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), the act also regulates organ donation by living persons. Enacted in 1987, it has undergone major amendments in 2004, 2008 and 2009 to extend its coverage so that more people can benefit from organ transplants.

History
Before HOTA was implemented, organ donation in Singapore was carried out on a voluntary basis under the Medical (Therapy, Education and Research) Act, or MTERA in short.1 The current MTERA was passed in parliament in 1972.2 It repealed a similar law that was passed in 1965, as this earlier legislation had been found to be flawed, because of its ambiguities and stringent rules.3


However, MTERA proved inadequate to meet the transplant needs of patients suffering kidney failure, due to the lack of voluntary donations. Only 22 cadaveric kidney transplants were performed between 1970 and 1978, and none between 1979 and October 1981. This prompted then Minister for Health, Goh Chok Tong to suggest setting up an opt-out system of obtaining cadaveric kidneys.4 After extensive studies and public consultation, the government introduced HOTA in 1987 to allow for the removal of kidneys from non-Muslim Singapore citizens and permanent residents between the ages of 21 and 60, who had died from accidental causes. However, under the opting-in system covered by MTERA, Muslims could pledge to donate their kidneys to be used for the purpose of saving lives, and not for research.5

The impact was significant. Between 1987 and mid-2004, a total of 222 patients received kidney transplants under HOTA, an average of 13 per year. Since 2004, HOTA has been amended to widen the pool of cadaveric organ donors, and this has benefitted more people in need of transplants.6 In 2007 alone, there were 46 cadaveric kidney transplants, 12 liver transplants and four heart transplants.7

Key changes under the Human Organ Transplant (Amendment) Act 20048
(1) Inclusion of deaths resulting from non-accidental causes.

(2) Inclusion of liver, heart and cornea donations.
(3) Regulation of living donor organ transplants.

Key changes under the Human Organ Transplant (Amendment) Act 20089
(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 200910
(1) Removal of the 60-year upper age limit on cadaveric organ donors.

(2) Allowing donor-recipient paired matching. This allows recipients who have medically incompatible donors to 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) Tenfold increase in 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.11

People who have not opted out of HOTA will have a higher priority on the waiting list, should they need an organ transplant.12

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.13

Besides cadaveric organ donation, HOTA regulates living donor organ transplants. In such cases, HOTA allows for living donor the removal of an organ from a living person, provided that there is written authorisation from the hospital's transplant ethics committee, and the donor has given and has not revoked or withdrawn consent to the organ donation.14

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.15 Although the proposed amendments were eventually passed, this issue of reimbursement was the subject of a much heated debate in parliament as some members of parliament were concerned that it could be a backdoor to organ trading.16

Timeline
31 Dec 1965: Parliament passes the Medical (Therapy, Education and Research) Act, 1965.17
2 Jun 1972: Parliament passes the Medical (Therapy, Education and Research) Act 1972.18
Nov 1981: Health Minister Goh Chok Tong proposes the idea of an opt-out plan for the removal of kidneys from cadavers for transplant.19
27 Oct 1986: First reading of the Human Organ Transplant Bill.20
9 Dec 1986: Second reading of the Human Organ Transplant Bill.21
11 Dec 1986: The Select Committee on the Human Organ Transplant Bill invites written representations from the public on the proposed law.22
19 Jan 1987: Select Committee report is presented to parliament.23
20 May 1987: Parliament passes the Human Organ Transplant Act 1987.24
16 Jul 1987: Human Organ Transplant Act 1987 takes effect.25
Jan–Mar 2003: Public consultation exercise on proposed amendments to widen the coverage of the Human Organ Transplant Act.26
Sep–Oct 2003: Second round of public consultation for feedback on the draft Human Organ Transplant (Amendment) Bill.27
6 Jan 2004: Parliament passes the Human Organ Transplant (Amendment) Act 2004.28
1 Jul 2004: Human Organ Transplant (Amendment) Act 2004 takes effect.29
Jul 2007: MUIS (Islamic Religious Council of Singapore) issues a fatwa, allowing Muslims to come under the Human Organ Transplant Act.30
Aug–Oct 2007: Public consultation exercise on proposed amendments to the Human Organ Transplant Act, mainly the provision of enforcement powers to MOH and the inclusion of Muslims.31
21 Jan 2008: Parliament passes the Human Organ Transplant (Amendment) Act 2008.32
28 May 2008: Amendments relating to the enforcement of the Human Organ Transplant (Amendment) Act 2008 take effect.33
1 Aug 2008: Commencement of all other amendments to the Human Organ Transplant (Amendment) Act 2008.34
 Nov–Dec 2008: Public consultation exercise on the draft Human Organ Transplant (Amendment) Bill 2009.35
24 Mar 2009: Parliament passes the Human Organ Transplant (Amendment) Act 2009.36
1 Nov 2009: Human Organ Transplant (Amendment) Act 2009 commences.37



