On Organ Donation in Singapore

On the front of my drivers license, it has a notation in bold red, ORGAN DONOR.

As long as I can remember, I’ve been an organ donor.  To me, it is an obvious decision and choice.

For some though, organ donation in Singapore is not a choice that is easy to implement.

Any Singaporean citizen or Permanent Resident (PR) is required – by the Human Organ Transplant Act (HOTA) – to voluntarily donate their organs over the age of 21.  The law used to enact an upper age limit of 60, but that has since been retracted.

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Just six years ago, in 2007, a 43 year old man named Sim Tee Hua was in a Singapore hospital, on life support.  Doctors were in the process of removing the life support in order to harvest his organs, despite his relatives “crying on the floor before the doctors.”

Mr. Sim was a lorry driver who suffered a stroke while working, and doctors declared him brain-dead.  While at the Singapore General Hospital, he also suffered a cerebral hemorrhage. The surgeons had waited 24 hours following the hemorrhage in order to honor the family’s request for time to be allowed for a miracle.

In the case of Mr. Sim, because of the 24 hour delay, his liver was unusable however the kidneys and corneas were transplanted.

The then Health Minister Khaw Boon Wan was quoted as saying “We try our best to be compassionate, but the bottom line is we need to be firm with this opting-out policy and respect the wishes of the dead,” he said. “People have a choice to opt out and if they don’t, we assume that they must have no objections.”

When asked about the success of the HOTA, Lee Wei Ling (a doctor and the daughter of the country’s founding father Lee Kuan Yew) is quoted as saying “Organ trading is frowned upon and usually not allowed in countries where political correctness reigns,” she wrote. “If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?”

The Singapore General Hospital responded to the incident by giving Mr Sim’s parents reduced hospital fees for five years following the death of their son, and the family was sent a letter thanking them for their “generous organ donation.”

Singapore law, the HOTA, assumes all citizens (except Muslims) are willing organ donors.  The ONLY caveat is if a citizen has explicitly opted out.

Singapore faced – like so many other countries in the world – a shortage of organs for transplant.  The kidney transplant rates TRIPLED since the HOTA was enacted in 1987.

Originally, the HOTA only allowed for the harvesting and transplantation of kidneys, but was expanded in 2004 to include livers, corneas and hearts. A further amendment in 2008 allowed for Muslim residents (exempted from mandatory donation) to receive the same priority if the need arose for an organ transplant themselves.  Outside of this policy (for a Muslim), if you have opted out of the HOTA, you subsequently fall to the bottom of the wait list should you need an organ transplant in the future.

Prior to the HOTA being signed into law in 1987, there were an average of 5 organ transplants per year. During the 17 years between the enactment of HOTA and its first amendment in 2004, the transplant total grew to reach an average of 13 per year.  During the next three years, the average grew to 49 transplants per year.Singapore is not the only country with regulations that require mandatory organ donation.  Brazil, Belgium, Poland, Denmark, Norway, Switzerland and Spain all have similar laws.

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Taken from the United States Organ Donor website,

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Singapore’s Live On website currently states that they have 468 people on the waiting list for organ donation (as of 2009),

If you are a Singaporean or a PR and wish to opt out, you can find the required form in several places, and you are simply required to fill it and send it. You can also use this form to opt-out of specific organs that you do NOT wish to donate. The only difficulty lies in remembering to fill the form after you reach the age of 21.Screen Shot 2012-12-12 at 9.36.24 AMWhat do you think?  Are you an organ donor?  Do you agree with the mandatory requirement (outside of the opt-out) that some countries have initiated?

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