HUMAN ORGAN TRANSPLANT ACT (Pledging of kidney by Muslims)

[Mr Speaker in the Chair]

Mr Imram bin Mohamed asked the Minister-in-charge of Muslim Affairs whether a Muslim is permitted to pledge his kidney under the Human Organ Transplant Act (HOTA) when it contravenes the Fatwa or Edict by the Majlis Ugama Islam Singapura dated 25th August 1994, issued in relation to the "living will", which requires three specialists to certify a patient to be brain dead whereas the HOTA requires only two medical practitioners.

The Minister-in-charge of Muslim Affairs (Mr Abdullah Tarmugi): ( In Malay): Mr Speaker, Sir, a Muslim is permitted to pledge his kidneys under section 3 of the Medical (Therapy, Education and Research) Act and not under the Human Organ Transplant Act which is an opting-out legislation. Also, the removal of kidneys under HOTA does not apply to Muslims.

For kidney removal, the following procedure is to be observed:-

i) The diagnosis that the patient is brain dead has been made by the doctor-in-charge.

ii) The death of the donor shall be certified by two medical practitioners:

a) who do not belong to the team of medical practitioners which will effect the removal of the organ from the body;

b) who have not been involved in the care and treatment of the proposed recipient of the organ; and

c) who possess such post-graduate medical qualification which is recognised by the Director of Medical Services as a qualification entitling them to certify death.

The situation here is that the person (donor) is already dead.

The "living will" or Advance Medical Directive (AMD) is effected when the patient is still alive but terminally ill. In this case, as the person is alive, there is a built-in safeguard that three specialists have to certify that the patient is terminally ill before the patient's AMD is effected. The Fatwa Committee of MUIS rules that it is permissible to suspend the life-sustaining treatment on the condition that the certification of terminal illness with no chance of recovery is made unanimously by three specialist doctors.

Under the Medical (Therapy, Education and Research) Act, the kidneys can only be removed from the patient when he is certified dead by the specialists. The question of the removal of kidneys does not apply in the administration of AMD.

Mr Imram bin Mohamed (Nominated Member): Sir, I would like to seek clarification. If a Muslim is involved in an accident and lapses into a coma and is hooked on to a life-support equipment but subsequently he dies and he has opted in under the Human Organ Transplant Act as well as the living will, which procedure would be required? Would three specialists be required to pronounce him brain dead and remove the equipment or just two medical practitioners are required?

Mr Abdullah Tarmugi: ( In Malay): In such a situation, the doctor who is responsible for the patient and two experts will certify that the kidney may be used for transplant. The person has passed away as a result of an accident and did not die due to the withdrawal of life-support equipment, in this case he is certified as already dead.

Mr Imram bin Mohamed: If the person did not sign the living will, will the requirement then be different?

Mr Abdullah Tarmugi: Sir, the question was whether if a person dies as a result of an accident and the person had a living will and had opted in to pledge his kidney, would he require three experts or the number of doctors as required under the Medical (Therapy, Research and Education) Act. In this particular instance, Sir, the person died not because of the stoppage of life-support equipment. In other words, he died naturally as a result of an accident. Therefore, the ability of the person to donate his organ will depend on the Medical (Therapy, Research and Education) Act. There are two different issues here. You cannot mix the two, in other words.

Mr Imram bin Mohamed: I am still not very clear. The AMD covers all manners of death, including death by accident. So we could have a common situation where the victim has pledged his kidney and now you need a specialist to certify him brain dead. Do you require two or three specialists?

Mr Abdullah Tarmugi: The AMD refers to persons who are terminally ill and who have not died yet. The person whom the Member is referring to has already died because of an accident. There are two different issues.