http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/02/worgans02.xml

Singapore's compulsory organ transplants

By Sebastien Berger, South East Asia Correspondent
Last Updated: 2:03am GMT 03/03/2007

As Sim Tee Hua lay on life support in a Singapore hospital, seven of his relatives knelt crying on the floor before the doctors, begging them not to remove his organs and give him a chance for a miracle recovery.

Their desperate pleas were to no avail and after police and hospital security staff were called in to restrain them, Mr Sim, 43, was rolled away to the operating theatre to expire.

"The hospital staff were running as they wheeled him out of the back door of the room," said Sim Chew Hiah, one of his sisters. "They were behaving like robbers."
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The previously healthy lorry driver was already brain-dead after suffering a stroke at work, followed by a cerebral haemorrhage in Singapore General Hospital. The harvesting surgeons had waited for 24 hours, but although his family still clung to hopes that he could recover, Singaporean law assumes all citizens except Muslims are willing organ donors unless they have explicitly opted out.

As a way to tackle the perennial shortage of organs that all developed societies face it has proved effective - kidney transplant rates have tripled since the measure was brought in - but it is also a policy that exemplifies the authorities' paternalistic attitude towards the people.

Nonetheless the spectacle of a distraught family abasing themselves in a futile attempt to win an extra day's grace for their son and brother has triggered a rare debate in the city-state, with the letters pages of its newspapers filled with comments for and against.

"Tears would roll down from his eyes when we spoke to him, telling him not to give up," Mr Sim's brother Tee Yong, 49, told the New Paper.

"We know that medically a brain-dead person cannot wake up. But we did not want to give up hope. All we asked for is just one more day for a miracle to happen."

Justine Burley, a bio-ethicist at the National University of Singapore, said the opt-out policy on donation was "fundamentally a good idea" but allowances had to be made on a case-by-case basis and relatives' mental trauma taken into consideration.

"The spectre of family members down on their knees begging the doctors is almost too much to bear from a human standpoint," she said.

Singapore's media generally follow the government line, and the Today newspaper yesterday implicitly rebuked the relatives, referring to the harvest taking place "in spite of a ruckus created by his family members".

In an article headlined: "Postponement killed dreams of liver transplant patients" it quoted the health minister Khaw Boon Wan telling parliament that the single 24-hour delay they had been granted rendered Mr Sim's liver unusable, although his kidneys and corneas had been transplanted.

"We try our best to be compassionate, but the bottom line is we need to be firm with this opting-out policy and respect the wishes of the dead," he said. "People have a choice to opt out and if they don't, we assume that they must have no objections."

Economically Singapore is a huge success, and Lee Wei Ling, a doctor and the daughter of the country's founding father Lee Kuan Yew, called for the buying and selling of organs to be legalised.

"Organ trading is frowned upon and usually not allowed in countries where political correctness reigns," she wrote. "If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?" Her suggestion was described as "wrong" by Alastair Campbell, the Chen Su Lan professor of medical ethics at the National University of Singapore, because of the "inevitable exploitation that would be involved".

"The sellers are always going to be the desperate poor," he said, adding that "to trade the human body as some sort of material possession like a car or house" was crossing an unacceptable line.

Mr Sim's parents have been offered reduced hospital fees for five years, and the family have been sent a letter thanking them for their "generous organ donation".

law's the law.

But let's be honest with ourselves.

For example, I've known about the law for years. I've never bothered to look up where to opt out.

Have you?

Can i really blame anyone if a stroke hits me tomorrow and they want to harvest my organs? Can you?

That’s scary. I will opt out.

Originally posted by fishbuff:

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/02/worgans02.xml

Singapore's compulsory organ transplants

By Sebastien Berger, South East Asia Correspondent
Last Updated: 2:03am GMT 03/03/2007

As Sim Tee Hua lay on life support in a Singapore hospital, seven of his relatives knelt crying on the floor before the doctors, begging them not to remove his organs and give him a chance for a miracle recovery.

Their desperate pleas were to no avail and after police and hospital security staff were called in to restrain them, Mr Sim, 43, was rolled away to the operating theatre to expire.

"The hospital staff were running as they wheeled him out of the back door of the room," said Sim Chew Hiah, one of his sisters. "They were behaving like robbers."
advertisement
Click to learn more...

The previously healthy lorry driver was already brain-dead after suffering a stroke at work, followed by a cerebral haemorrhage in Singapore General Hospital. The harvesting surgeons had waited for 24 hours, but although his family still clung to hopes that he could recover, Singaporean law assumes all citizens except Muslims are willing organ donors unless they have explicitly opted out.

As a way to tackle the perennial shortage of organs that all developed societies face it has proved effective - kidney transplant rates have tripled since the measure was brought in - but it is also a policy that exemplifies the authorities' paternalistic attitude towards the people.

Nonetheless the spectacle of a distraught family abasing themselves in a futile attempt to win an extra day's grace for their son and brother has triggered a rare debate in the city-state, with the letters pages of its newspapers filled with comments for and against.

"Tears would roll down from his eyes when we spoke to him, telling him not to give up," Mr Sim's brother Tee Yong, 49, told the New Paper.

"We know that medically a brain-dead person cannot wake up. But we did not want to give up hope. All we asked for is just one more day for a miracle to happen."

Justine Burley, a bio-ethicist at the National University of Singapore, said the opt-out policy on donation was "fundamentally a good idea" but allowances had to be made on a case-by-case basis and relatives' mental trauma taken into consideration.

"The spectre of family members down on their knees begging the doctors is almost too much to bear from a human standpoint," she said.

