Human Organ Transplant Act (HOTA)


The Human Organ Transplant Act (HOTA) provides an opt-out organ donation system that allows for the removal of kidneys, livers, hearts and corneas from Singapore citizens and permanent residents who have died, for the sole purpose of transplantation. Administered by the Ministry of Health (MOH), it also regulates organ donation by living persons. Enacted in 1987, it has since undergone three rounds of major amendments to extend its coverage so that more people can benefit from organ transplants.

History
Before HOTA was implemented, organ donation in Singapore was done only on a voluntary basis under the Medical (Therapy, Education and Research) Act, or MTERA in short. The current MTERA was enacted in 1972. It repealed a similar law that was passed by parliament in 1965, as this earlier legislation had been found to be flawed because of its ambiguities and stringent rules.

However, MTERA proved inadequate to meet the transplant needs of patients suffering kidney failure due to the lack of voluntary donations. Only 22 kidney transplants were performed between 1970 and 1978, and there were none between 1979 and 1981. This prompted then Health Minister Goh Chok Tong to suggest setting up an opt-out system of obtaining cadaveric kidneys. After extensive studies and public consultation, the government introduced HOTA in 1987 to allow for the removal of kidneys from non-Muslims who die from accidental causes.

The impact was significant. Between 1987 and mid-2004, 222 patients received kidney transplants under HOTA, an average of 13 per year. Since mid-2004, HOTA has been amended to widen the pool of cadaveric organ donors and thus benefit more people in need of transplants. In 2007 alone, cadaveric organs were used to perform 46 kidney transplants, 12 liver transplants, 4 heart transplants and 106 cornea transplants.

Key Changes Under the Human Organ Transplant (Amendment) Act 2004
(1) Inclusion of deaths resulting from non-accidental causes.
(2) Inclusion of livers, hearts and corneas in cadaveric organ donations.
(3) Regulation of living donor organ transplants.

Key Changes Under the Human Organ Transplant (Amendment) Act 2008
(1) Inclusion of Muslims.
(2) Provision of enforcement powers to give MOH the authority to investigate offences under HOTA.

Key Changes Under the Human Organ Transplant (Amendment) Act 2009
(1) Removal of the 60-year upper age limit on cadaveric organ donors.
(2) Allowing donor-recipient paired matching. Put simply, this is a system whereby recipients who have medically incompatible donors exchange their donors so that each recipient receives a suitable organ. The exchange can be carried out across two or more donor-recipient pairs.
(3) Reimbursement of living donors in accordance with international and local ethical practices.
(4) Increased penalties for organ trading syndicates and middlemen.

Description
All Singapore citizens and permanent residents who are at least 21 years old and of sound mind are automatically included under HOTA, unless they opt out. Upon their death, their organs will be removed if the following conditions are met:
- they died in a hospital;
- their organs are suitable for transplant; and
- there are suitable recipients for the organs to be removed.

People who have not opted out of HOTA will have a higher priority on the waiting list should they need an organ transplant.

HOTA covers only kidneys, livers, hearts and corneas, but people may pledge to donate any of their other organs and tissues (e.g., lungs, bones and skin) upon their death, for the purpose of transplantation, education or research under MTERA. The minimum age requirement is 18 years old. Foreigners can also sign up as donors under MTERA.

Besides cadaveric organ donation, HOTA regulates living donor organ transplants. In such cases, HOTA allows for the removal of a kidney or any part of the liver of a living donor for the purpose of transplantation, provided there is written authorisation from the hospital's transplant ethics committee. Following the 2009 amendments, payments may now be made to living donors to reimburse them for the loss of earnings and other costs or expenses, including medical care and insurance protection, incurred as a result of the organ donation. Although the proposed amendments were eventually passed, this issue of reimbursement was the subject of a heated debate in parliament as some Members of Parliament were concerned that it could be a backdoor to organ trading.

