Organ Donation in Singapore (under HOTA, or For Science)

With advances in medical science, organ donation has become a reality. For many patients, organ donation might be the only viable treatment option for them. As of 2017, there are over 400 patients on the organ transplant waiting list – this figure is expected to increase with rising life expectancy and chronic diseases in Singapore.

There are 2 ways in which organ donations may be legally performed in Singapore:

1. Under the Human Organ Transplant Act (“HOTA”), which is a mandatory enrolment scheme allowing the harvesting of specified organs after death
2. Under the Medical (Therapy, Education and Research) Act (“MTERA”), which is an opt-in scheme allowing a donor to donate his organs or tissues to be used for transplant, education or research purposes after his death

Compulsory Organ Donation after Death

The HOTA is a mandatory organ donation scheme that applies to all Singapore citizens and Permanent Residents aged 21 years old and above, regardless of religion. HOTA may also apply to those below the age of 21, as long as the person’s parent or guardian has consented to such removal.

The HOTA allows for specified organs (the kidneys, liver, heart and corneas) of a person to be harvested upon their death in a hospital, for the purpose of transplantation, unless the deceased person had earlier opted out of HOTA.

The organ should be removed and transplanted only by authorised medical practitioners. Otherwise, the removal of organs by an unauthorised person is an offence which can result in a fine not exceeding $10,000, or imprisonment for a term not exceeding 12 months, or both.

Opting Out of HOTA

A person may choose to opt out of HOTA by registering an objection with the Director of Medical Services using the HOTA Opt-Out Form. This form allows a person to indicate his objection to the removal of some or all of the specified organs. The completed form should be sent to the National Organ Transplant Unit. An acknowledgment of this objection will be sent to the person who has opted out of HOTA.

This objection can be withdrawn as well, by completing the Withdrawal of Objection to Organ Removal Form, which should also be sent to the National Organ Transplant Unit upon completion.

It should be noted that by opting out of HOTA, one would be given lower priority to another who has not opted out of HOTA on the organ transplant waiting list should he require an organ transplant in the future.

However, should he withdraw his objection thereafter (i.e. opt back into HOTA), he will be given the same priority as a person who has not registered any such objections after a period of 2 years from the date on which the Director of Medical Services has received his withdrawal. This is if he does not register another objection during the 2-year period.

Voluntary Organ Donation after Death for Science

The MTERA is a voluntary opt-in system that allows any individual who is 18 years old and above to donate their organs and tissues for the purposes of transplant, education or research after their death.

Under the Act, any gift of all or any part of the body must be made by the person who intends to donate any part of his body (known as the donor) either in writing at any time, or orally in the presence of two or more witnesses during a last illness. The purpose of the gift must be to allow:

1. Any approved hospital conduct medical or dental education, research, advancement of medical or dental science, therapy or transplantation; or
2. Any approved medical or dental school, college or university for the purposes of medical or dental education, research, advancement of medical or dental science, therapy or transplantation; or
3. Any specified individual for the purposes of therapy or transplantation needed by him.

Thus, it is possible for the potential donor to specify the recipients of his organs before his death under MTERA, as long as it is done through the method specified above.

The donor can revoke his pledge of organs, through one of the following methods:

1. A signed statement in writing delivered to the donee;
2. An oral statement made in the presence of 2 or more persons and communicated to the donee; or
3. A written document of the donor’s revocation found on his person or in his effects.

Living Donor Organ Transplant

Organ transplants from a donor whilst he is still alive is generally not allowed, unless the following requirements under section 15A of the HOTA are fulfilled:

1. The specified organ is removed in a hospital with the written authorisation of the transplant ethics committee of the hospital; and
2. The donor of the specified organ has given his consent to the removal of the specified organ from his body and has not revoked or withdrawn the consent.

For such transplants, only the kidney or any part of the liver may be donated. Before the donation, potential living donors will have to attend mandatory counselling sessions conducted by the Ministry of Health to understand the risks involved in organ donation.

Thereafter, an expert panel from the Transplant Ethics Committee of the hospital will interview and review the potential living donor’s health. The committee must also be satisfied that the donor is not mentally disordered, and is able to understand the nature and consequences of the medical procedures he has to undergo as a result of his donation.

Living donors can choose to either specify or not specify the intended recipients of their organs. In cases where the intended recipient is a family member, living donors will be given a mandatory cooling-off period of a week. If the intended recipient is not a family member, the mandatory cooling-off period is a month long.

In 2016, Mr Peter Lim Kok Seng became the first person in Singapore to donate a part of his liver to a complete stranger in a non-directed liver donation.

Is Organ Trading Illegal in Singapore? 

Organ trading is illegal in Singapore. A contract or an arrangement under which a person agrees for valuable consideration, whether given or to be given to himself or to another person, to the sale of any organ or blood from his body or from the body of another person, whether before or after his death or the death of the other person will be void.

Any person guilty of this offence shall be liable on conviction to a fine not exceeding $100,000 or to imprisonment for a term not exceeding 10 years or to both.

The following situations will be deemed as illegal under section 14 of the HOTA:

1. Any person who gives or offers valuable consideration for the sale or supply of, or for an offer to sell or supply, any organ from the body of another person other than for the purpose of transplantation to his body;
2. Any person who receives valuable consideration for the sale or supply of, or for an offer to sell or supply, any organ from the body of another person;
3. Any person who offers to sell or supply any organ from the body of another person for valuable consideration;
4. Any person who initiates or negotiates any contract or arrangement for the sale or supply of, or for an offer to sell or supply, any organ from the body of another person for valuable consideration other than for the purpose of transplantation to his body; or
5. Any person who takes part in the management or control of a body corporate or body unincorporate whose activities include the initiation or negotiation of any contract or arrangement referred to above.

An illustration of such a contravention would be the case involving Mr Tang Wee Sung, who was sentenced to one day in jail and fined $17,000 for his attempt to purchase a kidney from an Indonesian man.

However, the prohibition against organ trading does not apply to any contracts that provide only for the defraying or reimbursing for costs or expenses that may be reasonably incurred by a person for:

1. The removal, transportation, preparation, preservation, quality control or storage of any organ;
2. The costs or expenses (including the costs of travel, accommodation, domestic help or child care) or loss of earnings so far as are reasonably or directly attributable to that person supplying any organ from his body; and
3. Any short-term or long-term medical care or insurance protection of that person which is or may reasonably be necessary as a consequence of his supplying any organ from his body.