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21 Jan 2008
By Khaw Boon Wan
Venue: Parliament |
Mr Speaker, Sir, I beg to move, “That the
Bill be now read a Second time”. |
In 1987, this House, with the
recommendations of a parliamentary select committee, moved the Human
Organ Transplant Act (HOTA) after 2 days of debate. |
The debate in the House was, in turn,
preceded by 12 months of public discussion and consultation, involving
many stakeholders, religious bodies, professional groups, doctors, and
patients. The extensive public debate was necessary as we were then
breaking new ground over the sensitive and emotional subjects of organ
donation, organ transplantation, brain death and the concept of presumed
consent. |
Prior to HOTA, organ donation was done
solely through the Medical (Therapy, Education and Research) Act of
1972, or MTERA, which allowed Singaporeans to pledge their organs
through an opt-in system. However globally, the experience with opt-in
systems is that they have not been effective in saving many lives
through cadaveric organ transplant. |
Our experience with HOTA provides a good
illustration. Prior to HOTA, the number of cadaveric kidney
transplantations was only 5 per year, on average. With the
introduction of HOTA and especially after its amendment in 2004, the
rate has gone up ten times, saving the lives, on average, of 48
kidney patients every year, about one a week. Many other patients
with liver or heart failure have also been saved. Many more patients
have regained their eyesight through cornea transplants. |
HOTA saves lives and is an important
piece of legislation in our healthcare delivery system. On behalf of
the many patients with organ failure, I thank Members for their
continuous support of this piece of legislation. Singaporeans too
support HOTA strongly. |
HOTA does not take away the freedom of Singaporeans
to refuse organ donation for any particular reason. 1% of adult Singaporeans
have opted out of HOTA. We respect their decision. |
Inclusion of Muslims |
However, HOTA has not been able to bring
major benefits to the Muslims, as a deliberate decision was made in
1987 to exclude them from HOTA. |
This was because the Fatwa then required
the consent of two waris (paternal next of kin according to Islamic
hierarchy) for organ donation to proceed. Even so, the Majlis Ugama
Islam Singapura (MUIS) made it clear that organ donation to save
lives was permissible under Muslim law. Muslims who wish to donate
their organs can do so by making a pledge under MTERA. |
Because of the exclusion, Muslim non-pledgers
are accorded a lower priority for organ transplant than non-Muslims
who have not opted out of HOTA. In similar spirit, Muslims who have
pledged their organs under MTERA generally need to wait 2 years
before they are accorded the same priority as those who have not
opted out of HOTA, if they made theirpledge after the period
prescribed in the Act [1]. |
Unfortunately, there is a rising number
of kidney failure cases among the Muslim Malays. New cases of kidney
failure among the Malay population rose from 19% in 2000 to 22% in
2006. |
In Singapore, the primary cause of
kidney failure is diabetes mellitus. According to the 2004 National
Health Survey, there was a disproportionately higher number of
Malays with diabetes mellitus (11%) compared to the Chinese
population (7%). |
There is therefore a greater burden of
kidney failure among Malays. This trend is also evident from the
racial breakdown of the national waiting list for kidneys. Malays
made up 21% of the total number of patients on the 2007 kidney
waiting list, even though they formed 13% of the resident population
[2]. |
In 2004, MUIS through the Fatwa
Committee made it easier for Muslims to pledge their organs. But
this has not resulted in any significant increase in the number of
Muslim pledgers, despite intensive publicity by the Muslim Kidney
Action Association and the National Kidney Foundation. |
Since HOTA was enacted in 1987, there
have been about 16,000 Muslim pledgers. In 2007, there were less
than 200 pledgers. To date, these pledges have not yielded any
organ donations. |
When HOTA was amended in 2004, several
Members asked if MUIS could review its position on HOTA to bring
the disadvantaged position of the Muslim community up to par with
the rest of Singaporeans. I remember SMS Zainul Abidin Rasheed
stressing a point that “The disadvantage of (Muslims) being out of
the system are real and the Malay-Muslims as a community cannot
afford to let this continue.” |
In 2006, MUIS embarked on a series of
public education campaigns concerning organ donation and the
religious issues surrounding organ donation. While there were some
concerns on the practical aspects of transplantation, the Muslim
community generally voiced their acceptance of the permissibility
of organ donation from a religious perspective, and supported the
move to increase the number of Muslim donors. |
In parallel, the Fatwa Committee
launched a review of the Fatwa on organ donation. The review
eventually led to a new Fatwa being issued in July 2007, making it
permissible for Muslims to be covered under HOTA. |
With the new Fatwa, we are now in a
position to amend HOTA to include Muslims like the rest of the
Singaporeans. This is a significant achievement both for the
Muslim community as well as for Singapore. |
The main objective of this Bill which
is now before the House is to bring this about. Technically, the
Bill itself is relatively straight-forward as it merely removes
the current exclusion clauses of HOTA. Accordingly, clauses 2, 3,
and 8 of the bill expand the target population under HOTA to
include Muslims. |
With the inclusion of Muslims under
HOTA, Muslims who do not opt out of HOTA will be accorded the same
priority as other Singaporeans who have not opted out of HOTA.
Muslims who have already pledged their organs under the Medical
(Therapy, Research and Education) Act will also be placed in this
group and receive the same priority. This will level the playing
field for all Singaporeans who are in need of an organ transplant. |
Enforcement Powers |
I am also taking this opportunity to
amend HOTA, through clauses 4 to 7 of the Bill, to provide my
Ministry with the necessary enforcement powers to investigate any
offence under HOTA. |
HOTA includes regulations on living
donor organ transplantation to safeguard the well-being of the
donor and ensure that he was not under any form of duress or
coercion to donate his organs. HOTA also prohibits any trading in
organs and blood as it is deemed unethical. |
My Ministry currently relies on the
Police to investigate such offences as we lack the power to do so.
The proposed amendment would allow my Ministry to appoint
inspectors and provide them with the appropriate investigative
powers, which would enable them to look into complaints and
conduct investigations in a timely manner. |
We also need to be able to disclose
donor or recipient related information for the purpose of
administering and enforcing HOTA, as well as for the purpose of
referring complaints regarding any errant medical practitioner to
the Singapore Medical Council for disciplinary action. |
Lifting the Whip |
Mr Speaker, as the issues concerning
organ removal under the presumed consent framework are ethically
and culturally sensitive, I have asked the Whip to be lifted to
allow Members to debate and vote on the Bill based on their
religious and ethical beliefs. |
Conclusion |
Although the implementation of these
amendments to HOTA will not fully resolve the problem of organ
shortage, it will allow more Muslims to have the same chance as
others in obtaining a new lease on life through an organ
transplant. |
My Ministry has estimated that about
30 more patients per year may benefit from the proposed amendments
to HOTA. I hope the House will join me in giving them this gift of
life. |
Sir, I beg to move. |
Source: www.moh.gov.sg
News 21 Jan 2008 |
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