Wednesday, April 08, 2009

Thanks Minister, I also do not want Singapore to be a rogue regime!

Hi Friends,

It appears that Health Minister Khaw Boon Wan has changed his mind about including foreigners in the organ donation scheme.

The Straits times mentioned that “Only Singaporeans will be reimbursed for donating a kidney.” And that “Payments will be extended to foreigners only when there is enough confidence in the scheme, said Health Minister Khaw Bonn Wan yesterday.”

Mr. Khaw even said “We don’t want Singapore to be a rogue regime.”

This was one of the major sticking points for me as this potentially allows for legalized organ trading. ( read my post on this here) As mentioned elsewhere, I am not against reimbursing donors for expenses incurred as a result of this truly altruistic act.

If we include foreign donors into the scheme, we are unable to monitor the donor back in their homeland and we do not know where the money goes to and we are never sure that the money from the recipient really went to help defray expenses only.

This money could have been attractive enough to act as an inducement for the donor.

I know from conversations online and offline, that some people think that this is just demand and supply economics and I should not have made a big deal of it.

However for me and I think for much of the medical community, medical ethics is just as important as economics in this issue.

Anyway, I don’t expect everyone reading this to get it. Never mind.

Nevertheless, I am glad that Minister Khaw has come to his senses about this.

I might have supported him for the HOTA amendment if this was the case in the first place.

BTW, other positive aspects which he mentioned at the 40th anniversary celebrations of the NKF yesterday included:

Safeguards such as:
1.Thorough screening including psychological assessment to exclude exploitation.

2. Cooling-off period which is good as we do not want “pressure-selling” ala "time share" scams.

3. Kidney donors to be reimbursed through third party and payment partly into Medisave Top-ups (read here)

Also, Kidney patients will get travel subsidy. They should get all the help they need.

Dr.Huang Shoou Chyuan

Link: 1.Gigamole: Human Organ Trade- a nuanced approach
2.Gigamole: Human Organ Trade-Agree or disagree?


Anonymous said...

Doesn't make any difference. The rich can still exploit the poor here. Rich patients can still jump queue.

nofearSingapore said...

Ideally there should be 2 queues- one of kidney sufferers and their place in the queue is based totally on severity of kidney failure and the other queue made of willing donors.
The first willing donor's kidney should go to the first one in the recipient queue unless there is incompatibility and if this is so, the kidney goes to the next compatible recipient.
The pool of money comes from recipients ( pay as much as you can afford and from general public's donation) and the money never directly goes from specific recipient to specific donor. So in this case, the rich cannot jump queue. The only way for rich to jump queue is to take risk by doing transplant in China or those other countries.

Anonymous said...

Dr Huang, if what you mentioned about the 2 queues is adopted, then it will make a difference.

I was referring to the Minister's statement about excluding foreigners. Singaporeans or foreigners, they are still human beings.


nofearSingapore said...

Hi anon (12 MN)
If you really want to include foreigners ( to increase supply but yet not cause inducement), allow only foreigners in countries where there is ethical medical system and perhaps where there is a Singapore-associated hospital (SAH).
This SAH could be a branch of Parkway etc these SAH in Malaysia/Indonesia/India will be the point of treatment and for verification of how the funds are disbursed to defray expenses for medical treatment resulting from kidney donation.
Expenses verifiable so less danger of misuse of funds
Expenses will be lower than in Singapore hospitals
Increased numbers of donors ( population more than Sg's)

Anonymous said...

Hi Dr Huang,

However for me and I think for much of the medical community, medical ethics is just as important as economics in this issue.

Anyway, I don’t expect everyone reading this to get it. Never mind.

Hmm I do understand your concerns on medical ethics. But from an utilitarian perspective, those who require organ transplants deserve to be helped, and it seems a regulated organ trading market is best in raising their welfare.

Anonymous said...

George says,

There is more than one way to skin a cat. leaving out foreigners would basically narrow down the availability of suitable donors. Why do this? Why be half-hearted?

Reimbursement rates for various expenses can be easily worked out when pegged to a certain level of care. Does it really matter that a donor is from a foreign country and in all possibility a country that is 'poorer' than this place. Why is there any objection to paying the foreigner those reimbursement if the local authorities have done their sums and come up with a figure or figures? Why object, if the foreign donor ended up being able to stretch the payment further because of lower living cost in his home country? Can you be so fastidious about matters to such a nitpicking level?

nofearSingapore said...

Hi George,

So you think I am fastidious and being nitpicking if I insist on safeguards such that the money paid to donors is really for reimbursements as allowed in the legislation?

Perhaps you think that there should be no safeguards at all?
Why am I so fussy and difficult?

Like I said, I don’t expect some of you to get it.

clickTRUE said...

i am really impressed of him as an artist and as a person! a talented one