Here are excerpts of Health Minister Khaw Boon Wan's Human Organ Transplant (Amendment) Bill-Closing Speech

1. Remove Upper Age Limit

All supported the proposed lifting of the HOTA age limit for cadaveric donors. Dr Lim Wee Kiak gave a good explanation of why healthy organs from elderly donors can remain suitable for transplantation.

He asked how we would assess the health of the organs in practice. We have an expert committee to help us on this. They have drawn up comprehensive requirements for the evaluation of potential donors. This will include a rigorous evaluation of the donor’s medical history and organ function before death, and where indicated, pre-implantation biopsy of the organ, to ensure that only healthy organs are used for transplantation.

2. Allow Paired Matching

All supported the proposal to allow paired matching. Dr Fatimah called for the establishment of a “systematic, proactive and well-organised living donor registry” to support paired matching. I agree. The National Organ Transplant Unit of the Ministry of Health will take charge of this.

The same unit will also take charge of setting up a Donor Care Register to monitor the health of the donors. The proposed register will help us track long-term clinical outcomes and allow us to better understand the long-term impact of organ donation, if any.

3. Allow Payment for Living Donors

Organ trading still illegal

Let me reiterate that this Bill does not legalise organ trading. Our Bill in fact contains an amendment to raise the penalty on syndicates involved in organ trading.

The Bill is to catch up with what many OECD countries have already done for many years. In drafting our amendments, we took reference from similar legislations in several of these countries. We are correcting our current extreme position of criminalising all kinds of payment to the donor.

For example, currently donors are charged by the hospitals for all their transplant-related medical and surgical expenses. The recipients are prevented by HOTA from reimbursing the donors for these expenses. The proposed amendments will bring us in line with jurisdictions such as the US and UK to allow some payments to be made to the donor.

Not compulsory to reimburse living donors

Let me also clarify that we are not making it compulsory to reimburse living donors. We are merely allowing organ recipients, if they wish, to make some payment to cover the financial losses incurred by their donors.

This would address the concern of some members that low income recipients may not be able to afford such payment.

I must also explain that reimbursement only applies to living donors. It does not apply to cadaveric donation where allocation of organs will continue to be based on tissue matching, time on the waiting list and other clinical factors as objectively determined by an expert committee.

Safeguards against organ trading

First, we have a system for donor evaluation and selection to ensure that only healthy and suitable donors are selected. This is the first important step as the health of a living donor after organ donation is dependent on his health prior to the surgery. We require all transplant centres to have a system in place for this.

We will go further and we are now working with the expert committee to formalise a set of best practice guidelines for the medical and psychological evaluation of all potential donors.

Second, we have a system for informed consent established under the Human Organ Transplant Regulations, to ensure that the donors fully understand all aspects of the donation as well as the implications of becoming a living donor.

Third, every living donor organ transplant is subjected to a review by a hospital transplant ethics committee, whose job is to ensure that the donor is free from any undue influence, coercion, emotional pressure or financial inducement.

Fourth, my Ministry will closely monitor the processes of these transplant ethics committees by requiring the hospitals to submit the relevant data after every transplant. We will conduct regular audits to ensure that these ethics committees fulfil the legal requirements in evaluating transplant applications and comply with our guidelines.

Fifth, we have an enforcement system to detect fraudulent practices.

Challenge posed by foreign donors

Mdm Halimah was worried that the current recession would expose many poor foreign workers in Singapore to temptation and they would become easy target for exploitation by organ trading syndicates. Unfortunately, organ trading is happening in this region even as I speak. This Bill does not add to this phenomenon. The way to address this problem is better regulation and effective safeguards, as what we have proposed in this Bill.

There are ways to address this concern about the exploitation of foreign donors. For example if I were in the transplant ethics committee, I would be alert to representations by potential donors who are recently retrenched unskilled foreign workers and satisfy myself that there is no exploitation by the patient or an organ trading syndicate.

It is difficult to codify the assessment as each case will be different, but if the ethics committee is well briefed on the ethical principles and mindful of the potential for exploitation, it should be able to distinguish genuine donors with full informed consent from victims of exploitation.

Reimbursement to depend on cost of living

And clearly, in determining a reasonable quantum of reimbursement, we must take into account the vastly different costs of living here and overseas. When formulating quantitative guidelines for the hospital transplant ethics committees, we will prescribe a different and much lower reimbursement cap for foreign donors. This will not be discriminatory as the payment is for the reimbursement of expenses which is dependent on cost of living, not compensation for the value of the organs.

For the full speech, go to the Health Ministry's website at www.moh.gov.sg

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