NUMBER OF SUCCESSFUL ORGAN TRANSPLANTS RESULTING FROM HUMAN ORGAN TRANSPLANT ACT (HOTA)

14 May 2013

Question No. 1083

Name of Person: Mr David Ong Kim Huat

Question

To ask the Minister for Health (a) what is the process which an aggrieved family goes through when their loved one is declared "brain dead" for the Human Organ Transplant Act (HOTA) to take effect; (b) what more can be done to manage such extremely emotional situations; (c) what can be done to better communicate and raise the awareness of HOTA; (d) what is the success rate of organ transplants since the implementation of HOTA; and (e) if the number of beneficiaries is small, what are the key issues rendering HOTA ineffective.

Answer

Death, whether from an accident or from illness, is a tragedy for the family.  We empathise with families who lose their loved ones, and are undergoing an emotionally draining time.  The interests and well-being of our patients and their families are assured through stringent processes laid out in the Human Organ Transplant Act (HOTA) and the procedures adopted by each hospital.  While our doctors and medical team, counsellors and transplant co-ordinators try their best in every case, we understand that we can always do better to engage each family.

As a society, we forged a consensus in the provision of HOTA, to provide for an opt-out organ donation system that allows for the removal of kidneys, livers, hearts, and corneas from Singapore citizens and permanent residents who have died, for the sole purpose of transplantation.  Organs retrieved are transplanted to bring new lease of life to patients suffering from end-stage organ failure. Currently, there are more than 500 organ failure patients on the waiting list for various organs. With the help of HOTA, cadaveric donations have benefitted more than 850 patients between 1987 and end 2012.

Under HOTA, the issue of organ donation is only considered and brought up for the family’s attention after the patient is certified as brain dead.  Brain death is diagnosed only when there is catastrophic irreversible brain injury and is determined according to strict clinical criteria, similar to those adopted in countries such as the United Kingdom and Australia.  When brain death has occurred, blood flow and oxygen delivery to the brain ceases irreversibly and all brain functions are lost and will never return again. 

Certification of brain death is done by two independent doctors.  Neither of them has been involved in the care and treatment of the patient, or in the subsequent transplant.  This independence ensures that the diagnosis is made on the basis of professional criteria benchmarked to international best practice.

After brain death has been certified, the patient’s status as an organ donor would be verified against the Organ Donor Registry. If the patient has not objected to organ donation previously, in accordance to HOTA, the wishes of the patient to donate his or her organ after death must be upheld. 

The transplant coordinator from the National Organ Transplant Unit and physician in-charge would approach the family, as sensitively as they could, to share with them about the patient’s decision as an organ donor and also explain the process.

In situations where families have concerns about the donation of organs by the deceased, the transplant coordinators, social workers, and medical team would give the family more time. The doctors in the hospital have been trained to communicate empathetically and sensitively with the family members on issues related to organ donation.  They would meet up with the family to listen to their concerns, clarify any related issues that they may have, explain the legal requirements under HOTA and the process involved, as well as provide emotional support and active counseling to the family.  

Due to potential instability in the brain dead patient, the process is extremely time-sensitive, and we aim to recover the donor organs within 24 hours after certification of brain death. Beyond a certain time frame, the organs may no longer be suitable for transplantation. Wherever possible, our doctors accommodate a family's request for some additional time to grief and to address their concerns.  

We need on-going efforts for the life-saving and life-changing benefits of organ transplantation to be better understood and embraced by our people. The Live On campaign was first launched in 2008 to increase public awareness.  Over the past five years, we have had periodic campaigns and publicity to spread awareness about organ donation. We will continue to evolve our approach to engage Singaporeans about this important topic.  My Ministry will work with the community to strengthen outreach and engagement efforts to enhance public awareness on organ donation.