Monday, June 30, 2008

Organ trading: Peril of Slippery Slope and Ethics Committee's Impossible Tasks

Hi Friends,

I wrote the following letter to the forum pages of our MSM (Mainstream Media).

Addendum (1.7.08): The letter has been printed in all the 3 papers that I sent to. But in one of them, the letter is almost unrecognizable ( but better than nothing).It is mostly unedited in the other two (Actually totally unedited in Today's version).

Let me state that I am active in my hospital's committees- including the Medical Advisory Board ( elected) but I am not on the Ethics Committee of my hospital.

I have written some posts on Organ Trading and HOTA (Human Organ Trading Act) :

1. Organ trading- What next? Is there nothing sacrosanct?
2. Brain death case at SGH (HOTA)
3. Mystery of crooked undertakers and Alistair Cooke

Cheers

Dr.Huang


June 29, 2008

Dear editor,

I wish to make two points about Organ Trading.

1.Organ trading is dehumanising and problem of the “slippery slope”

I am opposed in principle to Organ Trading as to legalize the sale of human organs will inevitably put Singapore’s healthcare system on the slippery slope down to a level where we become less human. There are already some who argue that so long as there is a willing seller and willing buyer, the market should be left to sort itself out.

Although narcotics and other illegal drugs also have such a scenario, we do not seek to decriminalise them nor campaign to allow narcotics trading do we?

The “slippery slope” arguments also forces us to consider a scenario where we may start with trading of kidneys and livers now but will then slide down to include hearts and brains in the future. Although the sale of a human heart will entail the death of the donor, public consensus may by then be that as different people have different usefulness for society, it is then not immoral that the less economically productive should make the ultimate sacrifice ( with or even without payment).

It may seem unthinkable now but once we accept that the human being and his organs are mere commodities to be traded like meat in the market, it becomes less difficult to imagine Singapore in the future as a version of Aldous Huxley’s Brave New World where “Alpha humans” are treasured and “Epsilon humans” are expendable.

2. Ethics committees’ impossible job- MOH should take over policing of organ trading

In my opinion, any organ donation other than by a close family member (spouse/parent/children) should always be suspect. Why should any distant relative be so altruistic as to donate his kidney at great surgical risk to himself if there is no financial gain? I have even heard of a military general claiming that his humble private soldier is willing to voluntarily donate his kidney out of respect for the general!

The committee members are volunteers and are not professional sleuths. The two doctors and one layman can only trust their instincts whether to accept the accounts told to them by the donor and organ recipient. If these latter two are well coached and well-armed with affidavits and diagrams of family trees, short of going to remote towns and villages in South Asia or Indonesia, the ethics committee would just have to clear the transplant!

I suggest that the responsibility of detecting organ trading is too onerous for the hospital’s ethics committee. MOH itself should take over this function as it has more resources at its disposal and only after organ trading has been excluded by MOH’s committee should the hospital’s ethics committee convene and then only to do what these doctors have been trained to do- to vet the medical indications for transplant and other such medical-related issues.

Dr.Huang Shoou Chyuan

cc: Ministry of Health

PS: Published in Straits Times; Today; My Paper. No reply from MOH

14 comments:

SHIMURE said...

I think organ trading is just plain wrong.

It is in my opinion the core evil which will arise. Desperate People will start selling their organs for Gain.

Moreover, it will lead to lots of illegal activities surfacing in singapore and lots of indirect related crimes.

We may have people taking organs like kidneys and other stuff from poorer people or innocent victims off the street.

In addition, only the rich or people can afford the organs would get treatment, instead of who needs it more critically.

I am strongly against this new motion which has been put forth....

1 evil will lead to many.

my 2 cents worth.

nofearSingapore said...

Hi Shimure,
I fear that we are becoming a minority when it comes to views about organ trading.
During lunchtime at my hospital, a totally unscientific straw poll make me realise that many doctors are for organ trading. Their main reasons are that as it is already happening and to try to stop it is to deny the reality.
Some even said, the same logic goes to narcotics- legalise it!
Only about 3 of us in the tea-room were vehemently against it.
The other reason cited is that they feel the powers that be is hypocritical and they want the money from the transplant operations but want to be on high moral grounds and are just making the ethics committees scape-goats!
The committee is between the rock and the hard place! Too strict and reject and the patients may sue, too lenient and MOH will cite them for not doing their job and accuse them of not being objective!

