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.

Cheers
Dr.Huang Shoou Chyuan

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

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