Joseph Teo
In an article in the Sunday Times on 2 Nov 2008, the Minister for Health, Mr Khaw Boon Wan, announced that he planned to amend the Human Organ Transplant Act to allow people who donate their kidneys to get monetary compensation from the recipient or a voluntary organization.
He said that “the World Health Organisation, and countries such as the United States believe that it is ethical to compensate donors so they do not suffer for their act of altruism.” He hinted that the sum will be “at least five figures, possibly six”.
However, such an approach and argument is flawed on three counts.
First, altruism is “the fact of caring about the needs and happiness of other people more than your own.” Such acts are considered noble and worthy of admiration precisely because there is no material benefit – the altruistic person receives only the acknowledgement from one’s peers for their act of self-sacrifice. Such people and such acts are valued because they encourage the suppression of individual need for the good of others and for the good of the greater community. The greater the capacity of a society to do this, the better it is able to survive difficult times.
The act of compensating donors for kidneys removes the altruistic component from the act, and makes it a commercial transaction. By allowing compensation, we are saying that as a society, that we value altruistic acts less, and that with money and power, all things, including the denial of death, is possible. It will encourage individualism, and a “me first” mentality found in some other countries. This cannot possibly be good for us as a nation.
Second, organ trading will exacerbate the rich-poor divide. In an environment where all prospective recipients are in a queue regardless of whether they are rich or poor, all are treated equally, and the lives of both rich and poor are valued equally. Legalising organ trading creates an environment where those who can afford it “bypass the queue” – immediately creating the preferential treatment of one group over another. Poor or even middle-class Singaporeans are unlikely to be able to afford sums that are five or six figures.
Arguing that “the National Kidney Foundation could step in to help” does not work in a situation where a suitable donor for two prospective recipients with hard to match donor requirements are in competition for a single kidney. Would the wealthy recipient outbid the National Kidney Foundation? Would a poor or middle-class Singaporean die because he wasn’t rich enough to afford a kidney? In addition, one would ask if the National Kidney Foundation, even with its considerable reserves, would be able to fund more than a few six digit kidney acquisitions, and if so, are the funds best used in the interests of these very few?
In the National Longevity Insurance Committee (NLIC) Report, Professor Lim Pin noted that there were public concerns that “the scheme benefits those who are wealthier as they will live longer”. However, the NLIC noted that “there is as yet no robust local data to support the use of any other factor (apart from age and gender) to price the premiums”. The NLIC Report is silent as to whether such robust data exists in other countries, and did not propose that we try to obtain such robust data before making a key policy decision. Perhaps the NLIC might provide a reason for not making such a recommendation. Will legalising organ trading allow the rich to live longer?
Will it create a situation where where the poor and middle class end up subsidising the rich when the National Lifelong Income Scheme kicks in?
Third, legalising organ trading retards the search for alternatives. A wealthy cancer patient may, in recognition and acceptance of his impending death, and in a true act of altruism, use his wealth to support cancer research, so that others need not suffer the same pain. A wealthy individual suffering from kidney failure may instead choose to “compensate” a “donor” lavishly. The incentive to do something for the common good is removed, and is instead replaced by a private transaction where only individuals benefit. By making it possible to easily harvest organs from the poor, we reduce the incentive and desire to create fully artificial organs such as the Jarvik 2000 artificial heart .
Some have argued that banning organ trading is ineffective, since the wealthy may go overseas and obtain organs from willing “donors” anyway, and legalising organ trading is a means to protect the interests of the “donors”. This thinking is inconsistent and somewhat skewed.
In the first place, while it is true that banning organ trading in Singapore may encourage some to go overseas to obtain what they cannot obtain legally in Singapore, it is not sufficient reason to make it legal. If it were so, then we should not ban sexual relations between men and underaged girls in Singapore, since it would encourage some men to go to our neighbouring countries to seek this illicit pleasure. Second, it is not clear that getting someone to undergo significant risks to his health, and to jeopardize his future well-being for the sake of some money, is in his best interests. Just as it is not necessarily in someone’s best interests to offer him cheap and easy credit for him to buy a house that he could not ordinarily afford. A truly altruistic act, in the interests of a person in such dire straits as to be willing to give up a kidney for “compensation”, would be to use the money as an outright donation, to build infrastructure or otherwise improve the local economy.