Singapore's media generally follow the government line, and the Today newspaper yesterday implicitly rebuked the relatives, referring to the harvest taking place "in spite of a ruckus created by his family members".

In an article headlined: "Postponement killed dreams of liver transplant patients" it quoted the health minister Khaw Boon Wan telling parliament that the single 24-hour delay they had been granted rendered Mr Sim's liver unusable, although his kidneys and corneas had been transplanted.

"We try our best to be compassionate, but the bottom line is we need to be firm with this opting-out policy and respect the wishes of the dead," he said. "People have a choice to opt out and if they don't, we assume that they must have no objections."

Economically Singapore is a huge success, and Lee Wei Ling, a doctor and the daughter of the country's founding father Lee Kuan Yew, called for the buying and selling of organs to be legalised.

"Organ trading is frowned upon and usually not allowed in countries where political correctness reigns," she wrote. "If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?" Her suggestion was described as "wrong" by Alastair Campbell, the Chen Su Lan professor of medical ethics at the National University of Singapore, because of the "inevitable exploitation that would be involved".

"The sellers are always going to be the desperate poor," he said, adding that "to trade the human body as some sort of material possession like a car or house" was crossing an unacceptable line.

Mr Sim's parents have been offered reduced hospital fees for five years, and the family have been sent a letter thanking them for their "generous organ donation".

Originally posted by deathbait:

law's the law.

But let's be honest with ourselves.

For example, I've known about the law for years. I've never bothered to look up where to opt out.

Have you?

Can i really blame anyone if a stroke hits me tomorrow and they want to harvest my organs? Can you?

Quite agree with u... I wouldn't want to "live" if it means "living" in a vegetative state.

Its pointless to engage in those futile arguments about whether "brain dead" constitutes "clinically dead" or whether miracles can happen... Frankly, if miracles were meant to happen, u wouldn't need an extra 24 hours

I consider that it would be doing some good if the organs do save somebody's life.

Though I think that the hospital should have communicated better... If needs be, counsellors should be made available to give psychological and emotional support to the patient's family BEFORE the harvesting.

The HOTA is fundamentally sound and fair... But it turns me off how some bureaucrats manage to do their job in the most insensitive way conceivable...

it should be everyone is being opted out, those who wanna opt in can sign the form to do so.

HOTA Opt Out Form download from following link:

http://www.moh.gov.sg/mohcorp/forms.aspx?id=94

I think people needs to open up more to organ donation. What's the point of keeping your organs with you in death? Why not let others have a new lease in life with your inevitable death, and organs?

By the way, people who are going to opt out should be made aware of the fact that it goes in TWO-WAYS. By opting out, you will be made last in priority list (or you won't be there at all) for organ transplant should you need it one day. You can say it's harsh, but it is FAIR at the end of the day.

like alot of things in life, this is kind of a calculated gamble.

Most of us have no trouble accepting that we are on the priority list of organ transplants, but grow indignant at the prospect that our organs may be harvested.

You can't have it both ways. It's a zero sum game. organs in = organs out.

Still, studies have shown that opt in volunteers are usually about 3 times less than opt out ones, which is why the HOTA act was passed through. Most of it is based on inertia, like my personal one i described a few posts back.

Frankly, I think that in this case, the doctor's only mistake was to grant the first 24 hours. They weren't bound to do that, and by doing so, much valuable time was wasted. The only thing the first 24 hour gift accomplished was to convince the family members that more time was always available, which led to the cries of injustice when they found it wasn't so.

While i sympathise with the family involved, there IS a reason why judgement should always be passed by an impartial party. This is a classic example of it. The rational choice would be to harvest, and it is this rationality that has allowed us to advance to where we are today.

Did u mean DOTA ??

I don't think I'm going to opt-out

Emotionally, I really feel negative about my organs being removed

But hey

Its after death right

My liver would enable a person with liver failure to 'relive' again

So too would my heart

My corneas would give the gift of sight to another person

Finally, my kidneys would be given to 2 persons each

I, or anyone who doesn't opt-out

Would have given 5 people new leases of life

If 1 has always thought of doing good

This is the least 1 can do

Originally posted by Zarks:

Did u mean DOTA ??

you all may be very casual about your lives but do spare a thought for those that spend their lifetime raising you. if my children say such thing like the above to me, i will surely be extremely upset.

check this out... HOTA (not DOTA, this is not warcraft) rule..

"Authorities may remove organ after death
5. —(1) The designated officer of a hospital may, subject to and in accordance with this section, authorise, in writing, the removal of any organ from the body of a person who has died in the hospital for the purpose of the transplantation of the organ to the body of a living person.

(2) No authority shall be given under subsection (1) for the removal of the organ from the body of any deceased person —

(a) who has during his lifetime registered his objection with the Director to the removal of the organ from his body after his death;

(b) who is neither a citizen nor a permanent resident of Singapore;

(c) who is below 21 years of age unless the parent or guardian has consented to such removal;

(d) who is above 60 years of age;

(e) whom the designated officer, after making such inquiries as are reasonable in the circumstances, has reason to believe was not of sound mind, unless the parent or guardian has consented to such removal; or

(f) who is a Muslim."

I see your point. But decisions made by people of sound mind should not be undermined by those who may be emotionally distressed and incapable of objective reasoning. The law is very clear on this point. If the deceased is not of sound mind, the authorisation of the legal guardian is required prior to removal. Now, if the deceased is of sound mind and had consented by not opting out, how can those who are badly affected emotionally by the passing be allowed to overturn the lawful decision made by the deceased?