Increasing Singapore's Organ Transplant Rate

Assoc Prof Daniel Goh Pei Siong asked the Minister for Health (a) whether Singapore's organ transplant rate has increased since the launch of the "Live On" campaign in 2008; (b) how does the rate compare with those of other countries with similar quality of life; (c) whether there is adequate training of and buy-in from doctors in intensive care and emergency units to improve the organ retrieval rate; and (d) whether a review of the opt-out system and consideration of the mandated consent system is now timely.

The Ministry of Health (MOH) adopts a multi-pronged approach to promote and facilitate organ transplants. The Medical (Therapy, Education and Research) Act was enacted in 1972 to facilitate donation of deceased organs and tissues for the purposes of transplantation, education or research. The Human Organ Transplant Act (HOTA) was introduced in 1987 to facilitate deceased organ donation through an opt-out scheme. HOTA was subsequently expanded in 2004 to include heart, liver, corneas, as transplantable organs, instead of only kidneys, and institute a framework to regulate living donor organ transplants.

Dedicated public awareness efforts were also made to educate the public of the life-saving benefits of organ donation. In 2008, MOH launched a three year "Live On" campaign aimed at raising societal consciousness and acceptance of organ donation as an acceptable and generous act of goodness.

These efforts have helped to bring about close to 2,000 transplants from deceased organ donations between 2004 and 2015. These included 442 kidney, 157 liver, 42 heart and 1,333 cornea transplants. Over the same period, there were 478 living donor organ transplants. These included 379 kidney and 99 liver living donor organ transplants. Specifically, from 2008 after the launch of the "Live On" campaign, we observed an increase in the number of organ transplant conducted, from an average of 174 cases per year between 2004 and 2007 to 220 cases per year between 2008 and 2015.

While more patients had benefited from organ transplants through these efforts, there is still room to further improve the organ transplant rate in Singapore. Singapore's combined, both deceased and living, organ transplant rate for kidney was 20 per million population (pmp) in 2015. While our rate is higher than that of some developed countries, such as Japan (at 13 pmp) and Hong Kong (at 11 pmp), it is lower than Australia (at 40 pmp) and the United Kingdom (at 49 pmp).

Deceased organ donation is not only a complex medical process, but also a highly emotive and sensitive issue. Our doctors and healthcare staff are trained to be empathetic and considerate in attending to the grieving families. There are clinical protocols as well as ethical guidelines in place to facilitate the deceased organ donation process at the public hospitals. These ensure that the organ donation process is carried out in a timely, appropriate and dignified manner, with family members constantly informed and attended to. MOH supports the regular training of doctors and healthcare staff involved in organ donation and a large part of the training focuses on the skills required in communicating sensitively and empathetically with family members.

Improving organ donation goes beyond the roles played by the hospitals and healthcare staff. Social attitude and culture also play an important role. MOH will continue to promote greater awareness of organ donation and facilitate shifts in societal attitudes and views towards organ donation. As a follow-up to the "Live On" Campaign, MOH will be launching a new outreach campaign in the upcoming months on organ donation. Other efforts include expanding the training of more healthcare professionals on organ donation, working with doctors to raise organ failure patients’ awareness in considering living organ transplant as a treatment option, and encouraging individuals to share their decisions on organ donations with their loved ones. This will help their family members to understand and respect their decisions.

Assoc Prof Daniel Goh asked if it is timely for the Ministry to review the existing "opt-out" consent model under HOTA, and instead consider the "mandated choice" policy, where individuals are required to indicate their preferences on organ donation while interacting with the Government on other matters. We understand that some countries have experimented with the "mandated choice" policy with varying outcomes. Some states in the United States (US), such as Montana and Illinois, have adopted the mandated consent system with some success. However, other US states, such as Texas, as well as Australia, eventually abandoned their mandated choice policy and reverted to an opt-in consent model. It is not clear whether a mandated choice policy would have enhanced our organ donation rate. We need to study this carefully, taking into account the local context.

Nonetheless, we will continue to reach out and encourage Singaporeans to support organ donation. Their gift will go a long way towards saving lives and easing the suffering of patients with organ failure.