Blog 3: On legalising organ trading

In this article, Health Minister Khaw Boon Wan states that while the trading of human organs for money is “definitely wrong, morally and legally”, we should, for pragmatic reasons, still consider legalising it. This comes after the first ever case of illegal organ trading in Singapore, between CK Tang executive chairman Tang Wee Sung and two Indonesians. However, I find that this is an extremely dangerous position to hold; organ trading should not be legalised without given much consideration.

Most people who require organs turn to such illegal organ trading in the black market due to the reason that the demand far exceeds supply: one can expect to wait for years before one even has a chance of having a donation that matches. Supporters of organ trading suggest that if organ trading were made legal, both the donor and the receiver would get what they want. Sellers, especially the poorer ones, would get money to support their family with, whereas the recipients of the organs would be able to continue living the healthy life that they had always wanted. However, I find that this is rather flawed. Can we put a price on our organs, as though they were mere commodities like meat? I most certainly think not.

Also, even if this was intended to benefit both the rich and the poor, it makes the rich-poor divide even more apparent. Now, the poor and ill would have an even greater disparity in medical treatment than the rich, being unable to buy organs themselves. In addition, what most supporters of this envision is, despite their labels of “pragmatic”, still far too idealistic. The legalising of organ trading would certainly lead to many desperate poor people offering their kidneys or other body parts for sale, in hope of being able to solve their financial problems. However, a great increase in supply will lead to the price falling, leaving those who manage to sell their organs still fairly poor, and probably short of a kidney to boot. Such a thing is already happening in Iran, where organ trading is legalised: desperate sellers are often unhappy with the low prices their organs fetch, usually leaving them still unable to properly feed their family.

Perhaps the main reason why people give thought to the possibility of legalising organ trading is the fact that it trades an economical benefit at the cost of morality and ethics. Despite all the talk of “facing the reality”, I would rather not sell out my moral values for mere cash. Also, once there is economic benefit, the morally bankrupt will certainly find any way they can to exploit it. It is not too hard to envision people being swindled of their organs just to have them resold for a higher price to a needy buyer. In addition, with all the illegal child smuggling for purposes such as prostitution, do we really wish to add one more incentive for people to exploit children unable to defend themselves?

However, I do admit that it is hard to feed oneself on morals alone. If the government wishes to overlook its multiple flaws and legalise organ trading for the economic benefit, perhaps it may be able to sufficiently control it to mitigate its shortcomings. There might be a way to, as Mr Khaw says, “protect the interests of the donor and the patient”.

In conclusion, while organ trading has a few advantages and may benefit some people, it is a morally flawed system and has too many shortcomings to be a successful system. As the article states, Singapore can instead try to “learn from Norway and Spain, where organ supply almost matched demand” due to “specially trained doctors and an efficient donor detection programme”. I believe it is certainly possible to try to find a solution to the organ donor problem without resorting to organ trading as an easy way out.

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Original article
Straits Times
Jul 14, 2008

Let's not rule out organ trading yet, says Khaw
SINGAPORE is not ruling out legalising organ trading.
The surprise comment from Health Minister Khaw Boon Wan yesterday is bound to re-ignite the fiery debate on the benefits and dangers of allowing the buying and selling of human kidneys, lungs and other organs.
The Government has stood firm so far on enforcing the present laws, which prohibit organ trade.
Recently, five people were taken to court in the country's first kidneys-for-sale deals.
But yesterday Mr Khaw said that organ shortages and a black market in the region made legalising trading an option.
'I think we should not write off or reject the idea of selling organs. But I think we need to study it carefully,' he said.
There are no immediate plans to change the law, as there are practical reasons why overturning the ban could backfire - like shrinking the current donor pool, he added.
'By legalising trading, you could actually lose the family members who currently donate. Instead, you could get organs from outside the family, through payment, and the result would not be as good,' he explained.
Siblings are the best bet for a perfect tissue match if a transplant is needed - with a one in four chance of success. This figure shrinks to one in 2,000 for non-relatives.
Last year, 86 Singaporeans received kidneys from living donors, including 53 who got the organ from a relative.
Hundreds of others were not so lucky, most of them languishing on waiting lists and dying within five years without a transplant.
The minister's remarks at a community event yesterday came in the wake of a highly publicised organ trading case here, in which two Indonesians were jailed earlier this month for selling their kidneys. It also involved CK Tang executive chairman Tang Wee Sung, who was charged with attempting to buy a kidney.
In an e-mail response to The Straits Times, Mr Khaw said his stance yesterday was not a turnaround from his earlier comments that the trade, motivated by financial transactions, is 'definitely wrong, morally and legally'.
He said yesterday: 'I remain of the view that organ trading is not the way to go, but we should not reject any idea given the reality.'
Meanwhile, the Singapore Medical Association (SMA) has come out steadfastly against legalising the organ trade, following an emergency meeting on Saturday.
Its spokesman, Dr Tan Sze Wee, said organ sellers face an array of short- and long-term medical risks. The sellers, almost always desperately poor, could also be abused and exploited.
'We see tremendous resources needed to enforce organ trade regulations in a transparent and equitable way.
'These make it inappropriate for SMA to support any move towards legalising the trade,' he said.
Mr Khaw said the best approach is still one of prevention, such as better control of diseases like diabetes.
Singapore should promote altruistic donations through the Human Organ Transplant Act (Hota), and live transplants among relatives.
When Hota is extended to Muslims next month, the pool of organs would increase, he said.
Singapore could also learn from Norway and Spain, where organ supply almost matched demand - a figure higher even than Iran, the only country that has legalised organ trading.
In Spain, for example, specially trained doctors and an efficient donor detection programme have contributed to its success.
Mr Khaw added that he hoped to find a solution that protects the interests of the donor and the patient.
'How? I don't know. But if we do not force ourselves to think out of the box, then we will never be able to find a better solution,' he said.