In June 2018, the World Health Organization (WHO) enjoined governments all over the world to exert more effort in stopping “thousands of organs” being trafficked each year. Will the recently launched disease centre in Singapore prompt people to secure much needed organ transplants in legitimate ways?
SingHealth and Duke-NUS Medical School have set up a new disease centre to bring together all of its transplant capabilities, such as research and education, in a move to advance transplant care and increase legal access to organs.
With this undertaking, the SingHealth and Duke-NUS Transplant Centre have merged and strengthened all of the medical group’s solid organ, tissue and cellular transplantation services.
“This new transplant centre aims to harmonise SingHealth’s clinical expertise for transplant with its research and education capabilities … . It will explore ways to improve the transplant survival rates, optimise the quality of patients’ lives and keep transplant-related costs affordable for patients,” Health Minister Gan Kim Yong said during the launch on Friday (April 12).
Associate Professor Prema Raj Jeyaraj, a senior consultant at the Singapore General Hospital’s department of hepato-pancreato-biliary and transplant surgery, is leading the new facility.
The centre will have healthcare professionals from different disciplines, such as dietetics and physiotherapy, working together. Research-wise, the centre will explore the development of treatment strategies that could improve the body’s tolerance for transplanted organs and thus lessen the need for lifelong immuno-suppressants.
It will also probe the prospects of developing technology to 3D bioprint organs.
The centre’s drawing board includes collaborating with the National Organ Transplant Unit and other institutions like the National University Centre for Organ Transplantation to improve education and awareness of organ transplants among healthcare professionals and the public, Prof. Prema Raj explains.
Waiting for a new lease to life
The National Kidney Foundation indicated that the average waiting time for a kidney transplant in Singapore is nine years. Currently, over 250 patients are on this waiting list alone.
Prof Prema Raj says that one good way to increase the supply of organs for transplantation is to obtain them from donors after circulatory death, which is when the heart has stopped pumping.
At present, solid organs like the kidney, heart and liver are taken from donors only after brain death. This is because most vital organs deterioriate quickly once oxygen supply is cut.
“However, if surgeons are able to retrieve these organs within approximately 55 minutes of circulatory death, then these organs can still be used for transplants.
“There is currently a trial being done at Tan Tock Seng Hospital using kidneys from donors after circulatory death. We want to extend that to other organs. I think that will reduce our need for living donors,” he said.
Although organ transfers save thousands of lives, health experts reveal that demand is more than supply. This trend has regrettably caused the unlawful trade of human organs.
A 2015 account from the European Parliament’s Directorate-General for External Policies titled “Trafficking in Human Organs”, states that since 2000, organ trafficking has extended its reach from mainly South and Southeast Asian countries to Latin America, North America and other regions troubled by poverty and political volatility.
The document cited a World Health Organization (WHO) 2007 estimate that 5% to 10% of all kidney and liver transplants carried out globally were done with illegally-obtained organs.
The reality that a 2015 document uses a 2007 estimate can be attributed to the fact that there is difficulty in procuring fresh data on the subject. This was echoed by Francais Delmonico, a professor of surgery at Harvard Medical School, when he said that the unlawful nature of the trade complicates the chances of its impact being measured. Unfortunately, points out Delmonico, global inequality made the poor “ripe for exploitation.”
In August 2014, media reports emerged about new alleged organ trafficking cases at a military hospital in Phnom Penh, Cambodia. That same year, reports emerged of an 18-year-old Cambodian who had undergone surgery in a hospital in Thailand to remove and subsequently sell his kidney. In Thailand alone, there were 4,321 people on the organ waiting list.
In 2016, Australian-based ABC News found evidence of organ trafficking in West Java, Indonesia, where residents have sold their kidneys. According to ABC News, eight residents of a local village had sold their organs for around US$7,500 each.
Organ trading in Singapore
In Singapore, organ trading is unlawful and strictly prohibited by the Human Organ Transplant Act (HOTA).
In 2008, well-known entrepreneur Tang Wee Sung, then owner of the CK Tang departmental store, was sentenced to a day’s jail and fined $17,000 for trying to illegally obtain a donor kidney.
In 2015, more than 400 people were on the wait-list to receive an organ donation while trying their best to fight for survival. There were only 58 organ transplants of the kidney, heart and liver compared to 69 in 2006.
Under Singaporean law, the technicalities of organ transplants are supervised by two laws — The Human Organ Transplant Act (HOTA) and the Medical (Therapy, Education, and Research) Act (MTERA). The HOTA was enacted in 1987 which allows authorities to extract any organ from a Singapore citizen or Permanent Resident who has died in a hospital and to do so for the purpose of transplanting the organ to a living person. The HOTA is also the Act which criminalised organ trading. Two amendments have been made to cater to the escalating demand for donor organs. Notwithstanding the many changes and revisions to the law, organ donation remains low and the standard waiting time for a kidney transplant can take up to 10 years, with donor organ demand far outweighing supply.
Lack of availability of organs in SG
Even when facing harsh penalties, it is human nature for people to take risks to save the lives of loved ones. The lack of availability of legally-harvested organs in Singapore has not seen any improvement over the past ten years.
However, with the new disease center, there is now hope for patients who need organ transplants as well as for those working to stop illegal trafficking of human organs./TISG