HUMAN ORGAN TRANSPLANT ACT (Progress of Implementation)

14 Sep 2009

Question No:  44  

Question

Name of the Person: Mr Christopher de Souza

To ask the Minister for Health (a) what is the progress of implementation of new regulations under the amended HOTA; (b) whether the regulations will provide caps on the reimbursement amount for an organ such that the donation is done for altruistic reasons; (c) how will the regulations ensure that the reimbursement is not an inducement to donate organs; and (d) if the regulations will state the formula by which the quantum of reimbursement is calculated.

Reply

Reply From MOH

There are 4 major amendments to HOTA and we are at different stages of implementing them.

The first amendment is to lift the age limit on cadaveric donation. We have launched a large scale mass-media campaign, to inform Singaporeans about this amendment. This included newspaper and TV advertisements, brochures and posters in many public venues. We have mailed to all households the new HOTA booklet containing the information about the HOTA changes, in 4 languages. We have amended the HOTA forms for opting-out and withdrawal of objection; they came into effect on July 1. We have also gazetted the regulations setting the implementation date at 1 Nov 09.

In reciprocity to this amendment, we have lifted the age limit for patients on the waiting list for organs. We no longer remove patients from the waiting list when they reach 60.

The second amendment is to allow paired-match transplant. If suitable cases come along, we will allow it. So far, we have not received any such request yet. We do not expect many cases, but to ensure the best chance of realizing this, we have established a standard protocol and a national database to facilitate the paired matching.

The third amendment is to raise the penalty on organ trading syndicates. We are working closely with hospital transplant ethics committees (TECs) and will continue to maintain vigilance over this. We will not hesitate to bring culprits to court.

The fourth amendment is to enable organ recipients to reimburse the expenses incurred by their donors, if they wish to do so. The hospital TECs play an important role in ensuring ethical transplants. For each transplant application, they will have to review the mode, categories and the nature and quantum of any payment amount to satisfy themselves that there has been no inducement of or coercion on the donor. The declaration forms are legal documents submitted by the donor and recipient stating that no inducement or coercion is involved. They include the declaration of any arrangement by the recipient for reimbursing the donor’s expenses. It is an offence to submit any false or misleading declaration.

After consulting the National Medical Ethics Committee, MOH has revised the current set of guidelines for living organ donation. All TECs shall abide by the guidelines.

Meanwhile, we are reconstituting the TECs to include new members and more perspectives. At our invitation, many prominent citizens have agreed to join the panels, including a couple of our parliamentary colleagues.

We will be providing the TEC members appropriate training to help them conduct their assessments. The NUS Centre for Biomedical Ethics will be organizing these sessions on a regular basis. The Centre will also provide a platform for the TEC members to meet regularly and share their experiences, compare notes and learn best practices.

We have further refined the TEC approval process. If a case is approved by a TEC, the approval shall be valid only for 60 days, as circumstances can change and the justification on which the TEC made its decision may no longer be valid. If a case is rejected by the TEC, the rejection will be binding on other TECs. The case can only be reviewed after approval by MOH to do so. We have also imposed a mandatory cooling-off period of 1 week between TEC approval and the transplant surgery. This is to ensure that the donor has sufficient time to carefully consider his decision before taking this significant step.

Live organ donation is a serious decision. For the donor to make a fully informed choice, the transplant team must make sure that every donor is told about the risks involved. In addition to receiving a rigorous medical fitness evaluation, every donor will be counseled about the medical, psychological, social and financial aspects of the donation. The TEC must be satisfied that the donor demonstrates a good understanding of the organ donation process and its implications.

The National Organ Transplant Unit will provide independent donor advocacy. All potential donors will have access to relevant information so that they know what to ask their doctors, what are their rights and the provisions for their welfare. In addition, there will be a donor hotline to be manned by the Organ Transplant Unit for any queries by donors or their families.

Although donation surgery is safe, no surgery is 100% risk-free and there can be complications, which will require further treatment. Therefore, we will advise all donors to have medical insurance protection if they have not already done so.

Finally, Mr De Souza asked if the regulations will state the formula by which the quantum of reimbursement is calculated or include a cap on the maximum amount. We had a full debate on this particular point in this House. I do not intend to go through the arguments again. Let’s get the amendments implemented and as we gain more experience, we will see if we need to further revise our regulations.