Loading ...In an article in The Sunday Times on 2 Nov 20081 , 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 organisation. 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 would be “at least five figures, possibly six”.
However, such an approach and argument is flawed on three counts:
True altruism is priceless
First, altruism is “the act of caring about the needs and happiness of other people more than your own”2. Such acts are considered noble and worthy of admiration precisely because there is no material benefit for their 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, we do not really value altruistic acts, and that with money and power, all things, including the denial of death, is possible. This will encourage individualism, and a “me first” mentality found in some other countries. This cannot possibly be good for us as a nation.
The poor will be disadvantaged
Second, organ trading will exacerbate the rich-poor divide. In an environment where all prospective organ recipients are in a queue regardless of whether they are rich or poor, 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” – meaning there will be preferential treatment of one group over another.
Lower or even middle-class Singaporeans are unlikely to be able to afford sums that are five or six figures. The argument that “the National Kidney Foundation could step in to help” does not work in a situation where there are two prospective recipients with hard-to-match donor requirements competing for a single kidney. Would the wealthy recipient outbid the National Kidney Foundation? And would a poor or middle-class Singaporean die because he wasn’t rich enough to afford a kidney?
In the National Longevity Insurance Committee (NLIC) Report3, 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 on 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. Why? Will legalising organ trading allow the rich to live longer? Will it create a situation where the poor and middle class end up subsidising the rich when the National Lifelong Income Scheme kicks in?
No incentive to search for alternatives
Third, legalising organ trading retards the search for alternatives. 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 heart4, for instance.
Is legalising organ trading the best way to control it?
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 anyway, it is not sufficient reason to make it legal here. If it were so, then we should not ban sexual relations between men and underaged girls in Singapore, since doing so would encourage some men to go to our neighbouring countries to seek this illicit pleasure.
In addition, compensating organ “donors” may encourage them to undergo significant risks to their health for the sake of money monetary returns and this may not be in their 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.
Conclusion
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.
Loading ...1 “Law to change so kidney donors can be compensated”, by Salma Khalik, Sunday Times, 2 Nov 2008.
2 Oxford Advanced Learner’s Dictionary, Seventh Edition, Oxford University Press 2005.
3 “Report by the National Longevity Insurance Committee”, dated 4 Nov 2008, by Prof. Lim Pin et al. http://mycpf.cpf. gov.sg/Members/Gen-Info/CPF_LIFE/NLIC.htm,
4 “World’s first permanent artificial heart patient dies”, AFP, 4 Dec 2007. http://health.asiaone.com/print/Health/Health.html