The reality would be that no-one would volunteer to serve on this committee. Who likes to be a fall guy? we are not masochists!

SHIMURE said...

Dr Huang

This reminds me of another doctor in a manga.... Monster.written and illustrated by Naoki Urasawa.

In which a doctor saved the life of a child instead of a mayor of the city....

But the consequences are different....

Well we all have choices to make each day.

But as doctors, i suppose you have more to make.

to be ethical or not is very very hard.

Let faith and god decide that is what people always say.

I dunno.... but to me i follow my heart and my feelings.... not least follow what tarot shows me too.



my 2 cents worth.

nofearSingapore said...

Hi shimure,
You may be surprised but Monster is my favourite ( and only) anime which I have watched. I really love it. So real ( I actually know a Singapore neuro-surgeon who actually went to Germany to work - like the main character). You can watch animes for free at crunchyroll.com ( don't know about legality)!

Anonymous said...

Dear Dr Huang;

Fully agrees with views.

The present system with regard organ donations and transplants is more than adequate.

Other than blood and sperm,(sorry I am unable to think of other organs) only organs that are able to regenerate themselves in time to function as should, should be allowed to be extracted to save others.

Vital organs, like You said, should only be allowed to be donated to kins, kiths and friends with strong bloodline and emotional links. I cannot think of any other good reason for organ extraction other than those who died of accidents and compelled(other than those who opt out)by the Law.

The slippery slope is obviously the route we have to avoid.

patriot.

SHIMURE said...

you use cruchyroll too....

I also do so....
they have lots of other stuff too besides anime....

But i watch not a lot of anime lately cos i am researching on psychology mainly on Carl Jung's psychoanalysis.... and also into iching.

SHIMURE said...

source: http://www.channelnewsasia.com/stories/singaporelocalnews/view/357386/1/.html

SINGAPORE: Doctors say strict measures are in place to prevent people from donating organs for money.

Getting to the operating theatre for a kidney transplant can take up to three months of checks when a living donor is involved.

At the National University Hospital (NUH), donors go for repeated interviews, medical checks and psychiatric assessments to ensure they are aware of the risks and are donating for altruistic reasons.

Doctors and organ transplant coordinators pay particular attention when screening for non-related transplants or when the donor is a foreigner.

All transplant cases need to seek the hospital's ethics committee's approval.

Professor A Vathsala, director for adult renal transplant programme at NUH, said: "There are a lot of subtle clues and we look for stories that gel. We look for that emotive input between donor and recipient and sometimes that care and the concern comes through in conversations and we repeat ourselves many times. And when you do that, an inconsistent story does come out."

3,500 people in Singapore have kidney failure. Of these, 600 are on the transplant list, but will have to wait up to nine years for a cadaveric donation.

However, trading in organs is not a solution, said Professor Vathsala.

"Organ trafficking tourism for transplantation will all become rampant and the poor and the disadvantaged will become donors of the wealthy ill," he said.

Last week, two Indonesian men were convicted of organ trading in Singapore. One man intended to sell a kidney to C K Tang's executive chairman Tang Wee Sung for S$23,700.

Lawyer Palaniappan Sundararaj said a patient could face a fine of up to S$10,000, jail of up to 12 months or both if he or she knowingly accepts a sold kidney for transplant.

"The prosecution would have to prove the patient knew the kidney was sold. This is not always the case, for example, when the recipient is a child or when an adult patient has an over-enthusiastic relative who sources the organ," he said.

The lawyer said it is up to the prosecution to decide whether to press charges against a patient for buying an organ.

In Japan last year, a husband and wife were found guilty of buying a kidney for transplant. They received a one-year jail term which was suspended for three years. - CNA/ir

SHIMURE said...

