HOSPITALS' ETHICS COMMITTEES ON ORGAN TRANSFERS

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HOSPITALS' ETHICS COMMITTEES ON ORGAN TRANSFERS:

(Functions and duties): 14.

Mr Hri Kumar Nair asked the Minister for Health (a) what standards are expected of hospitals’ ethics committees in discharging their functions and duties in reviewing applications for organ transfers; and (b) whether the Ministry intends to review past organ transfers to ascertain if the relevant hospitals' ethics committee have properly discharged their functions and duties.

The Minister for Health (Mr Khaw Boon Wan): Sir, the Transplant Ethics Committee's primary function is to ensure that a living donor has been fully informed of the nature and the risk involved in the proposed transplant surgery, and that his consent is given freely and not under duress or for any financial gain. They discharge this function through a thorough review of the medical and social history of both the donor and the recipient, the submitted personal documents and statutory declarations. They would also conduct separate

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interviews of the donor and the recipient, before they come to any conclusion on the application. If the Committee has any doubt, they should not approve the transplant. If there is evidence of misconduct by any Transplant Ethics Committee, my Ministry will investigate. As the current cases are still before the courts, I should not comment further on them.

Mr Hri Kumar Nair (Bishan-Toa Payoh): Sir, I thank the Minister for his response. I have two supplementary questions. First, is the Minister aware of the Sunday Times' article, following the sitting last month, highlighting a village in a foreign country, where a good number of inhabitants had traded their organs and had operations in Singapore, in particular, highlighting a case where a farmer gave up what he thought was his heart to someone he had never even met before? Second, would such cases not indicate that the procedures currently adopted by the Ethics Committee are not robust enough to ensure that donations are all bona fide ?

Mr Khaw Boon Wan: Sir, in my many years in the health care industry, I have yet to hear of live donations of the heart. But I certainly have read the article about this village, I think in Medan, of people who sell parts of their bodies in exchange for money, and quite pitiful cases. In fact, next month, because I have to go to Manila for a WHO meeting, I am also planning a side trip to one of those villages, where there have been quite a number of those donors.

The recipients may not necessarily be in Singapore but these are donors who, for various reasons, were financially desperate enough to have to part with their kidneys. I intend to have a chit-chat with them to find out what happened after surgery.

I had shared with Members in this House last month that I intend to set up a

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proper donor registry so that we can focus on how to protect the welfare and also monitor the health of live donors, including family members of cadaveric donors, where donation is altruistically made. These are some of the most wonderful people on earth and I think society ought to find ways and means to protect the interest of them and their family members.

As to our own Singapore hospital ethics committee, whether it is robust enough, as I said in this House last month, the case is still before the court. Once it is fully wrapped up, we will see whether there are loopholes and, if there are weaknesses, definitely I will fix them. But I do not think we should be recalling cases just because there has been one case and conclude that every past decisions were flawed or wrong. Many of these volunteers are very experienced individuals and they volunteer their time to do a proper job, and I do not think we should assume that all of them have been negligent or there has been misconduct.

Mr Speaker: Mdm Halimah, last question.

Mdm Halimah Yacob: Sir, I would like to ask the Minister whether he does not as an inherent conflict – the fact that the ethics committee of the hospital is appointed by the hospital to approve the organ transfers and the operation is also done by the hospital itself? Is there not an inherent conflict in that arrangement? Could the Minister also share what is the practice in other countries, whether the same practice is adopted or a different practice is adopted to preserve the inherent integrity in the system?

Mr Khaw Boon Wan: Sir, I will take both supplementary questions together.

Indeed, the system we have here is not uniquely Singapore. It is a very common system adopted in practically all

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countries where we leave such decisions to the local hospital ethics committee. And, while there is potential conflict of interest, it can be managed. That is why the composition of the ethics committee is important. We have included members who are outside of the hospital and the individuals who are appointed include not just doctors but also non-doctors. It is not a system which must lead to conflict of interest as it can be managed properly.

As I have said, when we have fully wrapped up the current case, we will see whether there are better ways of doing it. There are options like whether we can have, say, a national ethics committee, which reviews all such cases. But this committee will then be inundated because today, I think, we are doing more than 120 transplants a year. Each case will require many rounds of interviews. The workload is already quite severe and we expect the transplant rate to rise, and we hope the transplant rate will continue to rise. I think the most practical way, as adopted in practically all other countries that I am aware of, is to leave the decisions to the local level but constitute the ethics committee properly. The ethics committee members do not report to the hospital. They report to their own conscience because, if I volunteer as a member in this committee, I know I have to discharge my responsibilities. In this case, it is quite straightforward – have the donors been properly informed, do they know the risk, and have they taken a decision purely based on altruism or is it under duress or being induced by financial compensation? So, their job is to try to make a judgement. But we know that in real life, if a person is determined to lie through sworn statements, it is not easy to pick up there and then. But dishonesty will be exposed, not immediately, but after a while.