Author

Valerie Chew



References
1. Care will be taken in implementing organ transplant bill. (1986, December 10), The Straits Times, p. 14. Retrieved from NewspaperSG.
2. Republic of Singapore. Government Gazette. Acts Supplement. (2014, May 31). Medical (Therapy, Education and Research) Act (Legislative history) (Cap 175, 2014 Rev. ed.). Retrieved 2016, October 11 from Singapore Statues Online website: http://statutes.agc.gov.sg/aol/search/display/view.w3p;ident=512f1c4a-c72b-4f8c-94b9-3cd6e99e21bc;page=0;query=CompId%3A57f7ffd6-6599-4c21-a2a7-80a4de6b129d%20ValidTime%3A20160824000000%20TransactionTime%3A20160824000000;rec=0;resUrl=http%3A%2F%2Fstatutes.agc.gov.sg%2Faol%2Fbrowse%2FtitleResults.w3p%3Bletter%3DM%3Btype%3DactsCur
3. Making it easier to donate organs for transplant. (1972, June 3). The Straits Times, p. 11. Retrieved from NewspaperSG.
4. Proposal to get more kidneys for transplant. (1981, November 3). The Straits Times, p. 1. Retrieved from NewspaperSG.
5. No major changes to Organ Transplant Bill. (1987, April 25). The Business Times, p. 2; Organ transplant act to take effect next week. (1987, July 7). The Straits Times, p. 1; Past, present, future. (2003, October 2). Today, p. 11. Retrieved from NewspaperSG.
6. Ministry of Health. (2009). Human Organ Transplant Act. Retrieved 2016, August 26 from Live On website: https://www.liveon.sg/content/moh_liveon/en/organdonation/hota.html
7. Salma Khalik. (2008, October 6). Fixing the kidney deficit, fast. The Straits Times, p. 2; Page 16 advertisements column 1: Human Organ Transplant Act. (2008, March 18). The New Paper, p. 16; Page 10 advertisements column 1: Human Organ Transplant Act. (2008, March 10). The New Paper, p. 10. Retrieved from NewspaperSG.
8. Page 23 advertisements column 1: Revised Human Organ Transplant Act (HOTA). (2004, June 30). Today, p. 23. Retrieved from NewspaperSG.
9. Zakir Hussain. (2008, January 22). Muslims to be included in the Act from Aug 1. The Straits Times, p. 32. Retrieved from NewspaperSG.
10. Lee, H. C. (2009, March 25). Registry to help find match for donor-recipient pairing. The Straits Times, p. 33. Retrieved from NewspaperSG.
11. Ministry of Health. (2009). Understanding HOTA: Human Organ Transplant Act (HOTA). Retrieved 2016, August 25 from Live On website: https://www.liveon.sg/content/dam/moh_liveon/docs/info_booklets/SO20870_Hota_english2013.pdf
12. Ministry of Health. (2009). Understanding HOTA: Human Organ Transplant Act (HOTA). Retrieved 2016, August 25 from Live On website: https://www.liveon.sg/content/dam/moh_liveon/docs/info_booklets/SO20870_Hota_english2013.pdf
13. Ministry of Health. (2009).  Understanding HOTA: Human Organ Transplant Act (HOTA). Retrieved 2016, October 11 from Live On website: https://www.liveon.sg/content/dam/moh_liveon/docs/info_booklets/SO20870_Hota_english2013.pdf
14. Republic of Singapore. Government Gazette. Acts Supplement. (2012, July 31). Human Organ Transplant Act (Part IVA Living donor organ transplants) (Cap 131A, 2012 Rev. ed.). Retrieved 2016, October 11 from Singapore Statues Online website:  http://statutes.agc.gov.sg/aol/search/display/view.w3p;ident=b05f99d9-9f5d-4a93-84a1-322189ea2b58;query=DocId%3Adb05e985-f8a0-4d61-a906-9fd39f3b5ac9%20Depth%3A0%20Status%3Ainforce;rec=0#P1IVA-.
15. Chen, H. (2009, March 24). Compensation to be replaced in Hota. The Business Times, p. 11. Retrieved from NewspaperSG.
16. Chia, S. A. (2009, March 25). Kidney payment law gets OK. The Straits Times, p. 1. Retrieved from NewspaperSG.
17. Republic of Singapore. Government gazette. Acts supplement. (1966, January 7). (No. 31 of 1965). Singapore: [s.n.], p. 45. (Call no.: RCLOS 348.5957 SGGAS-[HWE])
18. Making it easier to donate organs for transplant. (1972, June 3). The Straits Times, p. 11. Retrieved from NewspaperSG.
19. Proposal to get more kidneys for transplant. (1981, November 3). The Straits Times, p. 1. Retrieved from NewspaperSG.
20. Transplant Bill to be tabled in Parliament. (1986, October 27). The Straits Times, p. 1. Retrieved from NewspaperSG.
21. Query on divestment of govt-owned firms. (1986, December 9). The Straits Times, p. 12. Retrieved from NewspaperSG.
22. Panel invites written views from the public. (1986, December 11). The Straits Times, p. 23. Retrieved from NewspaperSG.
23. Republic of Singapore. Government Gazette. Acts Supplement. (2012, July 31). Human Organ Transplant Act (Legislative history) (Cap 131A, 2012 Rev. ed). Retrieved 2016, October 11 from Singapore Statues Online website: http://statutes.agc.gov.sg/aol/search/display/view.w3p;ident=6a109f33-ebdd-4a6e-bbe4-c5599ff45c1f;query=DocId%3Adb05e985-f8a0-4d61-a906-9fd39f3b5ac9%20Depth%3A0%20Status%3Ainforce;rec=0#xv-
24. House passes gift-of-life Bill. (1987, May 21). The Straits Times, p. 1. Retrieved from NewspaperSG.
25. Organ transplant act to take effect next week. (1987, July 7). The Straits Times, p. 1. Retrieved from NewspaperSG.
26. Chang, A. L. (2003, January 14). Move to get more organs for transplant. The Straits Times, p. 1. Retrieved from NewspaperSG; Ministry of Health. (2003, September 15). Public consultation on proposed amendments to the Human Organ Transplant Act [Press release]. Retrieved 2016, October 11 from Ministry of Health website: https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2003/public_consultation_on_proposed_amendments_to_the_human_organ_transplant_act.html
27. Ministry of Health. (2003, September 15). Public consultation on proposed amendments to the Human Organ Transplant Act [Press release]. Retrieved 2016, October 11 from Ministry of Health website: https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2003/public_consultation_on_proposed_amendments_to_the_human_organ_transplant_act.html
28. Salma Khalik. (2004, January 7). Wider organ act passed after concerns addressed. The Straits Times, p. H4. Retrieved from NewspaperSG.
29. Republic of Singapore. Government Gazette. Acts Supplement. (2012, July 31). Human Organ Transplant Act (Legislative history) (Cap 131A, 2012 Rev. ed). Retrieved 2016, September 15 from Singapore Statues Online website:  http://statutes.agc.gov.sg/aol/search/display/view.w3p;ident=6a109f33-ebdd-4a6e-bbe4-c5599ff45c1f;query=DocId%3Adb05e985-f8a0-4d61-a906-9fd39f3b5ac9%20Depth%3A0%20Status%3Ainforce;rec=0#xv-
30. Organ law get Muslim boost. (2007, July 28). The Straits Times, p. 58. Retrieved from NewspaperSG.
31. MOH hopes to change HOTA to include Muslims by year’s end. (2007, August 25). Channel NewsAsia. Retrieved from Factiva via NLB’s eResources website: http://eresources.nlb.gov.sg/

