Extracted from The Star
A price tag for human organs
A new Act aimed at stopping the illegal organ trade involving Malaysian patients is currently being studied by the Attorney-General’s Chambers.
DISHEARTENED by the prospect of a long wait for a transplant, kidney patient Simon (not his real name) decided to take a chance on a deal to get the organ in China.
Paying a significant amount of money to a third party, the 50-year-old businessman flew to China and was checked into a facility for eight days.
“I lived in fear of being discovered. I could not sleep,” he says of his time there, as such unregulated private transplants are illegal in China.
The operation was a success, says Simon, and he is currently on a course of anti-rejection drugs that costs him a few thousand ringgit a month.
Asked what made him resort to such drastic measures, he says he might have had to wait years for a transplant through regular channels in Malaysia; furthermore, he is already 50 and is not a preferred candidate for an organ compared with younger patients, he says.
Simon is not alone in taking such chances.
Desperate for a new lease of life, Malaysians in need of organ transplants are resorting to getting them in countries like China and India, and they are willing to pay through their nose for them – doling out up to RM500,000 for the part and the necessary surgery.
So far, there are no reports of Malaysians selling organs, says Health Ministry medical development division transplant unit head Dr Hirman Ismail.
But, yes, there are cases of Malaysian patients going out of the country to buy such parts, he says.
To deter such trading, the Organ and Tissue Transplantation Bill was drafted and is currently with the Attorney-General’s Chambers for further deliberation.
The new law is set to ban organ trading and regulate living organ donations, i.e. organ donations by people who are still alive.
Currently, the Human Tissues Act 1974, which will be replaced by the new Act, only governs organs donated after the donor is dead and is silent about organ trading.
“That is why we need a law to regulate living donations and prohibit organ trading,” says Dr Hirman.
“So far, organ trading has been happening outside Malaysia but Malaysian patients are involved. We need to be proactive to prevent such activities by having this law.”
The Star reported recently that the Bill proposes that those guilty of being involved in organ trading face up to a RM1mil fine and jail up to 20 years (“Move to curb trade in human organs”, Sept 18).
Dr Hirman points out that organ trading is illegal in many other countries, including in China. It is also against the World Health Organisation’s Guiding Principles on Human Cell, Tissue and Organ Transplantation, and the Istanbul Declaration on Organ Trafficking and Transplant Tourism.
But above all, Dr Hirman stresses that there is a need for more altruistic organ donations after death to ensure a steady supply of organs and to prevent people from going abroad to illegally source for organs.
“It is the right of the patients to seek other options and we can’t stop people from going to other countries. However, the public needs to be aware of the consequences and risks, which includes legal action by foreign authorities,” he says.
Dr Hirman points out that patients have the option of receiving organ donations from living donors who are their blood relatives or spouse, and such procedures can be done locally.
For living donors who are not genetically related, the case would have to be referred to the independent Unrelated Transplant Approval Committee for approval.
However, if there are no strong deterrents in place, such as those offered by the new Act, unregulated transplants between unrelated people could conceivably be carried out if the right incentives are offered.
“Potentially unscrupulous professionals may be tempted with lucrative income to perform transplants involving such dubious cases,” says Datuk Dr Ghazali Ahmad, who is Hospital Kuala Lumpur nephrology department head and senior consultant.
He points out such illegal unrelated transplants might attract foreigners to come to Malaysia on the pretext of altruistic donation.
“Malaysia would then become another controversial state that will attract international racketeers and organ brokers,” Dr Ghazali says.
“The new Bill will have deterrent elements that will criminalise any organ trading and trafficking with clear penalties.
“Right now, we have nothing.”
Dr Ghazali says the new law will deter hospitals, doctors and brokers from participating in such unethical acts.
He stresses that organ donations must stem from a genuine intention to assist a patient without coercion, force or persuasion.
“The donation must not be because the donor is in need of financial help, or is in a desperate socioeconomic situation.
“When a trade or cash exchange occurs as a result of organ donation, such organs will be treated as a commodity,” says Dr Ghazali.
He understands that transplant patients may be desperate to get the organs they need to save their lives but “the ends cannot justify the means”.
He says those who buy organs are normally rich members of society but the people who provide the organs to be sold are poor and risk becoming patients themselves.
“In legal organ transplants, safety and ethical standards must be adhered to.
“But once you put dollar signs into the equation, many requirements will be compromised and sacrificed. In a legal situation, donors are protected and cared for. In the illegal situation, donors can be abused and neglected,” Dr Ghazali says.
Malaysian Medical Association president Dr Ashok Philip says the association supports the new Act as organ trading is a dangerous activity which should be made illegal.
“Some people think that humans have two kidneys, so what is wrong with taking one away? But this could lead to crime.
“A poor and desperate individual should not go to the lengths of selling bits of himself to survive and make it a commercial enterprise,” he says.
According to figures from Malaysia’s National Organ Donation Public Awareness Action Committee there are about 20,000 people on the waiting list for transplants, with most in need of kidneys (see details in graphic, right).
At the same time, the number of transplant surgeons in the country is wanting, too, and the reason for this circles back to the low number of organs available.
Health Ministry director-general Datuk Dr Noor Hisham Abdullah likens the situation to the proverbial “chicken and egg” problem: “With low numbers of donors, it is difficult to build up the capacity of transplant surgeons in this country,” he says.
To increase the number of transplant surgeons here, Health Ministry (medical) deputy director-general Datuk Dr Jeyaindran Sinnadurai says the ministry is looking into bringing in surgeons from overseas.
“But it would require the necessary approvals,” he says, adding that the ministry is also considering roping in doctors from Commonwealth nations.
“Some retired doctors wouldn’t mind coming to Malaysia while middle-aged surgeons may be up for the challenge.”
Previously, it was reported that an average of 60 organ transplants are done in government hospitals a year but this number is small compared with the long waiting list of transplant patients.