In summary, legalising organ trading diminishes the value of altruism and encourages a “me first” mentality, divides the nation into “haves and have-nots”, and retards the search for alternatives to harvesting organs from poor people. Rich or poor, powerful or weak, smart or simple, we come into this world naked, and naked we will leave this world. Death is the great leveller. Let us come to a graceful acceptance of it, and not choose to exploit those less fortunate than us.
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Instead, the gahmen should encourage more singaporeans to eat and live healthier. By building more pools, gyms and parks instead of dedicating whole chunks of land to golf courses.
I can agree with the notion that people should be encouraged to be altruistic, but I have to draw the line in compelling people to be altruistic. How a rich man would want to disburse his largesse is essentially a private decision – and the government’s role in that should be limited. Altruism, like morality, should not be compelled by law or policies.
However, the concern that a compensation-active HOTA can lead to a zero-sum auction that favours the rich is valid. That does not mean that compensation per se is entirely bad and should be rejected; rather, the system would need to ensure equal access for everyone regardless of socio-economic status. The devil is therefore in the details.
It would be a pity to reject outright a compensation mechanism, since we could very well try to mitigate the potential drawbacks of such a system and make it work instead. Sure, it incentivizes the transaction but in moderation, is that inherently bad considering the physical risks that organ donation entails?
I disagree entirely with the article. Activists have long been trying to get governments to allow compensation for kidney donations as one of the most promising strategies to keep people from unnecessary suffering.
Read http://www.theatlantic.com/doc/200907u/kidney-donation for very well argued reasons, some of which I try to summarize below:
It is simplistic to assume that nonmaterially compensated donors are acting altruistically. Most of them are relatives or friends who stand to gain the benefit of saving someone they really care for. Thus it’s problematic to assume that people donate kidneys altruistically at all in the first place. Many people die from not being able to gain kidneys because governments have thought that maintaining “altruistic” donation is favorable to letting people die on donor waitlists.
Yet financial compensation doesn’t have take away from donor dignity. As noted in the article I linked, it is a matter of attitude, one that should say to the donor, “We can compensate you, but we can never repay you”. In fact, compensation can even make donors feel better about the act since they are less likely to be subject to emotional blackmail from recipients who are relatives or friends.
The danger from exploitation is also misdirected. Wealthy kidney seekers are not only unequally advantaged from “transplant tourism”, they also fuel a highly problematic and unethical trade. In China, for instance organs can come from executed prisoners. By creating a legal and ethical system that regulates and encourages kidney donation and compensation, unethical trading practices are disincentivized and wealthy recipients would not need to be unduly advantaged at the expense of less wealthy recipients. There are ways of doing this mentioned in the linked article, such as by creating donor chains, for instance, and instituting donor welfare measures to address exploitative concerns. Thus the analogy of legalizing donor compensation to legalizing underage sex is malformed. The latter is wrong and unethical any way and anywhere you go about doing it, but the former does not have to be so, and is in fact highly morally commendable for saving lives.
Contrary to what some may think, kidney donation is not significantly risky or harmful. Kidneys tend to fail together if they do, so it is not the case that donating one would leave one at a much more riskier health position than one was before. As well, recent advances in surgery has allowed for kidney donation to be done laparoscopically, which makes tiny incisions and reduces surgical risk and recovery time. In fact, this is also a reason to discourage desperate kidney seekers from going overseas to more dangerous places, since operations there can take place in less than sanitary conditions or with older riskier procedures. Legalizing donor compensation will make kidneys more readily available and diminish the incentive to undertake such risky excursions.
