Organ trading model in next 1 to 3 years

The New Paper
14 Aug 2008

Organ trading model in next 1 to 3 years

But Health Minister Khaw Boon Wan proposes that the model, only for kidneys, be managed by independent body using strict screening.

By Ng Wan Ching

SINGAPORE may have an acceptable model of organ trading in the next one to three years. While it may not be an ideal solution to the shortage of donor organs here, it cannot be ignored either.

That was how Health Minister Khaw Boon Wan characterised his dilemma in a closed-door dialogue held last month with 30 professionals. The dialogue, organised by the People's Action Party's (PAP) Women's Wing, was reported in the July/August issue of Petir, the PAP magazine.

Mr Khaw said that while the debate rages on, patients are dying and the poor are being exploited to part with their kidneys at a low price. Hence, he cannot ignore it.

'If we don't do anything about it, we will be guilty ourselves,' he said.

STOPPING EXPLOITATION

In the clearest picture yet of how an organ trading system might work here, Mr Khaw said this was how he would do it:

1. Restrict trading to kidneys only, as trading in other organs creates other problems or involves a higher transplant risk to donors.

2. Eliminate a direct transaction between the donor and the patient by letting an independent, professionally-run third party, the kidney bank, manage the donor pool and match the transplants.

3. Require stringent screening, full risk disclosure and communication with donors and their families, to ensure that only healthy donors are selected and their decisions fully informed.

The third party (the kidney bank) will also safeguard the welfare, health and interests of donors by providing pre- and post-surgery care.

Petir reported Mr Khaw as saying that this would be the greatest value of legalising kidney trading - to stop the exploitation of the poor and ignorant, who do not know the full value of their kidneys. For the best possible outcome, he added that matching should be based only on clinical criteria, not dollars and cents.

He suggested that a way to subsidise poor patients' access to kidneys is by requiring those who can afford it to pay the international price to the kidney bank - 'the Robin Hood principle where one rich patient can possibly support transplants for five poor patients'.

'This will address the current problem of black market trading where the poor can only be donors but not possible recipients,' he said.

The audience asked if more could be done to promote altruistic donations.

Mr Khaw said that compared to Sweden, where family members will readily offer their kidneys for transplants to their loved ones, Singapore's altruistic transplant rate is 'shameful'. There are hundreds of patients on the waiting list, but altruistic donations from family members number only in the dozens.

Mr Khaw said that currently, each year, about 200 Singaporeans join the pool of patients who can potentially benefit from a kidney transplant.

Of these, 50 will get one from deceased donors under the Human Organ Transplant Act (Hota); another 30 will receive a donation from a relative and 20 will go abroad for a transplant. To help the remaining 100, the Ministry of Health will propose that Parliament remove the Hota age limit for deceased donors, now set at 60 years.

The MOH will also explore matching a donor whose tissue is incompatible with the intended recipient's with another donor-patient pair in a similar situation.

These initiatives will raise the kidney transplant rate by another 30 to 40 patients a year. But that still leaves about 60 patients without a transplant option.

While altruistic donation is the way to go, he said that the door should also be kept ajar for some limited transactions to take place. His estimated time frame is to have an acceptable model of organ trading in the next one to three years.

Lipo new rules

I am intend to undergo liposuction in the future to remove some stubborn areas of fat.

But a GP? Frankly, the option is not that attractive when only one litre of fat can be removed per session.

I would rather pay a few hundred bucks more to consult with a licensed plastic surgeon and have a few more litres of fat pumped out.

I have consulted with a aesthetic doctor who is not a plastic surgeon. He charges $2500 - $3500 per area.

The tummy area is NOT considered one area. It is the middle section, the right abdomen and the left abdomen. So that is 3 areas! But then there is also the top abdomen and the bottom abdomen.

The range of prices for each area of lipo cost between $2,000 to $5000, depending on how experienced and famous is the doctor. Some doctors may even charge more.

Frankly, I would not advise anyone to see a plastic surgeon unless one is prepared to spend at least $10k -$30k!

Lipo can be a simple surgery of just pumping out the fats from parts of the body, but dun forget, complications can happen!

Can a GP handle all these complications of excessive bleedings, infections, nerve injury? Are they trained to do so?

Frankly, I am not that afraid of death, but I have seen pictures of lipo gone wrong. Gaping wounds, sagging skins, organs failure due to infections etc. And these sort of after effects of lipo are not really worth it!

Get a reputable doctor, preferably a plastic surgeon!

