Kidney Dialysis Foundation

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By SALLY KONG
(Organ Transplant Unit)

Transplantation in Singapore started in the 70s, however it was only in the last two decades that tremendous progress has been made in the various transplant programmes. This change is due to several factors, which are, a more organised and structured system to tackle procurement, legislations to assist the transplant programme and publicity programmes that has made organ donation and transplantation a reality to the general population.

The types of transplants that are presently carried out in Singapore are kidneys, livers, hearts, corneas, bones, skin and bone marrow. The cornea and kidney programmes were established in 1963 and 1970 respectively. However, the liver and heart programmes were established in 1990; bone banking in 1992; skin banking in 1998; and lung transplant in 1999.

In Singapore, the Ministry of Health's Organ Transplant Unit (OTU) oversees operational issues related to organ procurement, audits procurement and transplantation activities at the national level. The OTU also carries out education programmes for healthcare professional and the public.

There are two sets of legislations supporting organ donation in Singapore. When transplantation started in the 70s, the Medical (Therapy, Education and Research) Act (MTERA) was enacted in 1972 to allow for cadaveric organ donation. This law allows for any person above the age of 18 to make a pledge to donate any organs or body for the purpose of research, transplantation or education. If a pledge has not been made, consent can be obtained from the next-of-kin. The second set of legislation supporting organ donation is the Human Organ Transplant Act (HOTA).

HOTA was passed in 1987 and revised in July 2004. Prior to the amendment of the Legislation, extensive public consultation was carried out over two years, 2002 to 2003, with community, religious and professional groups. Several public forums were organised and feedback from the public was received through the MOH website, emails, letters and the telephone hotline. There was strong support from all groups to amend HOTA so that more lives could be saved and suffering reduced.

	THE THREE MAIN AMENDMENTS TO HOTA ARE:
		To extend HOTA beyond kidneys to also include liver, heart and corneas;
		To extend HOTA beyond death due to accidents to include all causes of death; and
		To extend HOTA beyond death due to accidents and to also regulate living donor organ transplants.

	HOTA applies only to those who died in hospital. It allows for the removal of the kidney, liver, heart and corneas only if the following conditions are fulfilled:
	1.	Singaporean or permanent resident;
	2.	Age between 21 and 60 years;
	3.	Non-Muslim (Muslims are not included under HOTA due to religious reasons. They can pledge to donate their organs under the MTERA);
	4.	Of sound mind; and
	5.	Has not objected to organ removal under HOTA.

HOTA and MTERA complement each other Singapore being a multi-cultural and multi-religious country it is therefore not surprising to encounter many myths related to organ donation. A survey carried out by National Kidney Foundation revealed that generally, the concept of organ donation and transplantation is perceived as positive. It is a magnanimous act, which offers a gift of life, with no objections from all the major religious groups. However, this still does not overcome some of the cultural beliefs like the desire to be buried whole and organ removal may violate the sanctity of the deceased. These beliefs can only be overcome with long-term continuous education.

The problem faced in Singapore is similar to that of other countries, which is the increasing number of patients with organ failure who need a transplant. The amendment of HOTA will provide an additional ten to 15 donors each year. This will benefit 60 to 80 patients with organ failure from the additional organs each year. Making sure that every suitable donor is referred is the goal. The generosity of those who have chosen not to send in their objection or have made a pledge towards organ donation will help restore lives, which have been shattered by organ failure. You can help save lives by sharing the message of organ donation with your family and friends.

For more information on HOTA, please call the MOH hotline at 1800 225 4122 or email MOH_HOTA@moh.gov.sg. You can also visit the MOH website at www.moh.gov.sg.

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