How to organ donate

There are 2 Acts in Singapore that make provision for organ donation after death. It is important to also talk about your preferences for organ donation in your discussion on end-of-life. 

• Human Organ Transplant Act (HOTA)

A mandatory enrolment scheme, which allows for the kidneys, heart, liver and corneas to be removed, for the purpose of transplantation, in the event of death from any cause.

 

• Medical (Therapy, Education and Research) Act (MTERA)

An opt-in scheme, where people can pledge their organs or any body parts for the purposes of transplant, education and/or research in the event of death.

 

Difference between HOTA and MTERA

	HOTA	MTERA
Organs included	Kidney, Liver, Heart, Cornea only	All organs and tissues, including skin and bone.
Purpose(s)	Transplant only	Transplant, Education and/or Research
Age	21 years old and above	18 years and above
Nationality	Singapore Citizens and PRs	Any nationality
Religion	Any religion (Muslims were included under HOTA from 1 Aug 2008)	Any religion (For Muslims, MUIS has issued fatwas stating that the donation of kidney, liver, heart and cornea is permissible.)
How do I opt-in?	Mandatory Opt-in	Voluntary Opt-in (Complete the MTERA Organ Donation Pledge Form and send to NOTU)
How do I opt-out?	Complete the HOTA Opt-Out Form and send to NOTU (Note: The objection can be organ-specific. By opting-out, you may have a lower priority for organ transplants in the future.)	Not Applicable
How do I opt back in?	Complete the Withdrawal of Objection to Organ Removal Form and send to NOTU (Note: By withdrawing the objection, you will be given the same priority as a person who has not registered any objections, after a period of 2 years from the date on which the may have a lower priority for organ transplants in the future.)	Not Applicable
Send completed forms to:	National Organ Transplant Unit (NOTU) c/o Singapore General Hospital, Singapore 169608 For more info, call 63214390 or email organ.transplant@notu.com.sg

 

Considerations and Points-to-note

1. Organ donation under HOTA and MTERA is not the same as Living Donor Organ Transplant.

Organ donation under HOTA and MTERA only applies upon death and you cannot decide to whom you want your organs to be donated to.

On the other hand, organ transplant from a living donor is generally not allowed unless the intended recipient is a family member and fulfils the requirements of the Human Organ Transplant Act (Section 15).

Only the kidney or liver may be donated. The Transplant Ethics Committee of the hospital will need to review the potential living donor's health.

The living donor must not be mentally disordered and is able to fully understand the consequences of medical procedures. 

 

2. Medical care is not compromised to expedite the recovery of organs.

One of the challenges hospital faces is objections from family members. Objections tend to arise due to doubt over consent to HOTA and whether the patient is given full medical care and chance at survival. HOTA being a mandatory opt-in scheme, it is not clear to the family members if it is the deceased's end-of-life wish. Family members also worried that it may be premature to declare a patient dead, especially for cases certified as "brain-dead".

It is important to note that organ donation is only considered after death has been declared by two well-qualified independent doctors who are not involved in the care of the patient. There are 7 strict clinical criteria that must be fulfiled before brain death can be certified. The patient's status as an organ donor would then be verified against the Organ Donor Registry to check if the patient has objected to organ donation previously. 

 

3. A patient in a coma is not considered dead.

Being comatose is at a state where a person is unarousable but tests confirm that some brain functions are still present. A comatose person may still recover or regain consciousness. Hence, organs are never taken from a person in a coma.

Brain death is when a person's brain functions have stopped irreversibly and cannot recover or regain consciousness again. A brain dead person on a ventilator may still feel warm to the touch, the heart still beats and the ventilator keeps the chest rise and fall, but to be brain-dead means the brain has been deprived of blood and the brain cells have died with no possibility of improvement or recovery.

 

4. Donation of organs such as kidneys, heart and liver is usually less possible after a Cardiac Death.

Unlike brain death, cardiac death is when the heart stops beating irreversibly. At the point of cardiac death, all vital functions of the body stop and the vital organs quickly become unusable.

Only tissues such as bone, skin, heart valves and corneas may be viable for donation within 24 hours of death.

For cases when there is a brain injury that leads to brain death, organs such as heart, lungs, kidneys, pancreas or liver may function for a brief period of time so long as the person is supported on a ventilator.

This is also the reason HOTA only applies to death that occurs in the hospitals (and fulfil specific conditions). If the person has died outside of the hospital, it is unlikely the organs are still viable even after the body is brought to the hospital.

 

5. Organ transplant rate in Singapore (2017) is estimated at 6.6 per million population. 

Despite the increase in the pool of potential donors with a mandatory opt-in HOTA scheme, the number of actual organ transplant has not risen correspondingly.

The rate of organ donation for kidney remains very low with over 400 individuals on the waiting list for a kidney organ transplant. Out of 504 deceased donor organ transplants in 2018, 88% were cornea transplants, 6 heart transplants, 19 liver transplants and 38 kidney transplants.

The organ donation system of HOTA that based on a presumed consent model has been a point for family members to object strongly, stating that the deceased did not receive or completely comprehend the relevant and critical information to make the decision of organ donation.

Read more here: MOH's Statistics related to Organ Donation

 

Besides creating awareness on the various options of organ donation, end-of-life conversation with family should also include the topic of organ donation. This will help family members to better understand and respect the patient's wishes and potentially seek solace in the beneficent act of organ donation. Discussing deceased organ donation at the point of death not only create unnecessary tension and stress for the grieving family, but it also delays the process, making the organs less viable for transplant.