| Yawning
Bread. 9 July 2008
Regulate, not ban, the sale of human organs
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Further complicating this debate is the faultline between those who would see a responsibility to protect the disadvantaged, and those who believe in individual autonomy. On this latter question, I am kind of uncertain where to draw the line. But on the first question, I don't think being preachy solves anything. In this case however, preachiness has attained the status of law, in the form of the Human Organ Transplant Act (HOTA), which makes it an offence to enter into a contract to sell one's own or another person's organs:
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This law hit the headlines a
week or so ago when two extremely poor Indonesians, brought by a middleman
to Singapore to sell their kidneys, were convicted here under HOTA on 27
June 2008.
Sulaiman Damanik, 26 an odd-job labourer from Sumatra, was promised 150 million rupiah (about S$22,000) in exchange for donating a living kidney to Tang Wee Sung, 56, the Executive Chairman of retail company C K Tang. Sulaiman would first have to lie on a statutory declaration that he was a distant relative of Tang and that he was giving his kidney altruistically, in order to circumvent the law and fool the hospital's ethics committee. 150 million rupiah was a lot of money for him, equivalent to a decade and a half's wages. However, he was caught before the operation was carried out, and it appears he has not seen the cash. Tang Wee Sung himself is under investigation. The other person caught was also from Sumatra, by the name of Toni. Aged 27 and an out-of-job garbage collector, he had undergone his operation before the law nabbed him. He had been paid 186 million rupiah (S$29,390) for donating a kidney to Juliana Soh, an Indonesian patient at Mount Elizabeth Hospital in Singapore. Toni had told the hospital's ethics committee that he was the patient's adopted son. He returned to Indonesia after his operation, but came back to Singapore on 29 May escorting Sulaiman, whom he was involved in recruiting. The chief middleman however was a certain Wang Chin Seng, who is reportedly well known in medical circles as a patient referral agent. He too is under investigation. [1] * * * * * Even though Singapore already has a law that makes cadaveric donations mandatory with an opt-out clause which few exercise while living, most deceased persons do not have organs suitable for transplant. Clearly, therefore, the supply of suitable kidneys in no way matches demand. More than 300 Singaporeans have gone overseas for transplants, many through the purchase of organs. [3] Desperate people, both those with kidney failure and those who are in economic hardship, will try to circumvent the law, which the Ministry of Health continues to defend. "Organ trading often involves the exploitation of poor and socially disadvantaged donors who are unable to make an informed choice and suffer potential medical risks," the ministry said. That's fine in principle, but what this case has also shown is that visiting the law upon those who are already unfortunate is causing Singaporeans some moral unease. The Straits Times reported that 77 percent of the 1,300 respondents to its online poll felt it was time to review HOTA. [4] Among the suggestions put up is for a central body to regulate the sale of organs. It would only be legal for an adult to contract with this body for the sale of an organ, with private contracts remaining illegal. Ditto for buyers. As a clearinghouse, this body can perform a number of functions that private contracts cannot quite satisfy, among which would be matching donor and recipient more accurately, and ensuring that the donor gets the best possible deal. Apparently, Iran, of all places, has such a system in place. This sounds a lot better than the present, absolutist approach that refuses to put a price on an organ. Underlying this approach are really two quite different concerns. One is that the poor would be exploited by the rich, e.g. as argued by the Ministry of Health; the other is that the human body is life and it would be obscene that it be priced. No amount of tinkering with HOTA will satisfy the second, quasi-religious concern, which once again shows how religion can get in the way of sensible policy-making. The first concern -- exploitation of the socially disadvantaged -- is not insoluble. Informed consent, adequate reflection time, transparency in pricing and good assurances of medical care are among the elements that help to address the issue. As Michelle Tan argued in her commentary in the Sunday Times,
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In a sense, therefore, HOTA
or whatever replaces it, doesn't truly address the root problem. The
problem isn't what to do about organ trading. The problem is why poverty
and inequality are so severe.
Unfortunately, the moral high horse is
often mounted by those who are great believers in prescriptive religion,
which in the American century is frequently associated with support for
untrammelled capitalism. That, to me, is the greater immorality. © Yawning Bread
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Footnotes
Addenda None
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The trade in human transplant organs is one of those issues where moral
absolutism comes up against reality. Opinion is, as with many of such
issues, going to be split along the same old lines. On the one side, there
are those who value abstract black-and-white standards, often derived from
some religious or quasi-religious principle about the sanctity of the
human body and who tend to expect people to live up to standards or die by
them. On the other side, there are those who put human beings centrestage,
especially those who are suffering, healthwise and economically, and
expect standards to be shaped to need rather than ideology.
