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     FrontPage Edition: Fri 1 February 2008

 HOTA (Amendment) Bill passed


Second Reading of the HOTA (Amendment) Bill

21 Jan 2008
By Khaw Boon Wan
Venue: Parliament
Mr Speaker, Sir, I beg to move, “That the Bill be now read a Second time”.
In 1987, this House, with the recommendations of a parliamentary select committee, moved the Human Organ Transplant Act (HOTA) after 2 days of debate.
The debate in the House was, in turn, preceded by 12 months of public discussion and consultation, involving many stakeholders, religious bodies, professional groups, doctors, and patients. The extensive public debate was necessary as we were then breaking new ground over the sensitive and emotional subjects of organ donation, organ transplantation, brain death and the concept of presumed consent.
Prior to HOTA, organ donation was done solely through the Medical (Therapy, Education and Research) Act of 1972, or MTERA, which allowed Singaporeans to pledge their organs through an opt-in system. However globally, the experience with opt-in systems is that they have not been effective in saving many lives through cadaveric organ transplant.
Our experience with HOTA provides a good illustration. Prior to HOTA, the number of cadaveric kidney transplantations was only 5 per year, on average. With the introduction of HOTA and especially after its amendment in 2004, the rate has gone up ten times, saving the lives, on average, of 48 kidney patients every year, about one a week. Many other patients with liver or heart failure have also been saved. Many more patients have regained their eyesight through cornea transplants.
HOTA saves lives and is an important piece of legislation in our healthcare delivery system. On behalf of the many patients with organ failure, I thank Members for their continuous support of this piece of legislation. Singaporeans too support HOTA strongly.
HOTA does not take away the freedom of Singaporeans to refuse organ donation for any particular reason. 1% of adult Singaporeans have opted out of HOTA. We respect their decision.
Inclusion of Muslims
However, HOTA has not been able to bring major benefits to the Muslims, as a deliberate decision was made in 1987 to exclude them from HOTA.
This was because the Fatwa then required the consent of two waris (paternal next of kin according to Islamic hierarchy) for organ donation to proceed. Even so, the Majlis Ugama Islam Singapura (MUIS) made it clear that organ donation to save lives was permissible under Muslim law. Muslims who wish to donate their organs can do so by making a pledge under MTERA.
Because of the exclusion, Muslim non-pledgers are accorded a lower priority for organ transplant than non-Muslims who have not opted out of HOTA. In similar spirit, Muslims who have pledged their organs under MTERA generally need to wait 2 years before they are accorded the same priority as those who have not opted out of HOTA, if they made theirpledge after the period prescribed in the Act [1].
Unfortunately, there is a rising number of kidney failure cases among the Muslim Malays. New cases of kidney failure among the Malay population rose from 19% in 2000 to 22% in 2006.
In Singapore, the primary cause of kidney failure is diabetes mellitus. According to the 2004 National Health Survey, there was a disproportionately higher number of Malays with diabetes mellitus (11%) compared to the Chinese population (7%).
There is therefore a greater burden of kidney failure among Malays. This trend is also evident from the racial breakdown of the national waiting list for kidneys. Malays made up 21% of the total number of patients on the 2007 kidney waiting list, even though they formed 13% of the resident population [2].
In 2004, MUIS through the Fatwa Committee made it easier for Muslims to pledge their organs. But this has not resulted in any significant increase in the number of Muslim pledgers, despite intensive publicity by the Muslim Kidney Action Association and the National Kidney Foundation.
Since HOTA was enacted in 1987, there have been about 16,000 Muslim pledgers. In 2007, there were less than 200 pledgers. To date, these pledges have not yielded any organ donations.
When HOTA was amended in 2004, several Members asked if MUIS could review its position on HOTA to bring the disadvantaged position of the Muslim community up to par with the rest of Singaporeans. I remember SMS Zainul Abidin Rasheed stressing a point that “The disadvantage of (Muslims) being out of the system are real and the Malay-Muslims as a community cannot afford to let this continue.”
In 2006, MUIS embarked on a series of public education campaigns concerning organ donation and the religious issues surrounding organ donation. While there were some concerns on the practical aspects of transplantation, the Muslim community generally voiced their acceptance of the permissibility of organ donation from a religious perspective, and supported the move to increase the number of Muslim donors.
In parallel, the Fatwa Committee launched a review of the Fatwa on organ donation. The review eventually led to a new Fatwa being issued in July 2007, making it permissible for Muslims to be covered under HOTA.
With the new Fatwa, we are now in a position to amend HOTA to include Muslims like the rest of the Singaporeans. This is a significant achievement both for the Muslim community as well as for Singapore.
The main objective of this Bill which is now before the House is to bring this about. Technically, the Bill itself is relatively straight-forward as it merely removes the current exclusion clauses of HOTA. Accordingly, clauses 2, 3, and 8 of the bill expand the target population under HOTA to include Muslims.
With the inclusion of Muslims under HOTA, Muslims who do not opt out of HOTA will be accorded the same priority as other Singaporeans who have not opted out of HOTA. Muslims who have already pledged their organs under the Medical (Therapy, Research and Education) Act will also be placed in this group and receive the same priority. This will level the playing field for all Singaporeans who are in need of an organ transplant.
Enforcement Powers
I am also taking this opportunity to amend HOTA, through clauses 4 to 7 of the Bill, to provide my Ministry with the necessary enforcement powers to investigate any offence under HOTA.
HOTA includes regulations on living donor organ transplantation to safeguard the well-being of the donor and ensure that he was not under any form of duress or coercion to donate his organs. HOTA also prohibits any trading in organs and blood as it is deemed unethical.
My Ministry currently relies on the Police to investigate such offences as we lack the power to do so. The proposed amendment would allow my Ministry to appoint inspectors and provide them with the appropriate investigative powers, which would enable them to look into complaints and conduct investigations in a timely manner.
We also need to be able to disclose donor or recipient related information for the purpose of administering and enforcing HOTA, as well as for the purpose of referring complaints regarding any errant medical practitioner to the Singapore Medical Council for disciplinary action.
Lifting the Whip
Mr Speaker, as the issues concerning organ removal under the presumed consent framework are ethically and culturally sensitive, I have asked the Whip to be lifted to allow Members to debate and vote on the Bill based on their religious and ethical beliefs.
Although the implementation of these amendments to HOTA will not fully resolve the problem of organ shortage, it will allow more Muslims to have the same chance as others in obtaining a new lease on life through an organ transplant.
My Ministry has estimated that about 30 more patients per year may benefit from the proposed amendments to HOTA. I hope the House will join me in giving them this gift of life.
Sir, I beg to move.

Source: News 21 Jan 2008

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