Anthony Yeo / Consultant Therapist, Counselling and Care Centre.

The amendment to the Human Organ Transplant Act (HOTA) allowing for reimbursement of living kidney donors was passed in Parliament with heated debate recently.

It generated such heat that MPs from the ruling party were given authorisation to vote in accordance to their religious or moral convictions.

The obvious objection seems to centre on the possible abuse from those donors who may do so for profit as well as how ethics committees can discharge duties responsibly.

Whatever the objections or concerns may be, it does seem that the primary focus is on the donor rather than the recipient.  In this sense, would it not be expedient to discuss this issue from a systemic perspective, taking into consideration the needs of recipients, consequences for donors as well as the larger health system.

It is certainly beyond the health system to meet demands for kidney transplants. The fact that there is such a long waiting list for kidneys, must definitely spur us to think of the burden of our health system to ensure that kidney patients do not need to experience undue suffering.

There is also the need to consider ways to ease the burden of having to deny those in grave danger not only from further incapacitation or death.  If laws are too stringent and kidney donation becomes restrictive, one wonders if our health system would have the reputation in being an illness system.

If our health system is to provide healing and enhancement of health, then the onus is on the administrators of the system to explore every avenue to ensure that this is made available to all in need.

It is always tragic to learn of those who have to endure extended suffering from kidney failure, far worse to witness those who die prematurely due to lack of access to kidney donors. 

We only need to recall the very heart-rending experience some years ago of the family of the Indian woman who experienced severe pain and suffering till her death because her life could not be saved due to restrictions prevailing at that time. 

Her family was traumatised and the health of her mother and sister were so badly affected that within a year or two, they too met their death.  The surviving sister needed help with her trauma that took a while to heal. 

Such an experience should not be repeated if we could consider the needs of kidney patients. If we value life, then surely saving lives must take precedence over laws and procedures.  And if easing the restrictions and making donation more readily available can be a way to promote living, then laws would need to be amended to make this possible.

If we were to have this expanded perspective, then it is a little easier to uphold the need to consider how best to make donation more accessible.  This is where the amendment to provide for reimbursement can make sense.

There must be a place for care of the donor as well.  For one, we are aware of the risks involved. Donors have encountered complications to their physical well-being including deaths, although the latter has been infrequent.

As the Health Minister asserted in Parliament, suffering from financial consequences is a major risk involved. Furthermore, during the recovery from the procedure, disruption to work and life, as well as the need to live with the loss of an internal organ are other risks that have often been overlooked.

To this extent, the amendment to allow for reimbursement can pave the way for reluctant donors to offer their kidneys.

Of course there will be possible risk of abuse of the system but that should not deter us from a very humanitarian approach to this matter.  Likewise, those who are concerned about the administration of reimbursement and procedures to be put in place to prevent abuse can be assured that these are operational matters that can be dealt with responsibly.

This confidence comes from the way our government has been functioning, ever cautious and prudent.  Sometimes they tended to be unduly vigilant to the point of stifling possibilities for change. If they continue to function as they probably would, then we can be hopeful that measures would be put in place to prevent abuse.

There are already ethics committees in place for approving organ transplants and we can rest assure that fine-tuning will be executed accordingly.

Hence, there should be optimism despite concerns expressed; support for greater flexibility in the midst of existing laws and public support for making kidney donation more readily available.

Hopefully our health system will be life-enhancing, life-preserving and life-extending with this amendment passed in Parliament.


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