Legalizing compensation not only helps improve the economy, contrary to claims made otherwise, it also improves the quality of life of people unnecessarily unleveled by circumstances beyond their control. Not only is dialysis extremely expensive to the state and patients alike, even more so than financial incentives to be offered to donors, it also degrades the quality of life of people requiring it, taking up many hours of their days and preventing them from leading normal lives. The solution to this is to help make people’s lives better, and not, as Joseph Teo callously states, to let people die which he seems to think will somehow level their lives to others’. Legalizing kidney donor compensation is a long overdue solution to an artificial problem created by unempathetic and poorly informed moral positions. Sperm, ovum and even blood donors are compensated in some way and it is unfair to deprive kidney donors of the chance to improve their lives for the ultimate good they do of saving another’s. Yes, it might cheapen the transaction to some people, but as concluded by the linked article (which everyone should read), “the vicarious thrill of someone else’s altruism comes at a terrible cost”.
Who will compensate, the hospital, the govt or the recipient of organs? I don’t mind the govt or hospital to compendate the donors because these are commercial insititution. Whereas some recipients might be poor, so asking them to compensate a 5-figure sum might not be sound and the poor recipients will be pushed to wait at the back of the list while the rich get the organs first. Anyway, I hope Khaw will look into compensating the HOTA family because the hospital will dig the deceased’s organs and sell them to the hospital patients. The family get nothing but the hospital profit from it. This is not fair!!!
The supply market for organ donation should be limited to countries that are capable of enforcing the relevant laws to ensure ethical consideration are kept in check. In another words, we cannot “purchase” organs from countries such as Indonesia, China and Nigeria.
If you believe that organ donation is the ultimate gift, you have to agree that there are serious flaws in the way the system is operated. We feel it is a grave injustice to encourage people to donate their bodies for the benefit of others, but refuse to pay just compensation to the donor and their family. This is a $20 billion a year industry in the United States, built on the backs of real people who have suffered severe economic hardship, not to mention the loss of a loved one.
We think that should a family make the supreme gift of love and life, the hospital and doctors have an obligation to make sure the last thing that happens is that the donor’s family is billed for any final medical expenses. We advocate a system in the United States that would allow for just compensation to organ donors. A whole body donation is worth at least $2 million to the organ procurement organizations, tissue banks, big pharma and transplant center hospitals.
Any industry that is based on free raw materials is already on the slippery slope of moral issues.
Check out http://www.DoNotTransplant.com for more information about the current state of the organ harvesting industry and your rights under the law.
“no free lunch”
very applicable to this topic too.
Second, it is not clear that getting someone to undergo significant risks to his health, and to jeopardize his future well-being for the sake of some money, is in his best interests.
Such acts are considered noble and worthy of admiration precisely because there is no material benefit – the altruistic person receives only the acknowledgement from one’s peers for their act of self-sacrifice.
It will encourage individualism, and a “me first” mentality found in some other countries. This cannot possibly be good for us as a nation.
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All these arguments show clearly that you are very against the economics way of thinking, the “invisible hand” argument by Adam Smith.
We can agree to disagree then
By allowing compensation, we are saying that as a society, that we value altruistic acts less, and that with money and power, all things, including the denial of death, is possible.
This statement is highly questionable, and I think the flaw may reveal itself when we compare it with the rationale of TOC’s appeal for donations…
Personally, I’m with removing barriers to organ transplants; however, as Jabir (#3) said, it’s the details that’s problematic.
The writer seem to already have establish a model of how it (distribution of kidney and compensation) will work and then work out conclusions based on that model. But is that the ONLY model?
What if organs is treated as controlled substances? E.g Rich or poor, we are not allowed to buy heroin legally. Distribution of it (if it is used at all as pain reliever) is controlled. Priority is determined medically, not first come first served.
The compensation sums will come from a charity fund like NKF. Only that the funds will not be used for treatment, but for a Cure (or something close to it).
Rather state fund goes into compensating donors than into pockets of already rich ministers.
Assumption two, highlighted in post #11, is flawed and displays a lack of knowledge of how markets actually work.
” Poor or even middle-class Singaporeans are unlikely to be able to afford sums that are five or six figures.”
What makes Mr Teo so certain that in a free and open market kidneys (or any other organs) will cost five or six figures?
With nearly six billion people on this planet (and rising), chances are that prices will fall rapidly if a true free market in organ trading is introduced. There is everything to be gained and nothing lost from such a system.
