Human organ trade - a necessary evil?...fait accompli...

So my information was correct. (see report in today's Channel News Asia)

Despite Minister Khaw proclaiming that "... there was no possibility of legalizing organ trading any time soon.", their legal eagles have already drawn up the amendments to HOTA (Human Oragan Transplantation Act) to allow "reimbursements"to living donors!

I have no problem with the idea of reimbursing living donors per se. They should be reimbursed in some way for the risks they take and discomforts they endure. This must extend beyond just a one time exchange of $$$...and must include some sort of longer term insurance coverage of a delayed form of risk should the remaining organ subsequently fail.

The idea of reimbursements is therefore not wrong. But the devil is always in the implementation. The Minister is right to point out that there is a scale of differences between reimbursement, compensation and inducement. How they intend to differentiate these, is the big devil in the works. Clearly what is one man's meat (pardon the expression!) is another man's poison. A scale of reimbursements for a middle income worker in Singapore may be ethical and appropriate, and something he can easily walk away from....yet the same sum to a struggling Indonesian farmer, may be one that can support his family for a few lifetimes, and will be an extreme inducement.

I understand from my colleagues in the clinical trial 'industry', a similar problem exists. Normal volunteers are 'reimbursed' for their time and effort in participating as clinical trials subjects...yet the scale of reimbursements can sometime be so lucrative as to be highly inducive. The ethics committees so far have not been very stringent in examining these issues, and have willy nilly allowed the scales of reimbursements to escalate upwards so that a whole corp of volunteers have been induced to become professional trial subjects. How can we be assured that this does not happen with organ trading? Who polices this? One might question if Ethics Committees, often appointed by the institutions themselves are as objective and independent as they make out to be. How often would they be biased towards saying yes than no, because they want to see the transplant proceed.

We certainly need to discuss this a lot more. It would have been better if if weren't so obvious that the decision has already been made to proceed with the HOTA amendments. It is really a fait accompli.

But then....one might ask...what better way to make Singapore a medical hub? ...sigh...