Facing certain death without kidney transplantation, many people will do anything in their ability to find a donor and to carry out the operation. For many patients, an organ from a deceased-donor is an adequate solution; others, however, require a kidney from a living donor, whose consent to donate the organ and to bear the risks involved in such a procedure is their only chance for survival.
This medical situation arises several ethical and social dilemmas, all of which are related to the inequality of healthcare among the socioeconomic layers of modern society. Chong & Khalik (2008) illustrate how socioeconomic differences affects one’s access to medical services in contemporary Singapore through the story of Tang Wee Sung, a retail tycoon who was charged for trying to buy a kidney.
The Human Organ Transplant Act (HOTA) is a legal framework for organ transplants, which is based on creating a link between one`s propensity to donate her organs after death and her access to transplants. That is, whoever agrees to donate will get priority for organs, if needed during life, which may be a critical decision. (Ministry of Health, Singapore, 2007).
The Act also sets clear guidelines for regulating living donor organ transplants. In order for such a procedure to take place, it must be authorized by the hospital’s Transplant Ethics Committee (TEC). In short, the latter must be convinced that the donor has given his informed consent to the transplants and understood the risks involved (i.e. complications that may be lethal); in addition, it is forbidden to persuade a person to donate an organ by emotional coercion and/or financial incentives.
The Act sets high ethical standards for living organ transplants by prohibiting the possibility of organ trade in Singapore. However, as mentioned in the introduction, desperate people will take risks, and when it comes to money, poor foreigners and rich Singaporeans may agree on such a transaction, which can change both people`s lives.
The article illustrates two ways in which wealthy Singaporeans use their power to purchase kidneys: First, an estimated number of 300 Singaporeans have already undergone kidney transplants in China and India, paying up to $200,000 for the procedure. Not only the willingness of the poor to take the risk is in question here, but also the weak regulation of those countries to prevent such deeds from taking place, indicating that the local healthcare system takes an active part in a clear violation of the very basis of medical ethics.
Second, some Singaporeans engage in organ trade within the country, arbitrating between the party who is willing to pay for the organ and bear the risk of infringing the law and a poor Indonesian. The latter can get paid up to $30,000 for his kidney; less than 10% from the total paid by the Singaporean, but a huge sum in Indonesian terms.
What can be learned about the healthcare system in Singapore? It is unclear how extensive is the organ trade in the country, but Singapore is definitely an actor in the regional organ trade scene, an international market in which wealthy Singaporeans’ demand for live donors fuels networks of intermediaries and medical staff.
It is also clear that Mr. Sung, who came to his trial accompanied by a private nurse, has the means to arrange an operation in the Singapore (rather than a Chinese hospital, for example), paying more than 50% for a similar procedure abroad. Less wealthy individuals in the country who, as Mr. Sung, are unable to find a living donor in a legitimate manner and turn to organ trade as their only chance, are at much higher risk of complications from having a transplant operation elsewhere.
But most importantly, Chong & Khalik (2008) ignores the failure of the current Singaporean transplant policies and HULA to protect the donors. That is, in order to prevent unethical kidney transplants, Singapore ignores its role as a significant organ-importing country in the region, exposing both donors and desperate people with kidney failure to medical and criminal risks.
Mr. Sung’s story can and should be used as a case study for reviewing the current debate regarding the current policies and revising HULA. The current official denial for a prospective legalization of organ trade, as it exists in Iran (Tan 2008) may worsen the situation of both Singaporean and foreigners:
First, as long as organ trade is unregulated, prices and the risks involved in the procedure are too high barriers for most people. Unable to pay $200,000 for the transplant, Singaporeans with kidney failure are prone to years of dialyses and death. As some argue, it is the government’s responsibility to give sick people with little resources the possibility to prolong and improve their lives by all means possible. Simply put, it is immoral to deny from them this option, especially when wealthy individuals will continue to engage in organ trade.
Second, poor countries and individuals in the region should have the possibility to use their biological assets (for many of them, these are the only assets they have) to improve both their own lives as well as the kidney patients’ lives. This trade can and should be regulated, making sure that the donors are not manipulated and exploited by organ “brokers.”
Chong & Khalik (2008) have also failed to discuss the motives behind kidney trade in Singapore. Although HULA is a comprehensive means that partially answers the need for organ transplants, it is far from providing a complete solution to the problem in the country. There are about 600 Singaporeans waiting for a kidney; some of them will have to wait up to nine years for an organ from a deceased donor (Palatino, 2008), and some will not survive until then. In addition, as argued in the introduction, a living kidney is often the only solution after the body rejected a transplant from the dead. Thus, Singapore should not ignore the debate on equal access for organ trade.
- Chong, E. & Khalik, S. (2008, July 13). Tangs boss charged; he was allegedly going to pay $300k. Retrieved June 14, 2008 from http://www.asiaone.com/Health/News/Story/A1Story20080711-76041.html
- Ministry of Health, Singapore. (2007). Human Organ Transplant Act. Retrieved June 14, 2009 from http://statutes.agc.gov.sg/non_version/cgi-bin/cgi_retrieve.pl?&actno=Reved-131A&date=latest&method=part
- Palatino, M. (2008, July 29). Legalizing organ trade in Singapore. Retrieved June 14, 2009 from: http://www.upiasia.com/Society_Culture/2008/07/29/legalizing_organ_trade_in_singapore/7019/
- Tan, V. (2008, July 13). MOH says Singapore should not write off organ trading. Retrieved June 14, 2008 from http://www.channelnewsasia.com/stories/singaporelocalnews/view/360100/1/.html