Friday, March 27, 2009

Organ-trading through the back door

Dear Friends,

The letter to the Forum page (see below) was sent a few days ago.

As the editor is taking a long time to decide if he should publish it, I feel that I should publish it now while it is still newsworthy and still fresh in your minds.

Personally I feel that this is an example of how bad laws still get passed through our parliament.

I am not arguing that all should agree with my views about transplant medicine.

It irks me that even when the details about the "hows" and "how much" of the compensation mechanisms are so sorely missing, an overwhelming majority still voted for the law to be passed.
What is the point of lifting the Whip? How many independently-minded parliamentarians do we have?

There is no need to hide in the shadows anymore. We can unashamedly say openly (just like Iran) that you can now come to Singapore from all corners of the world- bring your kidney donor with you, and you can pay him ( or to use the right word-reimburse him) at an amount to be determined in the future.

As it is impossible to police how the foreign donor uses the money back home- we won't. How convenient.

So one and all- We do not have organ-trading. You can come to sunny Singapore where you get serious money for your kidney. But I say again, we do not have organ-trading.
Dr.Huang Shoou Chyuan
Addendum (27.3.09 2.30pm): I just found out that the letter was actually published this morning. Maybe one paragraph ( which I thought was quite "juicy") was edited out, hence it was unrecognised by me in the wee hours of this morning.

The Letter to the Forum Editor

Dear editor,

I have deep reservations about the latest legislation which allows for payment for living kidney donors.

Although Health Minister Khaw Boon Wan had categorically assured parliament that the new law did not seek to legalise organ trading, many including myself remain unconvinced.

If we truly only wanted to reimburse donors for their altruistic acts, and not let this become a backdoor for organ trading, the following safeguards should have been present:

1. Foreigners should have been excluded
Only local donors should be allowed onto this scheme as we can then monitor them within our system and either reimburse them for healthcare expenses related to the organ donation through direct payment or through lifelong medical insurance coverage. Compensation for loss of earnings and other more difficult computations can also be decided by a neutral committee.

To allow foreigners into the scheme opens a Pandora’s box as it is impossible to know what a foreign donor does with the money back home. He could literally put the whole lump sum down on some gamble and have nothing left when he needs it most.

To include foreigners is also a tacit admission that transplant medicine is big business that Singapore cannot afford to ignore.

2. Compensation details should be available before parliament vote

The details about mechanisms for quantifying fair compensation should be present before MP’s were asked to vote on what must have been a tough moral choice. These details must surely be the difference between the money being “compensation” rather than “profit” for the donor.

To be asked to vote for something which lacked any specifics at all might cause our parliament to be misconstrued as a “rubber-stamp” as many may consider voting for this legislation in such a way to be irresponsible and akin to writing a “blank cheque”.

I fear that Singapore’s reputation as a medical hub with a “high ethical standard” has been seriously eroded by the passing of this legislation.

Dr.Huang Shoou Chyuan


Anonymous said...

Exactly my sentiments Dr Huang.

Would like to add that I find MP Sam Tan's response to the question about queue priority disturbing:

"To insist that in all matters of health, there is complete equality between the rich and the poor, is specious. There are cancer drugs that cost S$200 a pill. Once you cannot afford this drug, the cancer progresses and you are done for."

And Mr Khaw's response is even more disturbing:

"Let us not grudge somebody who is able to secure an altruistic donor because once he is out of the waiting queue, he benefits everybody else."

No mention about how priority in the queue is preserved. As it is, it does not benefit everybody else, only those who can afford to pay. Worse still, those who can pay can potentially jump queue.

(Quotes from CNA 24.3.09 -

nofearSingapore said...

Hi anon,
I am a doctor. I really empathise with chronic renal failure patients.
But there are many much better says of increasing the supply of kidneys.
We could have got a registry of kidney sufferers and prioritise them according to urgency of need and also have a separate registry of donors. Donors do not know who they donate to and are paid according to a what a neutral committee deems as appropriate reimbursement ( for loss of income/ medical expense due to donation).
In this way, the queue is really shortened.
For local donors- I see less problems as it is easier to calculate what is fair compensation but foreigners ( both recipient/donors) is a black hole.

Now the foreigners come and go and usually they already have designated donors and the recipients are non-Singaporeans. They are actually medical tourists and come here because back home, non-related recipient-donor pairings are not allowed as there is suspicions ( with good reasons) that there is monetary induccement.
So now we have put away ethics and anyone can come and do operation here and private hospitals and surgeons and singapore tourist board and hotels will be very happy.
Only stubborn docs who still cling to old values ( like myself) are upset.
I am stupid to be so upset. Just let the world do what they want. It's their lives and organs. Let them sell or buy.

Anonymous said...

Hi Dr Huang, I saw your forum letter today.

I think your concerns are legitimate and valid. I'm not sure if your blog has a piece elsewhere regarding your opinion on the topic?

