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(Therapy, Education and Research) Act, or MTERA in short.1 The current MTERA was passed in parliament in 1972.2 It repealed a similar law that was passed in 1965, as this earlier legislation had been found to be flawed, because of its ambiguities and stringent rules.3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,” Straits Times, 10 December 1986, 14. (From NewspaperSG)
2. Medical (Therapy, Education and Research) Act, Cap 175, rev. ed. 2014, legislative history.
3. “Making It Easier to Donate Organs for Transplant,” Straits Times, 3 June 1972, 11. (From NewspaperSG)
4. “Proposal to Get More Kidneys for Transplant,” Straits Times, 3 November 1981, 1. (From NewspaperSG)
5. “No Major Changes to Organ Transplant Bill,” Business Times, 25 April 1987, 2; “Organ Transplant Act to Take Effect Next Week,” Straits Times, 7 July 1987, 1; “Past, Present, Future,” Today, 2 October 2003, 11. (From NewspaperSG)
6. “Human Organ Transplant Act,” Ministry of Health, last updated 30 June 2020.
7. Salma Khalik, “Fixing the Kidney Deficit, Fast,” Straits Times, 6 October 2008, 2; “Page 16 Advertisements Column 1: Human Organ Transplant Act,” New Paper, 18 March 2008, 16; “Page 10 Advertisements Column 1: Human Organ Transplant Act,” New Paper, 10 March 2008, 10. (From NewspaperSG)
8. “Page 23 Advertisements Column 1: Revised Human Organ Transplant Act (HOTA),” Today, 30 June 2004, 23. (From NewspaperSG)
9. Zakir Hussain, “Muslims to Be Included in the Act from Aug 1,” Straits Times, 22 January 2008, 32. (From NewspaperSG)
10. Lee Hui Chieh, “Registry to Help Find Match for Donor-Recipient Pairing,” Straits Times, 25 March 2009, 33. (From NewspaperSG)
11. “Understanding HOTA: Human Organ Transplant Act,” Ministry of Health, last retrieved 25 August 2016.u
12. Ministry of Health, “Understanding HOTA,”
13. Ministry of Health, “Understanding HOTA,”
14. Human Organ Transplant Act, Cap 131A, rev. ed. 2012, Part IVA Living Donor Organ Transplants.
15. Chen Huifen, “Compensation to Be Replaced in Hota,” Business Times, 24 March 2009, 11. (From NewspaperSG)
16. Sue-Ann Chia, “Kidney Payment Law Gets OK,” Straits Times, 25 March 2009, 1. (From NewspaperSG)
17 Medical (Therapy, Education and Research) (Amendment) Act 1965, Act 31 of 1965, Government Gazette. Acts Supplement, 45. (Call no. RCLOS 348.5957 SGGAS-[HWE])
18. “Making It Easier to Donate Organs for Transplant,” Straits Times, 3 June 1972, 11. (From NewspaperSG)
19. “Proposal to Get More Kidneys for Transplant,” Straits Times, 3 November 1981, 1. (From NewspaperSG)
20. “Transplant Bill to Be Tabled in Parliament,” Straits Times, 27 October 1986, 1. (From NewspaperSG)
21. “Query on Divestment of Govt-Owned Firms,” Straits Times, 9 December 1986, 12. (From NewspaperSG)
22. “Panel Invites Written Views from the Public,” Straits Times, 11 December 1986, 23. (From NewspaperSG)
23. Human Organ Transplant Act, part IVA.
24. “House Passes Gift-of-Life Bill,” Straits Times, 21 May 1987, 1. (From NewspaperSG)
25. “Organ Transplant Act to Take Effect Next Week.”
26. Chang Ai-Lien,”Move to Get More Organs for Transplant,” Straits Times, 14 January 2003, 1. (From NewspaperSG); Ministry of Information, Communications and The Arts, ‘Public Consultation on Proposed Amendments to the Human Organ Transplant Act,” press release, 15 September 2003. (From National Archives of Singapore document no. 2003091503)
27. Ministry of Information, Communications and The Arts, ‘Public Consultation on Proposed Amendments to the Human Organ Transplant Act.”
28. Salma Khalik, “Wider Organ Act Passed after Concerns Addressed,” Straits Times, 7 January 2004, H4. (From NewspaperSG)
29. Human Organ Transplant Act, part IVA.
30. “Organ Law Get Muslim Boost,” Straits Times, 28 July 2007, 58. (From NewspaperSG)
31. “MOH Hopes to Change HOTA to Include Muslims by Year’s End,  (2007, August 25). Channel NewsAsia, 25 August 2007. (From Factiva via NLB’s eResources website)
32. Hussain, “Muslims to Be Included in the Act from Aug 1.”
33. Human Organ Transplant (Amendment) Act 2008, Act 2 of 2008), Government Gazette. Act Supplement. (Call no. RSING 348.5957 SGGAS)
34. Human Organ Transplant Act, part IVA.
35. “Public Feedback on Hota Sought,” Straits Times, 15 November 2008, 42. (From NewspaperSG)
36. Chen Huifen, “Reimbursing Donors Not a Must,” Business Times, 25 March 2009, 12. (From NewspaperSG)
37. Human Organ Transplant Act, part IVA.



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