32. Zakir Hussain. (2008, January 22). Muslims to be included in the act from Aug 1. The Straits Times, p. 32. Retrieved from NewspaperSG.
33. Republic of Singapore. Government Gazette. Acts Supplement. (2008, February 22). Human Organ Transplant (Amendment) Act 2008 (Act 2 of 2008). Retrieved 2016, October 11 from Singapore Statues Online website: http://statutes.agc.gov.sg/aol/search/display/view.w3p;page=0;query=Id%3Ad0f6723f-c3ab-4c51-aa70-1899cc5f1ac5%20Depth%3A0%20Status%3Apublished%20Published%3A18%2F02%2F2008;rec=0;resUrl=http%3A%2F%2Fstatutes.agc.gov.sg%2Faol%2Fsearch%2Fsummary%2Fresults.w3p%3Bpage%3D0%3Bquery%3DId%253Ad0f6723f-c3ab-4c51-aa70-1899cc5f1ac5%2520Depth%253A0%2520Status%253Apublished%2520Published%253A18%252F02%252F2008
34. Republic of Singapore. Government Gazette. Acts Supplement. (2012, July 31). Human Organ Transplant Act (Legislative history) (Cap 131A, 2012 Rev. ed). Retrieved 2016, October 11 from Singapore Statues Online website:  http://statutes.agc.gov.sg/aol/search/display/view.w3p;ident=6a109f33-ebdd-4a6e-bbe4-c5599ff45c1f;query=DocId%3Adb05e985-f8a0-4d61-a906-9fd39f3b5ac9%20Depth%3A0%20Status%3Ainforce;rec=0#xv-
35. Public feedback on Hota sought. (2008, November 15). The Straits Times, p. 42. Retrieved from NewspaperSG.
36. Chen, H. (2009, March 25). Reimbursing donors not a must. The Business Times, p. 12. Retrieved from NewspaperSG.
37. Republic of Singapore. Government Gazette. Acts Supplement. (2012, July 31). Human Organ Transplant Act (Legislative history) (Cap 131A, 2012 Rev. ed). Retrieved 2016, October 11 from Singapore Statues Online website:  http://statutes.agc.gov.sg/aol/search/display/view.w3p;ident=6a109f33-ebdd-4a6e-bbe4-c5599ff45c1f;query=DocId%3Adb05e985-f8a0-4d61-a906-9fd39f3b5ac9%20Depth%3A0%20Status%3Ainforce;rec=0#xv-



The information in this article is valid as at 2009 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
Transplantation of organs, tissues, etc.--Law and legislation--Singapore
Public health
Health and medicine>>Medical science>>Surgery
Politics and Government>>Health