IT is an issue that has divided patients, their families, doctors, lawmakers, ethicists and just about anyone who feels strongly about it.
Supporters of legalising organ trading say it is a no-brainer: Why not do it if it can save more lives?
Please, get real, no one is going to give a stranger his or her kidney for free, they argue.
Critics decry organ trading as unethical. They insist donors should do it out of the goodness of their heart.
Which way should Singapore go?
But does it always have to be narrowed to a zero-sum game - either pure altruism or financial reward?
Perhaps not, Health Minister Khaw Boon Wan revealed in Parliament yesterday.
He said he would sometimes get requests from charities and religious bodies who want to offer 'some compensation, in kind and in cash' to organ donors and their families to 'acknowledge their altruistic act'.
But the organisations would worry that their gestures might be seen as organ trading.
Mr Khaw said: 'My view is that we should encourage third parties, especially those from the charity and religious sector, to help promote altruistic organ donations, and that we should consider how they can be allowed to provide some financial compensation to the donors and their families after the transplants have taken place.'
Yes, push altruistic organ donations to their 'maximum potential', and let living-related kidney donations and those done under the Human Organ Transplant Act to still be the 'predominant sources' of kidney transplants.
But don't rule out organ trading, Mr Khaw added.
'If altruistic organ donations cannot fully meet the demand, we should continue to search for good complementary solutions,' he said.
'We should not reject any idea just because it is radical or controversial.'
Can legalising organ trading be the answer to our kidney donation woes?
Mr Khaw said: 'By forcing ourselves to think about unconventional approaches, we may be able to find an acceptable way to allow a meaningful compensation for some living-unrelated kidney donors, without breaching ethical principles and hurting the sensitivities of others.'
And perhaps it is time we get real, he said.
After all, there are desperate patients out there who want to live, and also desperately poor people willing to exchange a kidney for a better life.
'This is the reality and the human dilemma confronted by many in such desperate situations,' Mr Khaw said.
'Criminalising organ trading does not eliminate it. But it merely breeds a black market with the middle man creaming off the bulk of the compensation which the grateful patient is willing to offer the donor.'
WHAT PRICE ALTRUISM?
So, will putting a price on altruism work in Singapore?
It may still take some time before the Government reaches a decision.
For now, the Health Ministry will push to amend some other existing laws on organ transplants.
First, by removing the age limit of 60 years old on cadaveric donors.
Mr Khaw said: 'Many countries, including Spain, do not set such an age limit. The suitability of the organ depends on its condition, rather than the age of the donor.'
Second, by allowing pair-matched donations here.
This means that if patient A's donor does not match A and patient B's donor does not match B, they can switch donors if there is a match that way. A live donor registry will be set up to facilitate this.
With the two initiatives, Singapore can aim to raise its kidney sufficiency level from 50 to 70 per cent in the medium term.
What about those who have broken the law?
Mr Khaw said: 'Even as we take action against those involved in illicit organ trading and unscrupulously exploiting the desperate and the vulnerable, we will take a sympathetic approach to the plight of the exploited donors and the basic instinct of kidney failure patients to try to live.'
This story was first published in The New Paper on July 22, 2008.
