organ trading

Hurray for Michelle Tan Su May for her commentary in today's (6 July 2008) thesundaytimes headlined "Get off your high horse, moral arguments a luxury".

I feel for those who are compelled to go overseas to get organ transplants. I can understand the need and want to get well both for themselves and their love ones. And their fear and worry. And what the alternative would be if they do die or worse, suffer on. Some of these are not as rich as the magnate who is alleged to have attempted to buy a kidney and need to scrimp and save and borrow to go overseas for such transplants. Added to that possible concerns about the skill and quality of facilities in China or India where such transplants usually take place. Yes, the healthcare costs might be cheaper here and that might be a factor for going overseas. But there is now no real alternative to do it here in Singapore if one is concerned about the risks and prefer to do it here.

Yes. organ trade works to the detriment of the poor donor. But it may be a way for them to get out of the poverty trap as is the case with the donor to Ms. Tan's father. I cite the example of places in China where men (some old) would carry tourist seated on sedan chairs up mountain paths. Yes, you would feel sorry for them but getting on allows them to make an honest living.

What exists presently are:

1. Some forced to go overseas at possible risks for such transplants. Even if they would rather do it here, they cannot.

2. Resorting to buying organs under pretence and I would assume, paying large amounts to the middlemen who then pay pittance to the donor who are then that much poorer in terms of getting proper care and nutrition.

You really cannot stop certain things. People gamble whether you legalise it or not. If Singapore Pools does not take 4D bets, your friendly neighbourhood bookie will. Singapore Pools can use the profits for good, stop the bookie and his boss from getting rich and sometimes ripping punters off. Not unofficially condoning the sex trade would drive sex workers underground where control of STD will be a problem.

Having some form of control over organ trading would prevent the middleman from exploiting the would-be donor. I am not suggesting things are simple but the Singapore authorities are good at plugging the loopholes (HDB and LTA can offer suggestions).

Disclaimer: I am making the above comments as a "kay-poh" by-stander. None of my family members (knock on wood) will derive any benefit if the rules are changed.

For those who may not have read her piece, I copy below Michelle Tan Su May's commentary:

Get off your high horse, moral arguments a luxury
By Michelle Tan Su May

I am so sick and tired of hearing people who truly know nothing about the situation debate this issue in a vacuum, in principle, in theory, as a hypothetical ethics essay.
I was 14 when my dad's kidneys started to fail. It was the realisation of our worst fears, the culmination of a lifetime of worrying.

My whole childhood was filled with fear that my dad would die. Having been a diabetic since he was 20 years old, potential loss of sight, loss of his limbs and subsequent kidney failure were the perennial phantoms that lurked in the shadows of his entire adult life, and thus my whole childhood.

His burden of daily injections of insulin, never being able to eat anything sweet and a strictly restricted diet were suddenly compounded by kidney failure. Now, in addition to no sugar, he could not take any salt or water. His daily quota of water was only two tiny shot glasses a day - and these small mouthfuls had to wash down more than 10 pills daily.

The simple things that we take so much for granted became unattainable luxuries to him. Drinking, eating, walking without assistance, being able to urinate normally, being able to see your kids finish their O levels or PSLE (my younger brother).

He was only 39 at the time. He went on the two types of dialysis available to cleanse his blood of toxins. The first type (peritonial dialysis), which involved having a tube dangling out of a hole cut into his tummy, worked quite well for him but because of his diabetic condition, the hole kept becoming infected. So after a few months, he had to go on the more tedious type - hemodialysis. This involved him being hooked up to a machine daily for up to three hours at a time after having metal tubes the size of knitting needles inserted into his arm.

This did not work for him. So the symptoms of kidney failure returned full force. Constant retching, yellowed eyeballs, constant weakness, the inability to walk without assistance, and the inability to work. He was a Simex trader, and an outgoing man.

After a few months, we were given the bad news and the worse news. The bad news was that the dialysis was not working for him and he needed a transplant. The worse news: Because he had diabetes as well, he was not eligible to be placed on the Singapore organ waiting list! Without dialysis or a transplant, he would die within months. The doctor was basically delivering the news of a death sentence.

Fortunately, we were informed that it was possible to find a donor in India and have a transplant operation carried out there. After months of blood tests and groundwork, my dad flew to Mumbai to have the transplant. Despite putting on a brave front, he was terrified that he would not survive the operation. He told me later that he had brought extra money, 'in case I had to come home in a box'. I can only imagine what it feels like to say goodbye to your children at the airport thinking it may be the last time you ever see them.

The donor was a poor young man with a young family from India. He earned approximately $30,000 for his kidney. He used the money to buy a shop and start a business to support his young family. This young man and my dad gave each other a new lease of life.

My dad lived for seven years after that transplant. He died aged only 49, but he lived to see my brother turn 20 and to attend my university graduation. Never a day went by that he wasn't grateful for this second chance at life. Seven years is a lifetime when you have faced death and managed to get a second chance. Going through all that has also made me a stronger person today.

Madam Lam Yar Ee, in The Straits Times Forum page, said: 'The Health Ministry should discipline Singaporeans who return after participating in organ trading.' I say she should visit the homes of dying people who have no other option before she spouts such nonsense. She should look into the eyes of their loved ones, their young children, and get off her high horse.

Mr Jeffrey Chan said organ sales are wrong because they are 'exploitation of the poor'. Let me ask him this: If you were told that you could have someone abandon their children for years to come and live in your house and to wash your dirty underwear, to wait on you hand and foot, and to clean up your bedridden relatives' faeces, for up to 16 hours a day at 60 cents an hour, wouldn't you think such a situation sounded inhumane and unacceptable? Yet that is what our foreign domestic workers are forced to accept by coming here to work in Singapore.

Do they like it? No. Do they have a choice? Yes and no. They could stay at home and have nothing to feed their children. Or they could come over here in the hope of a better future eventually for their children. Yes, they are poor. Yes, they are desperate. By the same token, Mr Chan would have to argue that we ban the use of domestic workers because it is also exploitation of the poor.

It is time to wake up. The world is unfair, life is unfair. It is unfair that some people can live in good health until their 90s, while others like my father die at 49 or earlier. It is unfair that we get to be surrounded by our children and loved ones, while people like my Indonesian maid (whom we treat as part of our family and pay $500 a month instead of the standard $350) have to leave their kids for years in order to eke out a living in a foreign land so their children won't starve.

Inequality is a fact of life. Therefore, the role of a sophisticated society should be to regulate all dealings to ensure that the poor, the unhealthy and the desperate know their rights, and their risks versus their potential returns before they embark on any life-changing decisions. Taking the choice out of their hands in the name of protecting them is paternalistic and patronising. Being poor does not equal being stupid.

My stance is: 'Get off your high horse.' Till something terrible happens to you, you don't know what you would do to survive. Life is unfair. Poverty is unfair. Ill health is unfair. But we can do something to alleviate the misfortunes of those who are unlucky by allowing them the freedom of choice to save a life and better their own at the same time.

Freedom of choice results in human beings maintaining their dignity. The dying man who can buy a little more time, and the poor man who can better his family's life by selling an organ that he will be perfectly healthy without - they can both regain some dignity by entering into such a transaction with their eyes wide open and being well-informed of their rights.

Moral arguments are a luxury that healthy people indulge in before misfortune befalls them too.

The writer is a businesswoman in her mid-30s. A lawyer by training, she runs a property investment firm and owns an antiques shop. She is married with two children.