TRANSPLANT OF HUMAN ORGANS (Legislation)

[Mr Speaker in the Chair]

Mr Tan Soo Khoon asked the Minister for Health if he will introduce legislation to allow for the transplant of human organs from living persons to recipients who are not related to one another.

The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, the current laws governing organ donation are the Medical (Therapy, Education and Research) Act (MTERA) and the Human Organ Transplant Act (HOTA). MTERA provides for an opt-in system for organ donations, whereas HOTA provides for a presumed consent system covering only kidneys from accidental deaths. Both laws are narrowly defined and refer only to cadaveric donations. My Ministry regulates living donor organ transplantation through professional guidelines. The existing guidelines allow living donors who are related.

Last year, MOH announced that it was prepared to consider living unrelated organ transplants. We have examined the regulations and practices of other countries that allow living unrelated organ donations and have worked out a set of ethical guidelines.

There are legitimate concerns about allowing living unrelated organ transplants. Firstly, there are risks to the donor from the procedure, particularly for organs such as the liver, where the risk of death or medical complications is significant. Secondly, there is a danger that healthy individuals may be offered financial inducements to donate their organs, thus creating the potential for organ trading.

MOH is therefore very careful in allowing living unrelated organ transplants. They would only be allowed under exceptional circumstances if they meet the following conditions:

(i) the medical condition must be urgent;

(ii) all options for organ donation by a living relative of the patient have been explored and found to be not possible;

(iii) the donor's motive must be purely altruistic, as established through a review by an independent psychiatrist and a medical social worker, and stated by the donor in a statutory declaration; and

(iv) the risks and the possible outcomes of the operation must be fully explained to, and accepted by, the donor and the recipient.

Another, and better, option to increase the availability of organs for transplantation is to raise the number of cadaveric organs. To achieve this aim, my Ministry is considering amending the Human Organ Transplant Act, such as including non-accidental deaths under the Act.

Mr Tan Soo Khoon (East Coast): Mr Speaker, Sir, rather than leave the matter to guidelines, which means a decision would then have to be made by, presumably, a Ministry official, would it not be practical to have legislation to permit the transplant of the organs, so that the decision is not a discretionary matter?

Secondly, could we also not, when introducing such legislation, take steps to ensure that it would be an offence to engage in the trading of organs?

Mr Lim Hng Kiang: Mr Speaker, Sir, as I have explained, today our two Acts, MTERA and the HOTA, cover only cadaveric organ transplants. All other transplants, particularly for related organ transplants, we have regulated these through professional guidelines under the Private Hospitals and Medical Clinics Act. Last year, we said that we were prepared to look at unrelated living organ transplants. As I also said in my reply, we are looking at the Human Organ Transplant Act, and we will be conducting consultations sometime towards the end of the year to gauge public reaction to our proposals to expand the Act. Right now, the main thing we want to expand the Act is, first, to cover from accidental death to non-accidental death. The second thing we want to put forward to the public to consider is to expand the scope of HOTA, to expand from just kidney to also include liver, and maybe even cornea. This is something that we want to propose and gauge public response. And, third, to be able to move from cadaveric transplants to living transplants. All these are being considered, and the best way forward, because the Ministry does not want to be too far ahead of community reactions to such changes, we will put these proposals up for consultation. We will then make the necessary legislative amendments after that.

Dr Lily Neo (Jalan Besar): May I ask the Minister how would his Ministry ensure that donors are not under emotional coercion, and that donors know the long implications of organ transplants, as well as the high medical risks of organ transplants, including death? And whether we should make it compulsory for donors to have psychological assessments or evaluation by psychiatrist, apart from being certified fit by doctors for an organ transplant.

Mr Lim Hng Kiang: I agree with the hon. Member that there are many issues involved, and that is why we are taking a more cautious approach before expanding the scope of organ transplants.

As I mentioned earlier, before we allow a living unrelated transplant, we require that the donor's motive must be purely altruistic, and that the donor must be reviewed by an independent psychiatrist, and not just a medical report that he is medically fit. So, we do have these safeguards in place for living unrelated donor.

We are also concerned about emotional coercion and that there could be a risk of financial inducements leading to organ trading. We could put in a clause - as we have in HOTA - to say that organ trading is illegal, but then we have to enforce it. There are many issues involved and, as I have said, we are putting up some proposals. We will do a fairly comprehensive public consultation, and we will then come back to the House later with our final proposals.

Mr Inderjit Singh (Ang Mo Kio): I would like to ask the Minister, roughly, how long will the review take and how soon can the changes be implemented.

Mr Lim Hng Kiang: Sir, our time-frame is to put up the consultation paper sometime at the end of the year and then, depending on how the public response progresses, we hope to come to Parliament probably early next year.