Global Voices Online

An important debate is raging in Singapore: Should government legalize organ trade? The debate began last month when two young Indonesians were arrested and jailed for trying to sell their kidneys to a wealthy businessman in Singapore. The Human Organ Transplant Act “bans the supply of any organ or blood for valuable consideration” in Singapore.

mr wang says so articulates the key ethical issue in the debate:

“The key ethical objection is that human organ trading may lead to the exploitation of the poor and of socially disadvantaged donors who are unable to make an informed choice.”

Singapore is fifth highest in the world in terms of incidence of kidney failure. According to a news report, at least 3,500 people in Singapore have kidney failure; 600 are on the transplant list. But they have to wait up to nine years for a cadaveric donation.

Blinkymummy supports the legalization of organ trade:

“I personally believe that there is no good reason to prevent organ trading, provided the transaction is carried out within a well-defined framework. Why should anyone die on the waiting list because his family and friends are not equipped with a compatible kidney?

“On top of willing buyer and seller, these two parties ought to be fully informed of the risks involved. And the best party to be playing referee is the state. Because it is highly efficient and good at rationalising the necessary.”

But a reader has a different opinion:

“Is the state truly a good party to be a referee? In an ideal country, yes. Since no country is ideal, I do not think letting the state act as referee is safe.

“In a trade of organs, the poor will never have the chance for himself to enjoy a better life, only a chance to redeem his family from poverty. I do not think the state has the moral capacity to play this referee of fate.”

Singapore Law Watch uploads an article by Jennifer Yeo & Madan Mohan. The authors believe organ trade is beneficial:

“Organ donation, even if it involves valuable consideration, may make life better for both parties who find no way out of problems of health or poverty. If the state - and the altruists - cannot help the poor in overcoming their problems, it ought not to raise more barriers for them.

“Singapore can take the lead and set a good precedent for the international community by legalizing organ trade. The Republic has the infrastructure to facilitate such transactions.

“One idea is to set up a kidney registry for registering and screening donors and recipients to find matches and ensure that there has been no coercion, duress or exploitation. A charitable foundation or independent administrative body could take care of this and related matters such as informed consent, protection of identities of donors and donees, requirements, medical bills, insurance, compensation and benefits for donors, their families and other post-transplant issues.”

The authors’ proposals were echoed by government ministers who recently hinted that a certain procedure allowing organ trade will be implemented in the future. Carpe Diem - Seize the day also believes that:

“Singapore can take the lead in studying and implementing a system which permits the sale of organs that would strike a balance between individual needs and societal principal.”

But the Singapore Medical Association is opposing organ trade. Angry Doctor criticizes this position:

“Angry Doc feels that while doctors are individually entitled to their own moral viewpoints, and as a profession our ethics allow us to choose whether to participate or refrain from participation in a certain type of treatment, as advocates for our patients our role when it comes to a medical issue should be one of active participation through education and provision of information. We must not try to abdicate our responsibility while using the morality of a portion of doctors as an excuse.”

Catholic bloggers are opposing organ trade. A quiet moment shares a sample of the Catholic perspective:

“A donated organ can save a life but at whose expense? Somebody could be duped, coerced, pressured, offered incentives or even killed to have their organs extracted for the recipient.

“Has the patient been given adequate information, and made to understand what life will be after post-transplant surgery rather than living a life of regret from depression and ailments common to post-transplant surgery.”

Sze Zeng lambasts the commercialization of all aspects of life:

“In the organ trade, the term ‘organ donor’ is an oxymoron for in a trade there is no compensation but payment, and there is no donor but simply owner. The relationship does not bear any altruistic meaning but pure commercial transaction. The attraction in legalizing organ trade is the extension of widespread commercialization over all sphere of reality.”

Javert's World warns that organ trade will mean the “survival of the rich and extinction of the poor.” Another blogger points out that legalizing organ trade will not eliminate the underground market for kidney sales:

“Should the government decide to legalize organ trade and establish an organized system complete with standard operating procedures, there is no assurance that the black market will be totally eradicated. It is just like how loan sharks can still exist even with banks around, or how underground bets still thrive alongside the legal betting.”

But CTW explains that:

“Having some form of control over organ trading would prevent the middleman from exploiting the would-be donor. I am not suggesting things are simple but the Singapore authorities are good at plugging the loopholes.”

Anders Brink cautions against passing a law that would exploit the poor countries near Singapore:

“What kind of legal position is this, where Singapore can have a law that legalizes exploitation of the neighboring countries' poor people? What kind of message are we sending to our neighbors? Basically, Singapore is in this position because she is rich, while her neighbors are poor. If when you are rich, you demonstrate to others that you are willing to pass an exploitative law, how do you want to be treated when you are poor?”

Iran is often mentioned in the debates because it is the only country in the world which allows the selling of kidneys (Iranians call it ‘organ sharing’).

A comment written by a reader in the blog of mr wang says so highlights a very significant point:

“I think that a larger issue that has been overlooked is the holistic care of our citizens with chronic illnesses, which includes renal (kidney) failure patients.

“Renal failure patients with poor health are largely from a disadvantaged socioeconomic background. They usually have high blood pressure or diabetes, but could not afford the intensive medical care required to delay the onset of complications. As a result, they progress to renal failure much earlier, which needs to be treated with dialysis.

“How then do we avoid this whole mess? Prevention is really better than ‘cure', as in this case, kidney transplants are so limited, and essentially priceless. But the prevention is also expensive.

“The question really then, is how much is the government willing to step in to provide cheap healthcare to the people who need it, but are not able to afford it. Based on our national healthcare budget, it doesn't seem to be a lot, compared to other areas such as defence.”

For a more detailed study on organ trade (or transplant tourism) in the world, the WHO has good reference materials.