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 ©The
Star (Used by permission)
Insight Down South by Seah Chiang Nee
Some 600 sufferers below 60 years old are on a nine-year waiting list for a
transplant, many of them dying without getting it.
THE recent TV coverage of a man weakened by dialysis walking unsteadily to be
investigated for trying to buy a kidney has moved many viewers.
Tang Wee Sung, the 55-year-old executive chairman of retail company C.K. Tang,
was propped up on two sides as he staggered to meet his questioners.
Apart from kidney failure, he also suffers from high blood pressure and heart
disease. Tang has not been charged yet.
His plan was thwarted when his efforts to buy a kidney came to light. The
would-be Indonesian vendor was convicted for organ trading – together with a
fellow farmer – in a separate case.
A huge swell of sympathy was felt for the two Indonesian peasants when the
extent of their hardship back home was revealed in court. They were jailed for
two weeks and fined S$1,000 (RM2,300).
“These people had not committed any heinous crime. They were merely guilty of
trying to stay alive,” one dialysis sufferer commented.
They were unlucky. If they had waited a little longer their action could well
have become legal.
Selling or buying organs (or blood) is illegal in Singapore as in most of the
world, and carries a jail term of 12 months, or a fine of up to S$7,500
(RM17,900) or both.
In a surprising – and controversial – turn-around, Singapore now says it may
allow paying kidney donors, under certain conditions, to meet the dire need for
transplants.
This is a historic step and a turning point for the growing army of chronic
sufferers at home, and even abroad.
The republic could become the world’s second nation – after Iran – to allow cash
to be paid to kidney donors, a very controversial move.
The decision will probably stir strong criticisms amid fears that the rich will
exploit the poor and uneducated to take away a crucial body part.
Health Minister Khaw Boon Wan urged Singaporeans not to “reject any idea just
because it is radical or controversial”.
A devout Buddhist who hailed from Penang, Khaw said: “The reality is ... there
are many desperate patients out there wishing to live, and desperately poor
people willing to exchange a kidney for a hopefully improved life.
“We may be able to find an acceptable way to allow a meaningful compensation for
some living, unrelated kidney donors, without breaching ethical principles or
hurting the sensitivities of others.”
A roaring illegal trade has long existed in Asia for many years.
Thousands of desperate Singaporeans (and Malaysians) have bought kidneys for
transplant in countries like China and India and lived improved lives.
Some 600 Singaporeans below 60 years old are on a nine-year wait list for a
transplant, many of them dying without getting it.
This list could be longer if older people or the very sick are allowed to
register. Every year. The list grows by 1,000 new cases.
(This is despite the law that Singaporeans – including Muslims – will be
considered as having consented to donate their organs when they die, unless they
sign a form to opt out.)
“Patients on the list are about as likely to die than to receive a donated
kidney,” one official said.
The details of Singapore’s scheme are not known.
It will probably rest on two features: preventing profiteering and exploitation
of the seller and ensuring the post-operation health of both parties.
Singapore says it is studying Iran’s model, which has successfully reduced its
waiting list to zero.
This could be done through a central register, ruling out direct negotiation or
transaction between buyer and seller or the use of a middleman.
Instead, it will be channelled through a charity, like the National Kidney
Foundation (NKF), which will ensure adequate and prompt payment as well as the
health of the seller.
Iran’s system works in one of the two ways:
(1) The donor receives a fixed compensation from the state (US$1,200, or
RM3,900) plus limited health coverage for one year after the transplant, which
covers conditions deemed related to the surgery.
(2) A separate reward from the recipient, or if the recipient is poor, from one
or more charitable organisations (usually between US$2,300 and US$4,500, or
RM7,400 and RM14,600 .)
In materialistic Singapore, the amounts will be higher. For example, the two
Indonesians were paid about S$22,000 (RM52,500) each for their kidneys.
What about foreigners? The Teheran scheme keeps out foreigners, but Singapore
will likely include permanent residents since they are regarded as part of its
population.
At any rate, the new law could provide a big boost to Singapore’s medical hub,
if safeguards are adequately protective and fair. The need for kidney
transplants is universal and growing by the day; so is poverty.
“A transparent, fair-to-both-parties scheme is possible that can replace the
current regional black market,” said a doctor.
There is also an economic benefit to the nation, although it is less important.
“Singapore could become a centre for such practice working through a registry of
donors and recipients,” he added.
An editorial in the British Medical Journal in 2002 argued for a system that
involves a registry in which there are many sellers for each buyer – with the
state as the sole purchaser.
This would prevent the rich from exploiting the poor and ensure that poorer
recipients are not excluded from the exercise – if charitable organisations were
to help them.
For many, the idea of people selling their kidneys is disgusting. To them it is
an ethics issue.
However to the large numbers of kidney sufferers and their loved ones, it is
survival.
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