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".
