting against the dead man's family.

What are your views on it? Esp as a medical professional you may have seen more such cases and the emotional trauma of the families (both donor and recipient). Thanks!

Just my 2 cents worth... Somehow I find each of the above blog entries disturbing, and worse when one put both together. Even though I agree with organ donation in principle, I now have my doubts and may opt out.

7:28 PM

nofearSingapore said...

Dear Organ harvesting:

Let me say here that I fully support the police and the medical staff at SGH who are just carrying out their work.

The HOTA ( Human Organ Transplant Act) has been passed by Sg Parliament and hence is law.

As citizens, even if we do not like the law, we still have to obey it. Police and hospital workers have to carry out their duty.

If we don't like any law, we can lobby MP's ( PAP or opposition) to change it, vote out the party that does not support change etc.

Unfortunately, the vast majority of S'poreans are Very apathetic and does not care to do anything to help themselves. The HOTA has allowed an Opt-Out clause which is known to almost everyone but most has a cannot-be-bothered attitude and not opt out even if he/she does not want to donate organs.

Brain death is very precisely defined and the doctors have to be 100% sure that there is brain death ( that is legally dead) before enforcing the HOTA act.

Lesson: Let us all take control of our lives. Do what we need to do. Have an interest in policies and how are society is run.

Actually, I do not really like the tone of the article at MatrixIsland.Let's not target the Police. They are there to make our society work.

nofearSingapore said...

the url provided by Organ Harvesting to matrixisland was not correct.

It should be

Like I said, the police are our friends. They are just doing their job. (see above)


Organ Harvesting said...

Hi Dr H,

Thanks for your feedback! I do agree that the men-in-blue and the hospital staff are just doing their job, an uneviable one too. Feel that the trauma could be lessened for all involved (donor/receipient families, police, hospital staff). Why so little publicity or campaign about brain death and the HOTA, etc? Does the MSM often avoid such difficult/sensitive topics?

Anyway, I used to think "if I go... I go", might as well for my body parts to do some good. But now I realized how little I've put into consideration my family's feelings, esp under such traumatic situations. I have decided to opt-out so that in the event of my death, my family can decide then if they were ready to make something good of my death. From my perspective, after my death, my physical body bears no value to me, but it is invaluable to my next-of-kin for his/her grieving process.

Just my 2 cents worth.

nofearSingapore said...

Hi Organ Harvesting,
Glad that you have made up your mind about the HOTA ( even if you have decided to opt out).
All of us must be responsible and decide on such things and not leave our families to settle the problems after we leave.


Fox said...

Hi Dr. H:

I have a few questions.

1. What is the likelihood dying, for the donor, from a renal transplant operation given proper post-operative care and monitoring?

2. What is the average waiting time for a renal transplant in Singapore?

3. What is the likelihood of a person with ESRF on the list in Singapore dying before getting a transplant?

4. What are the known long-term health effects of having only one kidney?

5. What is the success rate of renal transplants with kidneys from cadavers vs.the rate with kidneys from living donors?

nofearSingapore said...

Hi fox,
Your questions are good.
Sounds almost like an interrogation( haha).
If I am not careful, I may end up saying things that will trap myself ( haha).
Since I am not an expert ( or a lawyer), please refer to other sources for the answers.
Try asking the MOH, maybe they can help you.


Fox said...

I have written two posts on the issue to paid kidney transplants here:

Please kindly offer your view and criticisms. Thank you.