Published January 13, 2009

When compensation is a bad word

Many think it conveys wrong impression about changes to Hota

By CHEN HUIFEN

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THERE have been some reservations on the use of the word 'compensation' to describe the payment to be disbursed to living organ donors, in the event that changes to the Human Organ Transplant Act (Hota) allow them to receive a monetary benefit for their altruistic act.

The ministry will follow ... guidelines... to cover the costs of expenses incurred by living donors so as to remove financial disincentives to organ donation. - Ministry of Health

This is because the word could be misunderstood as payment for the organ. And if so, it would amount to an inducement for people to donate an organ, in turn discouraging altruistic organ donation.

The finding came from a public consultation exercise conducted by the Ministry of Health (MOH) on the proposed amendment to Hota. The exercise included a public dialogue session as well as a written survey which was responded by 162 people.

While mindful of the sensitivities surrounding the payment for organ donation, the ministry stressed that it is committed to prohibiting organ trading in Singapore.

'The ministry will follow international practices and guidelines in working out a legally and ethical scheme to cover the costs of expenses incurred by living donors so as to remove financial disincentives to organ donation,' it said. 'The ministry will take into account the feedback that the word 'compensation' is best avoided.'

Semantics aside, 86 per cent of the respondents were in support of some form of payment to living organ donors. This could be by way of reimbursement or defraying of costs to cover direct expenses such as transport and accommodation, loss of time and earnings, and anticipated costs of medical follow-up.

About 96 per cent agree that penalties for organ trading syndicates and middlemen should be raised. The same proportion of respondents also said yes to allowing donor-recipient paired matching for exchanges of organs, while 93 per cent support lifting the upper age limit for cadaveric organ donation.

About 76 per cent of the respondents in the written survey are of the view that a reasonable payment level should exceed $50,000.

Hota currently limits cadaveric donors to those below 60 years of age. MOH is proposing that this age cap be removed. It is also looking at amending the Hota to allow paired matching so that a donor-recipient pair that are incompatible within the pair may find better options by exchanging donors with another pair.

Without specifying the actual levels or the matrix to derive it, the ministry is also proposing that reasonable compensation be provided to support the welfare of living donors. Penalties for organ trading syndicates and middlemen could also be raised to a fine of up to $100,000, or a maximum jail term of 10 years. This is up from the current maximum fine of $10,000, and a jail term of up to 12 months.