Well the Main stream media seems to be backing organ transplants.

Fox said...

Dr. Huang,

As a Singapore doctor, you should know that:

1. kidneys from living donors are better than those from cadaveric donors for renal transplant,
2. the longer one is on dialysis, the lower the effectiveness of the renal transplant,
3. there are not enough kidney available for renal transplant.
4. the risk from renal transplants are very low,
5. we have a long waiting list for kidneys.

In fact, I discussed the issue of renal transplant more than a year ago on my blog. See
Compassionately Logical: Part 1

Compassionately Logical: Part 2

Fox said...

I forgot to add, patients who have received a kidney transplant live on average 10 to 15 years longer than patients on dialysis.

lobo said...

I absolute abhor people who use 'slippery slope' as a reason to not do something.

I posted most of my comments as lobo_respawned in ST Forum, so I don't want to retype too much.
http://comment.straitstimes.com/showthread.php?t=12114

Basically I think there is/are ways to avoid the 'slope', and we should be exploring it, rather than just dismissing it with our own assumptions. And the reason that I advocate exploration is that it will increase the supply of organs available for transplant.

You can check our Mr Wang Says So blog also for some of the ideas mentioned.
http://mrwangsaysso.blogspot.com/2008/06/issue-of-human-organ-trading-in.html

Palliative care and medical research said...

Hi Dr Huang,

My thought is that organ trading should not be allowed. My concerns are listed in "Palliative care and medical research" entry on Mr Wang's blog.
http://mrwangsaysso.blogspot.com/2008/06/issue-of-human-organ-trading-in.html

Fox wrote in your blog, "patients who have received a kidney transplant live on average 10 to 15 years longer than patients on dialysis."

My question then is what happens after that 10 to 15 years more? Does the rich recipient procure yet another organ to further extend his life? How many persons' organ is he allowed to buy before he is ready to face the reality that death comes to all?

I'm not against non-related donation from one's own volition. I've done that before, not an organ but the goes-to-waste-unless-fertilised oocytes, and I took it as a learning experience. When it comes to non-renewable organs though, I wouldn't unless it's for someone with extremely close ties.

Btw, I am from the healthcare industry. I hope I'll not be involved in "legal organ transplant" if it does come to pass. I feel it still boils down to exploitation of the poor, even if the donor is driven by and benefits from materialistic rewards. An analogy would be to say that sweatshops exploiting child labour is acceptable because the poor child would otherwise go hungry.

nofearSingapore said...

Hi Palliative Care/Med Res:
Thanks.There are so many issues in this complex question about Organ Trading and yet there are some out there who treat it as frivolously as if one is going to the shop to buy candy!
It is only right that we tread with serious caution.
I am a doctor and my patients know how I feel when their disease seem to take a negative turn. We do our damnest within our limitation and leave the rest to Providence!
Who does not want to live to a ripe old age? But can we cheat death?
So do we as a society feel that there is no limit to what we can do? So prostitution is right? Gambling ( or gaming as some would call it)? Bestiality?
There are some out there who says, " I abhor anyone who uses the "Slippery slope" argument as if it is so unintellectual- so beneath their contempt?!
But the moment we allowed non-related organ transplant, we are already there! How do we pretend that when strangers donate organs, there it is only out of altruism? The powers already know that in non-related transplants strange things are already happening but they don't want to know. Let the ethics committee sought it out.

My opinion: Related transplants ok as we do donate to our loved ones ( no money transacted). Non-related transplants = organ sale already! If we really don't want organ sale, rescind the non-related organ transplantation clause!

BTW, I was a voluntary organ donor before it was mandatory ,before HOTA and the hallabaloo!

Where does it end? First cadaveric transplant then living related then living non-related then organ trading then what?... mandatory donation of organs from weak to powerful/rich?

Don't like the slippery slope? Too late, you are on it already!

Egg Donors said...

Great Post.....

I found your site on stumbleupon and read a few of your other posts. Keep up the good work. I just added your RSS feed to my Google News Reader. Looking forward to reading more from you down the road!

Thanks for sharing....