It is bigots and ill-informed people who obstruct the creation of an open market in organs who keep the price high and deny the benefits to those who badly need them.
wonder why we need this law here in Singapore?
for economic purpose?
Can we please steer clear of religious ridicule, such as the one propagated by “from the heaven”? Spiteful, religious postings such as this is deplorable, and should not have been published in the first place.
I believe the Tang saga got our wealthy ruling elite thinking “hmm…this could well happen to me and my loved ones”. So they immediately (amazing how fast they acted….if only they were as fast with helping ordinary S’poreans) started implementing organ trading.
Organ trading favours the very rich PERIOD. Right now, there is is sole lack of transparency in who gets say a kidney. Sure, there is a queue, but a wealthy individual can slot himself in front of the queue without anyone noticing….especially our ruling elite.
#16
Completely agree….the gahment could have passed so many other laws/amendments to lawa, but chose to fast track this one for obvious reasons, ie the elites and the rich. What did the 2 poor indonesians get nothing but long jail terms and what does Tang get, a couple of hours in jail and next time can find a legitimate kidney some more. He who has the gold makes the rules…………
It’s all very well to sit down and sprout stuff about morality and altruism, but the simple, stark fact is that there are real people dying. If you are ever in need of an organ, you have every right to refuse to buy one and accept your death, but you cannot tell others that they have to accept theirs just to be “moral” (and by “moral” I really mean what you consider moral).
And denial of death is not necessarily a bad thing. What is wrong with an individual exercising sovereignty over his own existence and using every resource at his disposal to stay alive? I instead find it disturbing that State/community/god(s) or any other entity should be able to tell a person when he should or should not die.
well CPF use for investment overseas with CPF contributors…if all works out we get our 1 – 2 %, while the other % go to god knows where…
as for this organ compensation stuff…seems the same as the CPF thingy set up…
folks, please take one step back…..will there be transparency, accountability etc etc….
we setting a precedent for this organ compensation stuff…who is gonna set the price of the kidneys, the liver etc…dones this mean a human being is worth only so much [especially if the parts go to the rich]…where is the line if it is crossed to the detriment of the donors…who will set it….or is it dependent on how much money is involved? Or how important or critical the recipient is to receive the organ? Who will set this rules in concrete, will the critical cases be the first? How about those less well-off or is it if they can’t afford it is going to be their fault again for not having enuf $…lol…oh i almost forget…like in animal farm by george orwell…those who are created more equal then others can always change the rules to the detriment of others…
sad. Wish it is not so…can hope someone in authority really think and re-think this thru that it is to really help people who are in pain and in need and to be based not on their color/creed, monies but to be seen as valued human beings…whether poor, rich or whatever all are valuable citizens of singapore…can only hope.
Sigh, even organ is “officially” tagged with a price. Is this how far we have fallen?
I am not disputing the fact that the organ be used for a good cause; but tagging a price tag seems “morally” wrong.
they will tagged a price…1st with kidneys then follow by other parts…best of all some people will make a profit out of it…and laugh at the donors who get the crumbs…this will happen is the transparency and checks are not made cleared from the start.
strange with all the R&D around the world in synthetic organs…why can’t singapore do the same to grown artificial or bio-engineered organs to save lifes not only in singapore but all around the world…oh almost forgot…they will as usual price it out of reach of the poor & less fortunate…
as usual it is only me and nobody else…
i think once we have too many people with the above thinking or fixed self-servcing ideas…
…thus the earth becomes more “damaged” directly/indirectly…i tik the human race dun have much future at the rate we are going, pity the kids in 20 years – 40 years time…i will be too ashamed to face them when they say it to my face that i allow this to happen.
Unless obama and wiser folks in power can head us off in time….the current folks in power [i am sad to say] rite now more interested in retaining power and make more $/assets for themselves…
haizzzz…
13) Peter Sellers
//////////…… flawed and displays a lack of knowledge……… //////////////
What else is new? Such blatant and irresponsible posts are rampant in TOC.
Hokkien say “mouth never paste stamp”
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