HOTA will follow sound ethical principles

20 Mar 2009, The Straits Times

Question

Name of the Person: Professor E Kesavan

President

Singapore Urological Association

Concerns over proposal to reimburse organ donors

THE Singapore Urological Association is a professional society representing specialist surgeons. Many of our members are directly involved in renal transplantation and the care of kidney failure and kidney transplant patients.

We commend the Ministry of Health's efforts to amend the Human Organ Transplant Act, with the intention of increasing the number of transplants.

Our association fully endorses the proposed amendments to lift the upper age limit for cadaveric donors and to allow donor-recipient paired matching as these are medically justified.

The amendment to support the welfare of living donors by allowing them to be compensated seeks to reimburse donors for expenses incurred through their altruistic act, including loss of earnings, transport costs and possible future medical expenses.

But this amendment raises the following concerns:

The proposed amendment currently before Parliament would allow for monetary payment of the donor for such costs. There is a real risk of manipulation by the indirect inclusion of financial inducements for the donor, in the guise of loss of earnings and potential medical costs, to inflate the amounts payable.

The provision for 'lump sum' compensation for potential medical expenses is problematic. The amounts of such expenses are, at best, uncertain; calculations of future health insurance premiums for the donors will be difficult.

It may be preferable to provide for such costs within Singapore's health-care framework. An example would be to issue donors with a medical benefits card that would cover related medical issues.

The ministry may also wish to consider wider medical coverage, given the potential problem of future insurability of the donor.

Having 'lump sum' compensation would be inappropriate for donors from foreign countries, as they will have no access to the Singapore health and legal systems once they return to their countries of origin. There will be little guarantee that any money paid will be used for its intended purpose. It will also negatively affect Singapore's international standing as a medical hub with high ethical standards.

We therefore recommend that the above amendment be restricted to Singaporeans and Singapore permanent residents.

The question of financial compensation for the donor remains a difficult ethical and practical issue, and should be tailored to the specific situation in Singapore. We hope these concerns are taken into consideration in the implementation of the proposed legislation.

Reply

Reply from MOH 

Prof E Kesavan and the Singapore Urological Association supported the proposed amendments to HOTA, but expressed “Concerns over proposal to reimburse organ donors” (ST, Mar 19). 

We are mindful of the underlying concerns. The main purpose behind this proposal is to be fair to donors, whether locals or foreigners, so that they do not suffer additional financial losses as a result of their altruistic act. In drafting the amendments, we have ensured that our position is compatible with sound ethical principles.  We will work closely with the Hospital Transplant Ethics Committees on implementation.