We could have got a registry of kidney sufferers and prioritise them according to urgency of need and also have a separate registry of donors.

So what will motivate the donors to come forward and submit their names to this registry? I know little of this donor thingy, but my guess is that patients will usually ask their family members or relatives to help them. In this registry of living donors, all of them are possibly just family members or relatives - some patients may get matches - but the pool of supply is doubtfully sufficient.

I am stupid to be so upset. Just let the world do what they want. It's their lives and organs. Let them sell or buy

Err, I'm just a young, inexperienced guy. But I do know lives and organs cannot anyhow play. However, people respond to incentives - and if a regulated market protecting both donors and patients is created, then why not? (I'm not referring to the current amendments)

11:46 AM, March 27, 2009 said...

You are one of the very few good humane doctors left. The rest are, from my first hand experience with them, only doctors by occupation.

nofearSingapore said...

Hi Aloysius,

I enjoy reading your stuff on economics.

About motivation- believe or not, there are good people out there who will donate their kidney for free. There are already people elsewhere ( but almost unheard of in S’pore) who would donate these organs to total strangers because they want to do good. I know in materialistic S’pore we think this is so stupid but there are such people. So if we can promise these people that our system will support them with life-long medical treatment if they part with one of their kidney, we may indeed increase supply.

The more likely source of increased supply may come from the matching-exchanging thingy where Relative A wants to donate to Recipient A but cannot because of in-compatibility. But if Relative A’s kidney to compatibility to Recipient B whose Relative B is compatible with Recipient A then we can match them and we have 4 happy people. This chain can of course go on for many links and more people can be happy. We should have explored this more before opening the door to organ-trading.


Thank you for your kind compliments.

I also know many very good doctors ( in both private and public hospitals) who work hard and treat all patients rich or poor/ locals and foreigners equally. We often give discounts to poor patients ( sometimes even FOC- but don’t tell too many people or else we can’t support our families).

Please tell your friends that doctors are human too and we have compassion for all people. If not, most of us would not have studied medicine.

Anonymous said...

Okay, I will tell my family and friends that there are still many good doctors around.

Regarding discounts, yes, I know of one such doctor. And definitely, we should not take advantage of kind-hearted doctors if we can afford.

I hope the government will take heed of your concerns and recommendations.

May you be blessed abundantly in return!

Anonymous said...

I highly suspect the government would implement a tax on those donors who get money from where/whoever. This way, they can say foreign "donors" are still taxed for the local system. Then obviously they will neglect how the local, truly altruistic donors get "ripped off".

Anonymous said...

Hi Dr Huang, thank you for your encouragement (:

So if we can promise these people that our system will support them with life-long medical treatment if they part with one of their kidney, we may indeed increase supply.

I see the rationale behind this, but doubt it will increase supply sufficiently to match demand. On the whole, the avg S'porean has more to lose from the entire kidney donation process than to gain. Hence the current amendment which did not 'discriminate' against foreigners is a quiet recognition of this, and also the fact that there are poorer people from our neighbours who are willing to sell their kidneys.

For the paired-matching amendment to HOTA, it will definitely go a long way in increasing supply. Similar to your suggestion, MOH is setting up a registry for these willing donors, often the relatives of patients.

Personally I think this step is not as effective as increasing supply through a legalised and regulated market. We'll probably see the results in a few years'time...

sgcynic said...

Khaw Boon Wan:
"Let us not grudge somebody who is able to secure an altruistic donor because once he is out of the waiting queue, he benefits everybody else."

I don't subscribe to this argument. There is no queue for anyone with money. "Compensate/reimburse" enough, and you can find an "altruistic volunteer" to donate his kidney. How does this scenario "benefit everyone else"?

CinCinnati said...

chanced on ur blog cuz was doing research on HOTA and right to life for my presentation.

I'm a nurse, and I do agree with what u said. The demand for organs, especially kidneys, is too high. With such a law being passed, I'm not too optimistic about the outcome. This will, to a certain extent, be misused by the rich. (of cuz i'm not saying the rich will ALWAYS be the one misusing it!) Just like the saying, the rich gets richer, the poor gets poorer. So those with monay can be top of the priority list while the poor will be lower and lower, just because they don't have the money to "reiimburse" those "altruistic donors"? I don't think the govt will be very happy with that.

Look at Tang WS's case. The donor was a 27yr old Indo man. 27 yrs old and the thought of selling his organs for money is there. What more can we say? The adverse effect of this is really scary.

I think ur idea of a registry is absolutely great. I'm not sure if u're aware of the bone marrow donor programme. It works just like ur suggestion of using a registry. People just need a finger prick sample of blood and a questionnaire to be registered. If the need arise, they will contact the donor. It's usually done in blood donation drives. Simple, yet there's no things like "tissue trading" involved.