Organ Donation in Singapore: Guiding Legislation Practices

Donating your organs after your passing is one of the greatest gifts anyone can give, and can make a significant difference in another person’s life. A donated organ can potentially save a life or significantly improve someone’s quality of life.

An organ donation recipient in Singapore will only receive the organ when his/her organ has failed, and no other treatment is available. Up to 7 lives can be saved by 1 donor. There are generally two ways in which organ donation in Singapore can be carried out.

The Human Organ Transplant Act (“HOTA”)

HOTA is a mandatory enrollment scheme that allows for the retrieval of specific organs from an individual after his/her death. The HOTA is a compulsory organ donation in Singapore scheme that applies automatically to all Singapore citizens and Permanent Residents aged 21 years old and above.

For individuals below the age of 21, HOTA may also apply to Singapore citizens and Permanent Residents below the age of 21 if such a person’s parent or guardian gives consent to the scheme. HOTA allows for organs that can be transplanted to be harvested from the donor upon their death in a hospital.

Transplant-able organs include the kidneys, liver, heart and corneas. A full list of transplant-able organs is available. The organ transplant procedures should only be performed by authorized medical practitioners. Any such removal of organs by an unauthorized person is a criminal offence which can result in a fine not exceeding $10,000, or imprisonment for a term not exceeding 12 months, or both.

Opting out of HOTA

Organ donation in Singapore is a personal choice. A person may choose to opt out of HOTA by filling out a form known as “Objection to Organ Removal under Scetion 9(1)”, available. The completed form should be sent to the National Organ Transplant Unit. An acknowledgment of this objection will be sent to the person who has opted out of HOTA. It should be noted that a person may indicate his objection to the removal of some or all of the specified organs.

If a person changes their mind during their lifetime in relation to their objection, this objection can be withdrawn by completing the “Withdrawal of Objection to Organ Removal under Section 11(1)” form, available. The completed form should also be sent to the National Organ Transplant Unit.

Individuals who opt out of HOTA would be given lower priority on the organ transplant waiting lists should he require an organ transplant in the future. However, should he withdraw his objection thereafter (i.e. if he decides to participate in organ donation in Singapore under HOTA again), his priority on the organ transplant waiting lists will be reinstated after a period of 2 years from the date on which the Director of Medical Services has received his withdrawal, as long as he does not re-register his objection to Organ Removal.

Medical (Therapy, Education and Research) Act (“MTERA”)

Another way to donate an organ in Singapore is under the MTERA scheme, which is an opt-in scheme. The MTERA scheme allows a donor to donate his organs or tissues to be used for transplant, education or research purposes after his death.

Voluntary organ donation after death

Any individual who is 18 years old and above may opt to donate his or her organs and tissues under MTERA. Under MTERA, any gift of all or any part of the body must be made by the donor either in writing at any time, or orally in the presence of two or more witnesses during a last illness. The purpose of the gift must be to allow: – any approved hospital conduct medical or dental education, research, advancement of medical or dental science, therapy or transplantation.

– any approved medical or dental school, college or university for the purposes of medical or dental education, research, advancement of medical or dental science, therapy or transplantation or – any specified individual for the purposes of therapy or transplantation needed by him. In that regard, it is possible for the potential donor to specify the recipients of his organs before his death under MTERA.

As with HOTA, the donor can withdraw from MTERA by:

• signing a statement in writing and delivering it to the donee
• making an oral statement made in the presence of 2 or more persons to the donee or
• possessing (on his body or in his effects) a written document of the donor’s revocation upon his death.

Living donor organ transplant

In general, living donor organ transplants (i.e. where the donor is still alive) are not allowed, unless specific requirements under section 15 of the HOTA are satisfied:

• The specified organ is removed in a hospital with the written authorisation of the transplant ethics committee of the hospital; and
• The donor of the specified organ has given his consent to the removal of the specified organ from his body and has not revoked or withdrawn the consent.

Only the kidney or any part of the liver may be donated under the living donor organ transplant procedures. Before the donation, potential living donors will have to attend mandatory counselling sessions conducted by the Ministry of Health to understand the risks involved in organ donation in Singapore.

Subsequently, an expert panel from the Transplant Ethics Committee of the donee hospital will conduct an interview with the donor to review the potential living donor’s health. The committee will also review the donor’s mental health, and must be satisfied that the donor fully understands the nature and consequences of the medical procedures the donor is consenting to. The donor can choose as to whether to specify the intended recipients of his or her organs.

In cases where the intended recipient is a family member, the donor will be given a mandatory cooling-off period of a week, during which the donor may consider withdrawing his consent. If the intended recipient is not a family member, the mandatory cooling-off period is one month long.

Is organ trading illegal?

Organ trading is illegal in Singapore. Any contract or an arrangement where a person agrees for valuable consideration to the sale of any organ or blood from his body or from the body of another person, whether before or after his death or the death of the other person will be void and unenforceable.

Any person guilty of this offence shall be liable on conviction to a fine not exceeding $100,000, to imprisonment for a term not exceeding 10 years, or to both. Under section 14 of the HOTA, any of the following circumstances will be considered illegal:

• Any person who gives or offers valuable consideration for the sale or supply of, or for an offer to sell or supply, any organ from the body of another person other than for the purpose of transplantation to his body.
• Any person who receives valuable consideration for the sale or supply of, or for an offer to sell or supply, any organ from the body of another person.
• Any person who offers to sell or supply any organ from the body of another person for valuable consideration
• Any person who initiates or negotiates any contract or arrangement for the sale or supply of, or for an offer to sell or supply, any organ from the body of another person for valuable consideration other than for the purpose of transplantation to his body
• Any person who takes part in the management or control of a body corporate or body unincorporate whose activities include the initiation or negotiation of any contract or arrangement referred to above.

However, organ trading prohibitions does not apply to any contracts or agreements that a person enters into which provide only for the defraying or reimbursing for costs or expenses that may be reasonably incurred by a person for:

• The removal, transportation, preparation, preservation, quality control or storage of any organ
• The costs or expenses (including the costs of travel, accommodation, domestic help or child care) or loss of earnings so far as are reasonably or directly attributable to that person supplying any organ from his body.
• Any short-term or long-term medical care or insurance protection of that person which is or may reasonably be necessary as a consequence of his supplying any organ from his body.