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The Straits Times
23 July 2008

Most GPs able to perform liposuction under new rules

Majority would clear key hurdle - a year's surgical training - when rules kick in

By Lim Wei Chean & Jermyn Chow

IT WILL likely be business as usual for most doctors who do liposuction when rules governing the now-unregulated surgery kick in this November. Most GPs would clear what many see as the main new hurdle - having one year of surgical training in fields ranging from urology to paediatric surgery.

Professor Foo Chee Liam, who is chairman of a new committee that will licence the surgery, said 'initial data' show that most GPs satisfy that requirement.

It was one of several rules unveiled over the weekend designed to regulate liposuction, which has led to deaths in other countries, but not here.

In November, doctors will also be required to have nurses on hand to monitor sedated patients. They are allowed to remove less than one litre of fat per session. Doctors who want to be accredited will also be assessed on their track record for liposuction.

The Society of Aesthetic Medicine, formed mainly by GPs, hailed the rules, which allow doctors to continue performing the procedure in their clinics.

Dr Benjamin Yim, a spokesman for the society, said the move requiring GPs to be accredited for liposuction by the new committee will benefit patients. The regulations will see the procedure performed in a safer and more professional manner, he added.

Doctors estimate that thousands of people have liposuction annually. A single session can cost $2,000 or more.

Some plastic surgeons, who for months had criticised the rules as being too lax, voiced their disappointment again on Monday. 'How is one year of surgical training in urology relevant to liposuction?' said Dr Colin Tham, spokesman for the Singapore Association of Plastic Surgeons. He said the new rules could sidetrack Singapore's goal of becoming a centre for medical excellence.

But others hailed the new rules as a move in the right direction.

'At least it will no longer be a cowboy industry where anyone can just buy the machine, watch a few DVDs and do the procedure,' said Dr J.J. Chua, a plastic surgeon. 'The onus lies on all doctors, including plastic surgeons, to show the authorities that everything they do is above board,' said the 42-year-old, who runs his own practice at Mount Elizabeth Hospital.

Madam Halimah Yacob, chairman of the Government Parliamentary Committee for Health, said the new rules will help protect the safety of patients. But she cautioned that liposuction should not be considered the only way to lose weight. 'Exercising regularly and maintaining a balanced diet are still the best ways to look good,' she said.

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What you need to know about the procedure

What is liposuction?

It is an invasive surgical procedure in which solid fats are sucked out of the body. Performed under general anaesthesia, it typically takes a few hours and costs at $2,000 or more. Recovery follows in one to three weeks. Less invasive ways to remove fat include laser- or ultrasound-assisted liposuction.

How widely done is the procedure?

One of Singapore's most popular vanity procedures, liposuction is done here thousands of times every year, doctors say. No exact figures are available, though.

What can go wrong?

Botched jobs can result in infections, bleeding, skin ulcerations and nerve injury.

Who can perform liposuction now?

For now, liposuction is performed by a range of doctors - from plastic surgeons to general practitioners (GPs) in operating theatres or their clinics.

From Nov 1, however, only plastic surgeons and accredited GPs will be allowed to perform it.

To be accredited, GPs need to have spent at least a year in surgery, and they must acquire some training. They need to observe at least five such procedures being done by qualified medical practitioners and perform at least five procedures themselves under the supervision of these qualified practitioners.

Where can it be done?

From Nov 1, operations to remove more than a litre of fat have to be done in a hospital or surgical centre. Procedures involving less than this amount can be done in approved premises.

How is this procedure regulated overseas?

In Malaysia, private GPs have been barred from performing liposuction since last November, along with breast implants and laser- and light-based therapies. They also cannot use unapproved agents or inject products unsupported by evidence, such as growth hormones.

Britain, Australia and Canada have no specific regulations on cosmetic procedures. The British government encourages self-regulation, and independent bodies in Britain set recommended standards.

Doctors there are not required to undergo special training in aesthetic medicine, and no register of specialists in the field is kept.

Medical clinics in Canada are regulated, and they are required to administer anaesthesia.

France has a 15-day 'cooling-off' period, which forestalls liposuction practitioners who are hard-selling the procedure to their patients.

Email to Plastic Surgeons

I was really interested in having my drooping eyelids done. So I emailed a few local plastic surgeons on their fees.

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Hi,

I am interested in having double eyelid surgery and nose reshaping surgery done.

My eye lids consists of 1 eye double lid and 1 single lid.
For my nose, it is a bit bulbous and fleshy on the tip.

I would like to check the price range for each of the surgery?

Thanks.