HOTA - Opt-out if you are not ready to donate your organs

In the handbook, "Helping Others Through A Gift of Life" published by the Ministry of Health, it explained that Singapore has an opt-out system under The Human Organ Transplant Act (HOTA) because an opt-in system has no significant impact on the number of pledges.

Having a relative with kidney failure, I welcomed the HOTA opt-out system. To-date, none of my family members has opted out from it.

In early 2007, the unpleasant and sad experience of one family as reported in the Straits Times sparked off an exchange of views among some doctors and readers in the Straits Times Forum.

In this sad incident, the relatives of a cadaver donor (who did not opt-out) pleaded unsuccessfully with the medical team to delay the harvesting of organs under HOTA. To make matter worse, the policemen behaved roughly towards the grief-stricken relatives. It sent me into deep thoughts - the medical team and policemen became devoid of human feelings - showing no sympathy while enforcing the law. Clearly, it was an unwilling donation that brought great distress upon the distraught living relatives, especially the donor's mother.

The key question is how many Singaporeans are aware of the HOTA opt-out system. I spoke with ten people and found out that eight of them were unaware that they have to opt-out if they do not wish to donate their organs (kidneys, liver, heart and cornea). Immediately, I gave them the opt-out forms. My gesture was condemned by some people as they feel that it is a good deed to save lives with their organs after they pass on. However, I strongly feel that the donation must be made willingly, and to spare the living relatives from distress. It poses a great challenge for the living relatives, especially, parents letting go of their children when doctors pronounced them to be brain dead.

One mother shared with me her experience while coping with the loss of her young son. She agreed to donate her son's organs in December 2002. The medical team wanted to harvest his organs at 10pm but she bargained to spend one more night with her child until the next morning at 6am. Before 6am, the medical team was already there to move the boy to the operating theatre. Uncontrollably, she shed tears while relating this past event to me. It was a sad story. Even though she had made the donation willingly, it was certainly a painful moment, hastening the death of her only child.

I wonder how many people can face such painful moments. It is also important to recognise that there are also rare cases where apparently brain dead patients had regained consciousness.

To reduce such emotional burden on their loved ones, it is important to encourage the practice of giving power of attorney for health care decisions in the event of one's inability to make decisions to a trusted family member or friend. This can include decisions on organ donation.

The HOTA opt-out form can be downloaded from the Ministry of Health's website at www.moh.gov.sg.

Two kind doctors had openly expressed their concern over the rigidity on the enforcement of HOTA in the Straits Times Forum. They strongly feel that the living relatives should be given the option to object to the donation. The rationale is that this will reduce the likelihood of people opting out because of distrust of the competency of doctors to diagnose brain death. However, their proposal was slammed down by another doctor who argued that it is unfair to others. Under the law, people who opt out of HOTA, as well as those who are not covered under HOTA, will receive lower priority on the waiting lists if they need an organ transplant. This will be specific to the organs which they have opted out of or have not pledged. She also made a bold assumption that many people do not opt out from HOTA because they do not want to be penalized, i.e. given the least priority in the queue for organ transplants.

I disagree with her views as I would think that many people do not opt-out because they do not have full knowledge of HOTA. If people are really motivated to be given first priority, they would have opted-in under the old scheme to receive such privilege. Likewise, many people would have flocked to donate blood if they are really motivated to receive medical privileges as blood donors. However, this is not the case as evidenced by the frequent shortage in our blood bank.

Advertisements on HOTA only became apparent in the recent months. In March 2007, when I went to Sengkang Polyclinic to collect the opt-out form (previously not available on the website), I had to get it from a senior nurse. Logically, the opt-out form that is found in the handbook, "Helping Others Through A Gift of Life" should be made available openly and in public view. To create awareness of HOTA, I had written to the Minister of Health a few years ago, proposing a HOTA Day to honour organ donors.

When the dust settles down, I reckon those advertisements on HOTA will be far and few in between. There will still be people (those above 21 years old when HOTA came into force) that will remain oblivious to HOTA (Chapter 131A) Objection to Organ Removal Under Section 9(1).

Donation of organs is a sensitive and emotional issue. A meaningful "Gift of Life" scheme such as HOTA should encompass compassion and humanity. Hopefully, one day, the law can be amended to incorporate the human touch by allowing living relatives to object to the organ donation. If this happens, it will make the work of medical team easier - striking a balance to save lives without hurting the other living souls. A blessed organ donation will bring great joy to the recipients, a good closure to the donors' living relatives, and a heart-warming accomplishment to the medical team. Kudos to our humane legislators if we can achieve this harmonious scenario.

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