ONE of the amendments to the Human Organ Transplant Act (Hota) proposed last week will go some way, but not all the way, in assuaging misgivings over compensating organ donors. Increasing the maximum fine and imprisonment ten-fold, to $100,000 and 10 years, for organised organ trading may deter where the current law has failed to do so, at least as shown in the Tang Wee Sung kidney sale case. The need for deterrence, ironically, may decline, along with the desperation of patients in the transplant queue. More organs would presumably be made available, since the other Hota changes would provide for extending the cadaveric donation age beyond 60 and donor-recipient paired organ matching, as well as compensating living donors.

If offered reimbursement for expenses and lost earnings, follow-up medical care, surgery insurance and transplant priority, altruistic persons may be more inclined to offer up a kidney, say. At the least, there will be less disincentive than before. If the shortage is indeed thus relieved, the recipient or demand side would have less need for deterrent penalties than would the donor or supply side. Since foreign donors would not be barred, there should not be a shortage of supply from abroad either. But, in this case, relative abundance requires stiffer penalties, to prevent exploitation of donors by middlemen. Judging again from the Tang case, they would have little difficulty in procuring organs from donors in neighbouring countries. Are the proposed penalties sufficiently strong to deter syndicated trading?

Foreign cases are not as easy to detect, investigate or prosecute as local ones, because the deal-making may take place partly outside Singapore's jurisdiction, in countries from which extradition of offenders may not be available to the Singapore authorities. Already, care should be taken to see that the quantum of compensation, especially if determined according to Singapore living costs, is not so high as to induce impecunious foreigners to part with their organs. Even more caution - and an administrative mechanism to enable the exercise of such caution - would be needed to ensure that foreign donors, if not altruistic, are not exploited by middlemen in their home country when they show up here for the surgery.

Part of the solution lies in making information freely available to would-be donors everywhere, to acquaint them with authorised or legitimate organ donation channels, which would presumably drive most syndicates out of business. Heavier penalties are warranted, but they alone will not be enough to prevent abuse.

This article was first published in The Straits Times on Nov 15, 2008.

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