To be continued
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The New Paper
30 June 2008
KIDNEY QUESTION: ALLOW SALE, OR... ...BAN SALE?
Aussie doc: SELL ORGANS TO GOVT, SAVE LIVES
IT is the first case of its kind in Singapore, where two Indonesian men have pleaded guilty to organ trading. And it throws open the door for debate again, on the issue of legalising organ trading.
Organ trading is banned in Singapore for a variety of reasons, including ethical ones. But some have argued that lifting such bans could save lives. Last month, an Australian kidney specialist sparked national debate by suggesting the government should pay up to A$50,000 ($65,450) for kidney donations to overcome a chronic shortage.
Dr Gavin Carney said eliminating a law that prohibits the selling of organs would save thousands of lives and billions of dollars (euros) in care for patients on organ waiting lists. He also said it would stop people from going to Third World countries and paying for black-market organs and risky, unregulated surgeries.
FEW DONORS Australia has one of the lowest rates of organ donation in the developed world, about 10 donors per 1 million people, according to a federal health task force. 'We've tried everything to drum up support for organ donation and the rates have not risen in 10 years,' Dr Carney was quoted as saying in Fairfax newspapers. 'People just don't seem to be willing to give their organs away for free... 'Let's pay people some money for a new car or a house deposit and those waiting lists will be halved within about five years.'
Dr Carney, a professor at the Australian National University, could not immediately be reached by The Associated Press. Dr Carney's proposal was immediately criticised by transplant groups, who fear it would exploit poor people.
QUASHED
The idea was quashed by Health Minister Nicola Roxon, who said Australians would not be allowed to market their organs. 'But we do know that we need urgent action in this area of organ donation,' Ms Roxon told Australia Broadcasting Corp. radio. Rather than paying people for organs, Ms Roxon said her ministry would act on some of the recommendations of a federal task force that recently completed a review of the organ donation system.
The task force attributed Australia's low organ donor rate to a decrease in road accidents and strokes, lack of public awareness, and poor identification of donors in hospitals, among other factors. In comparison, Germany has 15 donors per 1million people, the Netherlands has25, the United States has 27, and Spain has 35, it said.
Selling or buying organs is illegal in Australia, as in most countries, and carries a penalty of six months in jail and a fine of up to A$4,400. More than 1,800 people are waiting for kidney transplants in the country but only 343 kidneys were donated last year, Fairfax reported. Transplant Australia said the average wait for a kidney transplant is four years.
Transplant Australia chief executive Chris Thomas said his organization rejects paying for organs and instead is working with the government to change the donation system. He said Dr Carney's proposal would leave poor people vulnerable. 'It really focuses on the poor and people who are least able to pay for things in society. They get attracted to these types of things,' he told ABC Radio. 'We'd reject that.' Kidney Health Australia also rejected Dr Carney's proposal, saying it would be open to 'many ethical issues and abuse.' - AP
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The New Paper
30 June 2008
TIME FOR S'PORE TO RETHINK ISSUE
By Ng Wan Ching
WOULD I pay for a kidney if I were dying, there were no donor kidneys available and there was a willing seller?
At this point in my life, I want to see my children grow up. And I want to live this sweet life a little longer. So my answer would be yes, with certain caveats.
First, the seller must be informed of the risks of the procedure and be educated on what it means to be a kidney donor. He must undergo careful medical and psychological evaluation and receive follow-up care. That said, the reality is still that such a course is illegal here. But might we not examine the feasibility of a kidney market?
The way the Iranian government does it is to provide a fixed compensation to the seller of about $1,500 as well as limited health insurance coverage. Second, he also receives separate remuneration either from the recipient or, if the recipient is poor, from a designated charitable organisation; this amount is usually between $3,000 and $6,000. In Iran, there is no longer a queue for donor kidneys.
One idea, which has been mooted elsewhere, is to take the money spent to provide dialysis and use it to fund programmes aimed at helping lower-income people buy kidneys. The rich will be able to take care of themselves.
It was reported last December that Singapore's National Kidney Foundation had spent $17.5 million on dialysis and kidney failure prevention services for about 2,000 kidney patients in 18 months. If this money were used to set up a kidney bank, which would buy kidneys, at $20,000 a kidney, 875patients every 18 months would be freed from the need for dialysis. Over time, the numbers would get better, as kidney patients here wait an average of seven years before they get a donor kidney.
What about the risk of surgery to the donor? Doctors I spoke to said that the most significant risks were those associated with anaesthesia and surgery which, at 0.03 per cent mortality, was comparable to any other operation. Long-term risks are also low. A 1997 study from Norway that followed 1,332 kidney donors for an average of 32 years found no difference in mortality rates between kidney donors and the general population.
A 25-year follow-up of 70donors conducted by the Cleveland Clinic found that the renal function is 'well-preserved' and that the overall incidence of hypertension was comparable to that of non-donors.
EXPLOITATION
But the potential for exploiting donors - especially low-income ones - is always there, for they will be the ones most likely to find monetary incentives attractive. Protecting them is of utmost importance. That is why any plan for compensation should be regulated by the government.
Legal scholar Richard Epstein puts it in his own special way (The Wall Street Journal, May 2006): 'Only a bioethicist could prefer a world in which we have 1,000altruists per annum and over 6,500 excess deaths over one in which we have no altruists and no excess deaths.'
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The New Paper
30 June 2008
Health Minister: It won't be legal any time soon because...
UNDER the Human Organ Transplant Act (Hota) here, it is a criminal offence for any person to 'enter into a contract or arrangement under which a person agrees, for valuable consideration, to the sale or supply of any organ or blood'.
The penalties are a jail term of up to a year, or a fine of up to $10,000, or both. Health Minister Khaw Boon Wan has said that there was no possibility of legalising organ trading any time soon. He has argued that such a move raises difficult ethical problems, and would also encourage the wrong types of people to become donors, such as the poor.
It is also an idea that many here and elsewhere find 'degrading' and 'repulsive', he was reported to have said last year. Efforts to increase the supply of organs for transplant should focus on greater public education instead.
Mr Khaw noted that countries which have tried organ trading attracted the 'wrong' type of donors - drug addicts, for example. Apart from the moral issues, ophthalmologist Lam Pin Min, now deputy chairman of the Government Parliamentary Committee for Health, also pointed out the medical risks to donors in a report last year.
Kidney donors face less than 0.1per cent risk of death, but it is more dangerous for liver donors who have a 1-3 per cent chance of dying and a 25per cent chance of problems from surgery.
There has been one kidney donor-death in Singapore. A woman who donated her kidney to her husband died shortly after the surgery in 2005. The cause of her death is still not known.
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