Timeline
31 Dec 1965 : Parliament passed the Medical (Therapy, Education and Research) Act.
2 Jun 1972 : Parliament passed the Medical (Therapy, Education and Research) Act 1972.
Nov 1981 : Goh mooted the idea of introducing an opt-out plan for the removal of kidneys from cadavers for transplant. The health ministry began studying this and various other options to increase the supply of kidneys for transplant and invited views from the public.
12 Jun 1982 : Symposium titled Organ Donation - Whose Responsibility? was held, where experts explained the various systems of organ donation in other countries and local doctors, lawyers and members of the public aired their views on the subject.
27 Oct 1986 : First reading on the Human Organ Transplant Bill.
9 Dec 1986 : Second reading on the Bill.
11 Dec 1986 : A Select Committee appointed to study the Bill invited written representations from the public.
Mid-Dec 1986 : Advertising agency J. Walter Thompson, which had been hired to handle the publicity for the new Bill, began its ten-month publicity campaign to explain the proposed legislation to the public. The programme included print and television advertisements, posters and pamphlets.
7 Jan 1987 : Closing date for public representations.
22 Apr 1987 : Select Committee's report was presented to parliament.
20 May 1987 : Parliament passed the Human Organ Transplant Act 1987.
16 Jul 1987 : Human Organ Transplant Act 1987 took effect. People who wished to opt out were given six months to register their objections.
13 Jan - 31 Mar 2003 : Public consultation exercise on proposed amendments to widen the coverage of HOTA.
15 Sep - 31 Oct 2003 : Second round of public consultation.
6 Jan 2004 : Parliament passed the Human Organ Transplant (Amendment) Act 2004.
1 Jul 2004 : Amendments came into effect.
Jul 2007 : Fatwa committee of the Islamic Religious Council of Singapore issued a fatwa, a religious edict, allowing Muslims to come under HOTA.
25 Aug - 5 Oct 2007 : Public consultation exercise on proposed amendments to HOTA, mainly the provision of enforcement powers to MOH and the inclusion of Muslims.
21 Jan 2008 : Parliament passed the Human Organ Transplant (Amendment) Act 2008.
28 May 2008 : Amendment relating to the enforcement of HOTA came into effect.
1 Aug 2008 : Commencement of all other amendments.
1 Nov 2008 : MOH launched a new long-term public education programme with the theme "Live On" to raise public awareness and support of organ donation.
14 Nov - 15 Dec 2008 : Public consultation exercise on the Draft Human Organ Transplant (Amendment) Bill 2009.
24 Mar 2009 : Parliament passed the Human Organ Transplant (Amendment) Act 2009.



Author
Valerie Chew



References
Chia, S. (2009, March 25). Kidney payment law gets OK. The Straits Times. Retrieved April 6, 2009, from Factiva database.

Govt to seek public views on HOTA changes. (2008, November 1). Channel NewsAsia. Retrieved December 11, 2008, from Factiva database.

Human Organ Transplant Bill: Panel invites written views from the public [Microfilm: NL 15636]. (1986, December 11). The Straits Times, p. 23.

Hussain, Z. (2008, January 22). Muslims to be included in the Act from Aug 1. The Straits Times. Retrieved December 11, 2008, from Factiva database.

Making it easier to donate organs for transplant [Microfilm: NL 7071]. (1972, June 3). The Straits Times, p. 11.

Ministry of Health. (n.d.). FAQs on policies: Human Organ Transplant Act (HOTA). Retrieved December 4, 2008, from http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx?qst=2fN7e274RAp%2bbUzLdEL%2fmJu3ZDKARR3p5Nl92FNtJie8pByIMium%2b96IFsmAcEka%2bpIKxFLl%2bbsTxHVE3%2fpFsXIkii%2bakrP9JvTq0g9m%2fgz6kkbcvQptk23HEACXM9FNn0UQqJ%2fPlcO17qN9e7L%2b43g4GT9QiZGWWvdvoB4Vi%2bNy6oZpxAfJtcAR%2fEIKqmp2YAozrd9VgIg%3d

