Blog Entry 1-Legalising Organ Trade in Singapore

Two days ago, on Thursday, 4th Sep 2008, ailing retail tycoon Tang Wee Sung, age 56, whose purchase of a kidney through Wang Chin Sing as the middleman for $300,000 was exposed, was fined a total of $17,000 and jailed a day. The district judge sentenced Wang, 44 years old, to a 14-months jail term in the illegal kidney-for-sale case. Although the Indonesian kidney sellers were not forced into the trade, the judge said they were poor and Mr Tang was a 'clearly vulnerable' victim 'who was in desperate need of a transplant to save his life'. From The Straits Times, Sep 6, Saturday, “Judge Ng added: 'The intricate web of cross-border transactions and elaborate arrangements carried out smack of it being a syndicated operation.'” He also noted Wang had not told Mr Toni and Mr Sulaiman, the 2 donors involved, about the health risks they faced and now Mr Toni were suffering the after effects of post-donation.

After reading this article in the news, I was appalled by Wang’s greed and manipulation of the weak and economically-deprived. With desperation built in on both sides of the equation - deathly ill 'buyers' and desperately needy 'sellers', he exploited the situation to his advantage. Just a little statistics first, Singapore is ranked fifth in the world in terms of incidence of kidney failure. According to a news report, at least 3,500 people in Singapore have kidney failure; 600 are on the transplant list. But they have to wait almost a decade for a cadaveric donation, meaning that the donors give up their organs after they are deceased. Cases such as Wang are not isolated in Singapore as there are also medical middleman pocketing thousands just by referring patients to doctors, or by bridging the gap between patients and donors. Almost everything that is bad can be traced back to money. Currently, the only country in the world that allows organ trade is Iran, where they call it ‘organ-sharing’.

The news has raised issues about legalising organ trade in Singapore, creating a fierce debate about whether Singapore should have a system that manages the buying and selling of organs. The local public has urged the government to officially permit organ trade, providing their respective arguments to support their stands. In relation to Communication concepts that I learnt in week 2, many varying perceptions surround the issue of organ trade. I was intrigued by the sensitivity and ethical elements that are involved, and how different variables like selection and perceptual errors, social network, psychological state and the environment influences groups of people in interpreting the pros and cons of organ trade.

Like for the free-thinkers who are for organ trade, they fail to see the consequences it will have on the social and economic values on our country. They do not realise that even with a system regulating an organ market in Singapore, there is no assurance that the black market will be totally wiped out. It is just like how loan sharks can still thrive even with many banks and authorised money-lending schemes around, or how underground bets still thrives alongside The Singapore Pools. Thus the perspective taken are skewed and laden with perspective errors due to oversimplification and ignorance.

Naturally for those on the waiting list, they would definitely campaign for legalisation of organ trade. In a desperate and life-threatening state, their psychological state, priorities and motives placed them in favour of organ trade too. In the shoes of the middlemen, their agenda is to take advantage of the situations of both donor and patient hence has no moral concerns or qualms about this thriving medical business.

And considering the economic situation of the hopelessly poor, I believe those people's decision is also 'weakened' by their economic predicament. If they had another way out, they wouldn't go to extreme means and risking their health for the rest of their lives. Thus this is where the environment such as physical setting and external factors easily come into play to influence and make biased one’s POV in the issue of legalizing organ dealings.

My point of view that legalising trading of organs should be implemented and the process by which I come to make sense of this issue are largely based on my social network. By social network, I refer to self-beliefs, religion preferences and habits of family and friends.

In Buddhism, the decision for or against organ donation or trading very much depends on the individual’s decision. There is no right or wrong choice, but however there are also rituals and rules guarding against the need to ‘disturb’ a dead body. In my religion, more emphasise is placed of entity conscience and of letting family members know about my wishes in relation to organ donation or trade after death. I honour those bonded to holy conventions, which overlook their ethics and offer their bodies to the advancement of medical science and technology and to prolonging another being’s life.

It is important to not omit the multi-racial strand in Singapore that comes into the foreground in every ethical issue raised. According to the Muslim Religious Council, as long as “it is done with respect for the deceased and for the benefit of the recipient" Muslims have no restrictions on organ transplants. Similarly to Bhuddism, Hindus are not prohibited by any religious commandments from donating their organs according to the Hindu Temple Society of North America. This act is an individual ruling and decision about what to do with their organs after they die. Under “Church of Christ,” the listing states very simply: “Organ transplants should not be a religious problem.”

The Catholics view organ donation as an act of charity, fraternal love and self sacrifice. Transplants are ethically and morally acceptable to the Vatican. Pope John Paul II in a recent statement said, "Those who believe in our Lord Jesus Christ, who gave His life for the salvation of all, should recognize the urgent need for a ready availability of organs for transplants a challenge to their generosity and fraternal love. Since the basic race groups locally share similar perceptions, then I believe we have come to a successful communication and reading, at least in relation to religious views.

I support organ trade because I recognise the advantages it can bring to both parties involved. This can be the only way out for people that are trapped in the vicious economic cycle, or in critical life-threatening situations. Why should anyone die on the waiting list because his family and friends are not equipped with a compatible kidney? And if our government cannot alleviate extreme poverty in some families, it should not create more obstacles for the people to fish for methods to survive. I lost my grandfather to diabetes and kidney failure 10 years back, so I personally identify with the desire for family members to purchase an organ to save their loved ones. My grandfather fought with the disease for a few years, having to take insulin shots twice daily. Given the chance to relieve the pain and prolong his life, everybody in my family clan will unquestionably take it up. Singapore has the best medical technologies available to extend life. Eighty percent of patients successfully receive correctly matched kidney and heart transplants in Singapore, thus I see no reason why the government if capable of implementing a fully regulated system, is holding back its resources and not helping its people.

If the government has some form of control over organ trading, it would prevent the middleman from exploiting the would-be donor. I’m not implying things are simple but the Singapore authorities are good at tying up loose ends. Singapore can front the lead and set a good precedent for the global world by legalizing organ trade.

Last of all, how I perceive organ trade can be attributed to my environment that commercialisation is all around. Like how commercialism has tainted the ideals of sportsmanship, of winning for its own sake and fair play, legalizing organ trade is actually another extension of widespread commercialisation over all spheres of our lives. In the organ trade, it is a business driven by the simple market theory of demand and supply. It’s the nature of these markets to reduce everything including human beings and even their reproductive capacity, to commodities. Women unable to conceive themselves, look for surrogate mums who rent out their wombs for money. And with the globalisation of the economy, the circulation of body parts will transcend national boundaries. And the movement of flow, from the way I see it, will inevitably will be seen from South to North, from poor to rich, from black and brown to white, and from female to male bodies, just like the movement of global wealth and resources. It is a phenomenon not surprising due to the globalisation, commercialisation and mass media perpetuating information.

Up-to-date, the Human Organ Transplant Act “bans the supply of any organ or blood for valuable consideration” in Singapore. However, government ministers recently hinted that a certain procedure allowing organ trade will be put into practice in the upcoming years. There will be no serious ethical clashes among racial groups as the spectrum of positions taken by the various religious organizations listed above strongly support and view organ donation as “an act of charity, fraternal love, and self sacrifice.” Together with The Republic’s capability, competency, leadership, low bribery rates and infrastructure to facilitate such transactions, I personally believe that there is no good reason to prevent organ trading, provided the transaction is carried out within a well-defined framework.