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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?
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