Saturday, March 28, 2009

Human Organ Trade - Rationalizing the problem

The starting point is the easiest part. Noble intentions.

We all have sympathy for and want to find ways to help the patient with end stage renal failure, whose life can be extended (not somehow made immortal, by the way) by a timely renal transplant. The problem is there is a shortage of donors. The solution would seem pretty straightforward - encourage more living donors to come forward by making sure they don't suffer financial or personal losses by being a donor. QED.

The question is how do we reimburse the donor? The fact is no matter what scheme we come up with, it will always carry some element of exploitation. Invariably, it will be the poor and desperate who will sell their organs. Quite frankly, who else will do it? Apart from the obvious ethical difficulties here, this is a particular problem for us as Singapore is likely to be a wealthy net importer, in a socio-political hinterland of poor desperate donors. Accepting that we can never ever free ourselves from the reality of the burden of somehow being exploitative, if we go ahead with it, the question is how to do this in the least exploitative way, i.e., let's face the reality that we are being exploitative, but let's do it in a way that is as fair and reasonable as we can be. We will pay the social and ethical costs of being exploiters for the sake of our patients who are dying of renal failure, but let's try and be as fair as we can be.

Can this be done? Perhaps, ... with a complex regulatory system in place, and with difficult mathematics of computing payouts (or the more palatable term, 'reimbursements'). Can it be regulated? Clearly only with great difficulty. The Ministry of Health has been vary vague about all this, and the lack of clarity clearly troubles many people. The Ministry of Health's position essentially is ... "Trust us...."....

OK , lor.

What worries many is that once legalized, the Ministry of Health will no matter what it says now, quickly forego it's role as a regulator, and default this responsibility to local hospital review boards with different bottom lines. The payouts will be simplified to a lump sum cash payment ($50-100,000? or more?), with the possibility of variable ang pow sweeteners from grateful recipients. What about the problem of exploitation? By this time, who in pragmatic Singapore cares?

How about the recipients? We started this thinking with the noble intention to help our local Singaporean kidney failures. But by not restricting the recipients to Singaporeans, the Ministry of Health is suggesting that its real purpose, is to develop Singapore into a transplantation hub. A centre of excellence for human organ trade even. We can pay the social and ethical cost of being an organ importer and an exploiter of the poor for the sake of our renal failures, but by opening the system up to foreign recipients, the dynamics of this process will become completely changed.

The organ to the highest bidder. It will become unabashedly, a free trade in organs. How else can it be? Almost predictably, if the system works, the actual number of Singaporeans benefitting from this trade will eventually only constitute a small percentage of the overall human organ entrepot trade.

This will be the logical outcome. Good for Singapore? Yeah...but only from a commercial sense. Someone joked recently that we now at least have a dollar value for our bodily parts....

But what value, our souls?

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