Human Organ Transplant Act

Human Organs Transplant Act

Just for Info, if you want to opt out from HOTA, please visit this website or get this form.

The recent uproar over how a “declared brain dead” but breathing patient's organs being forcefully removed from his body under the Human Organs Transplant Act (HOTA) has significant impact on various areas. One of my friends rang me up to express his unhappiness over the methods used in enforcing this law. Although he is not totally against HOTA but he feels that there is a total lack of tact and empathy from the hospital in enforcing it.

I have been pondering over this issue for the past few weeks, not only on the way the patient's immediate family members are being treated in the whole process but also on the merits and the philosophical MORAL grounds of HOTA.

I guess nobody could argue with the fundamental aim of HOTA in saving lives by providing the framework whereby organ transplants could be done legally. However, it is important to examine on how the law is being drafted.

While human organs trading is prohibited in Singapore, HOTA allows the state (government's proxies such as hospitals etc) to harvest human organs from certain dead persons which includes persons who died in accidents or those declared brain dead. The most important clause in HOTA is that it allows the state to harvest these organs if the dead did not sign any documents that indicates his objections while he was alive.

There are a few issues which I would like to highlight:

1)When HOTA allows the state to harvest organs from persons who are declared brain dead, then it would mean that those doctors must be 100% sure that the patient is indeed brain dead. But as far as we know, there are instances whereby persons who were declared brain dead “revived” themselves after a certain period of time. Thus, it is impossible for anyone to be 100% sure that a person lying in coma is indeed brain dead.


2)It is the state's responsibilities to educate the public on the necessity of supporting Human Organ transplants by means of donating their organs when they are dead. The clause in HOTA allows the state to harvest human organs without the need of direct consent from the dead or his immediate family members. This will naturally mean that the state no longer need to carry out the necessary educational program to cultivate the people in believing in the merits of human organs transplant.


3)Silence means consent? This is a moral issue. Many people are ignorant of HOTA and the requirement of their documented dissent before they could “opt out” from such scheme. I think in many instances, PAP government has taken things for granted. It has chosen to take the easier way out by using “opt out” schemes for various things. But when it comes to HOTA, it does not merely involve money but human organs, emotions and personal religious beliefs as well. Could the state come up with a law that says if the one did not “opt out”, the state could use his body for drug experiments when he is admitted into hospital! The state could further come up with laws that dictates that if one did not “opt out”, the state could forcefully take blood from people if the needs arise (especially so for those with rare blood groups)!


4)The most fundamental question is this, do your dead body belong to the state after you are dead? If not, then why does the state empowers itself the right to do whatever they want to your body after you are dead? If so, then why the state did not take up the responsibility in conducting the necessary funerals and cremation of the dead bodies? Instead, it just takes whatever it wants from the body and then dump it back to the immediate family members!


5)If saving lives is the primary concern of the state in enforcing HOTA, then my question is this: citizens have already done their part in “donating” their organs to save lives, will the state provide the necessary organ transplant surgery for those who need these organs FREE OF CHARGE? This would mean that whether you are rich or poor, you will have the equal chance of receiving organ transplant without the need to pay the hefty fees for such transplant to take place.


6)If the state is not going to sponsor FREE organ transplant surgery, then it would mean that only those rich individuals who could afford the expensive surgery will get the organs. The problem is, rich or poor, if you did not “opt out” of the scheme, your organs are “liable” for harvesting when you are dead. Is this a “FAIR” system?


7)Who will benefit from the “donation” of the organs if the surgery is not free? Those who need the organ transplant as well as the hospital and doctors that are doing the transplants. The ultimate question is this, if we do not allow people to trade their organs for money, but in the end, this law conveniently allows some other people to benefits indirectly from such “donation”!


8)Those who drafted this law really lack empathy. They have made various assumptions about death and take those family members for granted. This is especially so when there is a asymmetric of knowledge between doctors and layman on what constitutes “brain dead”. For the patient's immediate members, it would be difficult to convince them that a breathing patient is indeed “dead”. Thus, the conflicts arise from the recent case is within really expectation. It is really unimaginable that a self proclaimed world class government could draft a law that lacks simple empathy and sensitivity to the citizens.


9)On the other hand, I really wonder how could those hospital staff and policemen could enforce such law right in front of those grieving relatives! How could the law makers expect hospital staff and policemen to enforce such a law on breathing brain dead patients?

My reflection on HOTA is that this government lacks empathy in governance. We should always remind ourselves that we are dealing with human beings, not just mere digits. You could use cold logic to deal with digits but we should use empathy to deal with human beings.

Most of the time, it would be too simplistic to think in such “cold rationale”:

Brain dead= dead = alright to harvest human organs.

The truth is, there are numerous “miracle revival” of supposedly, scientifically “brain dead” individuals in this world. Thus “brain dead” is actually not “definite death” but just a “probable”
death. i.e. High probability that the patient is dead.

Besides, it is just not about whether the patient is truly dead or not, but rather, whether the family members could accept the death in view of a breathing body. We are after all, dealing with human beings, not some robots.

HOTA is merely one of the many examples whereby this self proclaimed “World Class Government” uses “cold logic” to deal with human beings..i.e. Citizens. Everything could be “digitized” and “explain away” without the need of using human empathy. This also explains why many Singaporeans are unhappy of what PAP does (including minister pay rise, GST rise etc) but they are unable to “logically” rebuke PAP's policies. It is just a matter of empathy.

Goh Meng Seng