I recently received a letter from the Ministry of Health (MOH) informing me that I would be automatically enrolled in the Human Organ Transplant Act (HOTA) when I am 21 years of age.
According to the letter, “HOTA allows the kidneys, liver, heart and corneas of all Singaporean Citizens and Permanent Residents to be used for the purpose of transplantation after their death” for other patients in need of an organ donation. Likewise, those enrolled in HOTA will receive higher priority should they need an organ donation.
The letter continued on to instructions on how to opt out of the act, and this is where I got curious. Why would anyone opt out of a win-win situation; to donate your organs when you don’t need them, and receive organs when you do? I started researching on the web and found a big group of people objecting to the Act on various websites. Here are some of their arguments:
- Doctors still can’t tell if “brain dead” means real death.
Take a look at this article of a Singaporean lawyer who wakes up from a coma in Hong Kong right after being declared brain dead, and this one of a young Singaporean man whose organs were harvested against the wishes of his parents after being brain dead.
Think about this: If the Singaporean lawyer was declared brain dead at home, not Hong Kong, would she have enough time to wake up before her organs are harvested? Probably not. According to Professor Teo Eng Kiong, chairman of the medical board at CGH, “organs are usually recovered within 24 hours after the certification of brain death.”
In another article by the Telegraph, a brain dead Singaporean teared when his family pleaded him to wake up while nurses rolled him away to have his organs harvested.According to consultants at MOH and Tan Tock Seng Hospital, brain death is certified by the “absence of pupillary response to light, absence of corneal reflex and absence of respiratory drive or spontaneous breathing.”
Although these requirements are similarly used in other countries, such places do not require doctors to harvest organs from brain dead patients – this is where we start noticing how some brain dead patients aren’t really dead, but victims of conditions still not fully understood by science, i.e. Total locked-in syndrome.
- Low priority doesn’t mean no priority. Many Singaporeans discussing HOTA on the internet seem to believe that opting out would mean that they would not receive an organ when they need one. However, this is untrue. You simply receive a “lower priority on the specific organ transplant waiting list” if you are in need of an organ, and this brings me to the next point…
- The wait list is too damn long. Chances are, whether you are in or out of HOTA, you are unlikely to survive long enough to receive an organ donation through the Act. According to SingHealth, 420 patients were on the wait list for a kidney transplant in 2011, with 15-20 patients dying each year from the 8-9 year wait. If you happen to be one of the 420 patients, you’d face a 42% chance of dying during your wait for a kidney, assuming that you have enough cash in the bank to for 9 years of medical treatment.
- Your family suffers more.
Let’s go back to the article on the 22 year old who had his organs harvested. His mother was yelling at the hospital staff, and his family also filed a police report against the hospital to delay his scheduled expiry.
The tearing lorry driver who also had his organs harvested was carried out of his ward by staff “behaving like robbers”, all while his family “knelt crying on the floor before doctors, begging them not to remove his organs and give him a chance for a miracle recovery.”
Now, try to put yourself in the shoes of the families of these men and imagine your loved one being carried away, their lives to be terminated while you look on helplessly.
- There are other ways to receive an organ. Appeal for a private donation. Find a relative who can donate. Go overseas and buy an organ.
- If you are on the top of the list for an incoming donation, it’s probably not worth it. This point is rather personal, but if I were on the priority list for an organ donation, I’d probably have injuries that I don’t want to live with for the rest of my life, new organs or not.
After reading through the letter and informational booklet for a second time, I decided to opt out of HOTA. The opt out form is available in the informational booklet and on MOH’s website (you’ll need a witness to countersign). You’ll be sent a card to carry in your wallet with you.