Angry Doctor

Tuesday, July 22, 2008

How much is that kidney in the window? 2

They say that one week is a very long time in politics...

New hope for kidney patients?
Age limit of 60 raised,swap registry to be set up:
Tan Hui Leng

HE HAD said ideas such as organ trading should not be rejected just because they are controversial, and the Health Minister is considering “financial compensation” — but not before pushing altruistic organ donations to their “maximum potential” with two new initiatives.

Mr Khaw Boon Wan told Parliament the Ministry of Health (MOH) will first lift the “arbitrary” age limit of 60 years on cadaveric donors and set up a national registry to swap living donors whose tissues do not match the intended recipient with another pair or pairs in a similar situation.

More controversially, he said that the MOH is studying whether to encourage third parties to promote altruistic organ donations by providing financial compensation to donors and their families after the transplants have taken place.

Mr Khaw revealed that he occasionally receives requests from some charities and religious bodies to compensate donors “in kind and in cash ... to acknowledge their altruistic act”. But these third parties worry that this may be construed as organ-trading.

The MOH is studying if the idea, which Mr Khaw would encourage, can be feasibly implemented and if the Human Organ Transplant Act (Hota) needs to be amended.

This was a possible example of “good complementary solutions” when the demand for kidneys are not fully met.

“By forcing ourselves to think about unconventional approaches, we may be able to find an acceptable way to allow a meaningful compensation for some living, unrelated kidney donors, without breaching ethical principles and hurting the sensitivities of others,” said Mr Khaw.

In the meantime, the two new measures, which are expected to be implemented within a year, should boost transplant rates from 50 to 70 per cent in the medium term. This means seven out of 10 on the waiting list will be able to get a donation on a yearly basis.

The age limit that had been set under Hota “has unnecessarily put many organs to waste”, said Mr Khaw, who noted that many countries do not have an age limit.

“The suitability of the organ depends on its condition, rather than the age of the donor. The condition of the kidney can be determined by the transplant doctor.”

On living donor transplants, the MOH will facilitate “pair-matched donations” through the set-up of a live-donor registry. This would require proactive coordination to overcome incompatible donations in order to “meet the altruistic wishes of such living-related donors”.

Hota will be amended where required for the two initiatives.

In response to questions by MPs Halimah Yacob (Jurong GRC) and Lam Pin Min (Ang Mo Kio GRC) on the current organ trading case, Mr Khaw answered generally that “a black market of illegal transplants flourishes in many countries and not just in Asia”.

The result — and the reality — is “poor clinical results for many patients and exploitation of many in poverty”.

He added: “We must therefore take a practical approach. Criminalising organ trading does not eliminate it. But it merely breeds a black market with the middleman creaming off the bulk of the compensation which the grateful patient is willing to offer the donor.”

The MOH will take a sympathetic approach to the plight of exploited donors and the “basic instinct of kidney failure patients to try to live” even as it takes action against those involved in illicit organ trading.

Currently, three Singaporeans are being charged for breaching Hota. The trio appeared in the Subordinate Courts yesterday for a closed-door mention in chambers, and will next appear on Aug 1 for a pre-trial conference.

angry doc should be excited about these developments, but he is still suffering from the after-effects of a the rough weekend.

He hopes he can contribute to the discussion more actively later this week.

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