Proposed Amendments To The Human Organ Transplant Act

25 Aug 2007

Following the recent ruling by the Fatwa Committee of MUIS that Muslims can be included under the Human Organ Transplant Act (HOTA), the Ministry of Health intends to amend HOTA to improve the access of Muslim patients to donated organs. HOTA allows for the removal of kidney, liver, heart and cornea upon death for transplant purposes, from Singapore Citizens and Permanent Residents between the ages of 21 and 60 years, unless the individual has registered an objection. Presently, Muslims are not covered under HOTA and have to opt in under the Medical (Therapy, Education and Research) Act (MTERA) for organ donation.

At the same time, MOH intends to introduce enforcement powers to investigate offences under HOTA.

MOH will conduct a 6-week public consultation (25 August 2007 to 5 October) to obtain feedback on:

1) the inclusion of Muslims under HOTA; and

2) the provision of enforcement powers to investigate offences under HOTA.

Proposed amendment to include Muslims under HOTA

MOH proposes to amend the HOTA to include, upon death, Muslims who are Singapore Citizens and Permanent Residents (PR) between the ages of 21 and 60 years, who are of sound mind, and who have not opted out. The inclusion of Muslims under HOTA is expected to provide up to five additional organ donors per year (yielding up to 10 kidneys, 10 corneas, 5 livers and 5 hearts).

A larger pool of donated organs would benefit the entire community. For Muslims patients, it means enhanced access to donated organs as those who require an organ transplant will enjoy equal priority for organ transplants as all other Singaporeans who have not opted out.

When HOTA is amended, all eligible Singapore Muslim Singaporeans and PRs will be notified of the changes and they will be able to opt out if they wish. 

Disease burden among Malays

Statistics obtained in 2006 showed that the disease burden of end-stage kidney failure among the Malays, the majority of whom are Muslims, is disproportionately higher than in other races. Of the new cases of end-stage kidney failure, 22% were Malays although they made up only 14% of total resident population. [1]

In 2006, the main cause of kidney failure in Singapore was diabetic nephropathy (severe kidney disease caused by diabetes mellitus) which accounted for 58.9% of new end-stage kidney failure cases. The 2004 National Health Survey reported that an estimated 11% of Malays have diabetes mellitus compared to 7% of Chinese and 15% of Indians.

In 2006, Malays made up 21% of the total number of patients on the kidney waiting list.  However, in the same year, only 16% of transplanted patients were Malays.

Revision of Enforcement Powers Under HOTA

As part of the amendment, MOH proposes the provision of enforcement powers to give MOH the authority to investigative offences under HOTA. Trading in organs and blood, carrying out living donor organ transplants without the authorisation of the Transplant Ethics Committee, and disclosure of confidential information obtained under the Act, are examples of some of the acts prohibited under HOTA. MOH currently does not have the full enforcement powers to properly investigate such offences.

It is therefore proposed that HOTA be amended to provide MOH with suitable powers of investigation in these key areas of enforcement:

Providing for the appointment of inspectors to conduct investigations under HOTA;

Empowering inspectors to enter premises and to inspect, search and seize evidence;

Providing inspectors with powers to examine witnesses and to secure their attendance;

Permitting authorised inspectors to arrest persons suspected of committing offences under HOTA;

Protecting the identity of informers who furnish MOH with information relating to possible offences under HOTA;

Permitting disclosure of information which may disclose the identities of organ donors and recipients for the purpose of administering and enforcing HOTA, and for the purpose of referring a complaint or information regarding any medical practitioner to the Singapore Medical Council for the purposes of disciplinary action.

Public Consultation

The Ministry of Health would like to obtain public feedback in the following areas:

Should HOTA be amended to include Muslims to enhance their access to donated organs?

Should HOTA be amended to provide MOH with powers to investigate HOTA-related offences?

All feedback should reach the Ministry by 5 October 2007.

The Ministry will also be conducting dialogue sessions with the Muslim community on the 25th, 27th and 29th Aug 2007.

References:

Public consultation on the proposed amendment to HOTA - English

Public consultation on the proposed amendment to HOTA - Malay

Draft HOTA (Amendment) Bill

The Human Organ Transplant Act - FAQs

Brain Death – FAQs

The Human Organ Transplant Act and Brain Death FAQs - Malay

The Human Organ Transplant Act and Brain Death FAQs - Tamil

[1]Resident population refers to all Singapore Citizens and Permanent Residents.