Ministry of Health. (2003, January 13). Ministry of Health seeks public opinion on proposed amendments to the Human Organ Transplant Act [Press release]. Retrieved December 5, 2008, from http://www.moh.gov.sg/mohcorp/pressreleases.aspx?id=1078

Ministry of Health. (2007, August 25). Proposed amendments to the Human Organ Transplant Act [Press release]. Retrieved December 5, 2008, from http://www.moh.gov.sg/mohcorp/pressreleases.aspx?id=16896

Ministry of Health. (2008, March 4). Human Organ Transplant Act [Brochure]. Retrieved December 5, 2008, from http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Educational_Resources/2008/Brochure%20-%20English.pdf

Ministry of Health. (2008, November 1). Live On - Support organ donation [Press release]. Retrieved December 5, 2008, from http://www.moh.gov.sg/mohcorp/pressreleases.aspx?id=20156

Ministry of Health. (2008, November 14). MOH seeks public feedback on proposed amendments to the Human Organ Transplant Act [Press release]. Retrieved December 5, 2008, from http://www.moh.gov.sg/mohcorp/pressreleases.aspx?id=20320

Ministry of Health. (2009, March 23). The Human Organ Transplant (Amendment) Bill second reading speech. Retrieved April 6, 2009, from http://www.moh.gov.sg/mohcorp/speeches.aspx?id=21280

Opt for life - Give hope to every kidney patient [Advertisement] [Microfilm: NL 15636]. (1986, December 14). The Sunday Times, p. 21.

Organ bill publicity: Ad agency chosen [Microfilm: NL 15635]. (1986, December 5). The Straits Times, p. 23.

Organ transplant act to take effect next week [Microfilm: NL 15867]. (1987, July 7). The Straits Times, p. 1.

Proposal to get more kidneys for transplant [Microfilm: NL 11382]. (1981, November 3). The Straits Times, p. 1.

Spare-part people: In Singapore... [Microfilm: NL 12181]. (1966, May 15). The Sunday Times, p. 1.

Tan, B. (1982, June 14). Kidneys decision after study of options [Microfilm: NL 12094]. The Straits Times, p. 1.

Teo, B. (1991, December). Organs for transplantation: The Singapore experience [Electronic version]. The Hastings Center Report, 21(6), 10-13. Retrieved December 5, 2008, from JSTOR database.


Further Readings
Ministry of Health. (n.d.). FAQs on policies: Brain death. Retrieved December 4, 2008, from http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx?qst=2fN7e274RAp%2bbUzLdEL%2fmJu3ZDKARR3p5Nl92FNtJifJ1L2GFUnw2fcaq9YEtaTM%2flQJTqes9E80Kv9yPo%2bjclvGZPu6KeBnjaFDw8obwRor068ETXk95FDQrXNGlX36h9nX1%2fZJekk%2bFUQaUmyzywzOtd5Qz4H%2fJMV7lKlH5Yo%3d

Ministry of Health. (2008). Proposed amendments to the Human Organ Transplant Act: Public consultation paper. Retrieved December 5, 2008, from http://www.moh.gov.sg/mohcorp/uploadedFiles/News/Press_Releases/2008/HOTA%20Public%20Consult%20Paper%202008%20(Final).pdf

Ministry of Health. (2009, March 24). The Human Organ Transplant (Amendment) Bill closing speech. Retrieved April 6, 2009, from http://www.moh.gov.sg/mohcorp/speeches.aspx?id=21294

Parliament of Singapore. (1987). Report of the select committee on the Human Organ Transplant Bill [bill no. 26/86]: Presented to parliament on 22nd April, 1987. Singapore: Singapore National Printers.
(Call no.: RSING 344.595704194 SIN)



The information in this article is valid as at 2008 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

Subject
Politics and Government>>Health
Health and medicine>>Medical science>>Surgery
Transplantation of organs, tissues, etc.--Law and legislation--Singapore

All Rights Reserved. National Library Board Singapore 2008.