I REFER to the letter “Radical option for organ transplant” (The Star, Aug 2) by Gomez Jacob and Datuk Dr Ghazali Ahmad’s response “Poor rate in organ donation” (Aug 4). I am responding to Dr Ghazali’s invitation for an open discussion.
I am not a lawyer or a doctor, just a member of the public. I have a friend who is on dialysis. My offer to donate a kidney to him was refused not by him but by doctors because we are not related.
The subject interestingly raised by Gomez refers to kidney transplantation from live unrelated donors. He does not refer to heart, lung or liver transplantations. These are more complex and have a different connotation and implication.
Heart, lung and liver transplants involve cadaveric organ donors and require the consent of family and relatives. I think everybody will agree that cadaveric donation of organs should not be the subject of buying and selling.
As Dr Ghazali says, organ donation should be associated with a sense of altruism, kindness and sacrifice. There is much sadness connected with the death of the potential donor who is a close relative, so buying or selling of organs under these conditions can be unpleasant and unacceptable, and should be rightly condemned.
However, in the case of live kidney donation, the donor makes a decision himself to sell his organ devoid of any external influences and emotional circumstances. Thus, Dr Ghazali cannot include this act in the scheme of buying and selling human organs.
Jacob makes a very specific point. Since his kidney belongs to him, why can’t he offer it for sale like his car? Does the government, the medical fraternity or some international organisation have some kind of vicarious claim on Jacob’s kidney to say that this sale cannot take place, especially since the medical profession has consistently asserted that no harm would befall the donor who is presumably young and healthy?
Dr Ghazali says: “there are many other initiatives and efforts which the public, professionals and the authorities can consider to introduce or implement in order to invigorate the terribly sluggish local transplantation programme.” However, he does not explain what these initiatives are.
Cadaveric kidney transplantation is logistically complex and difficult in this country, as has been lucidly explained by Datuk Dr Jeyaindran Sinnadurai, the deputy-director of Health, “Critical situation in all areas” and “Don’t kid with kidney failure” (Sunday Star, April 9, 2017).
Viewed against Dr Jeyaindran’s logical findings, the proposal by the director-general of Health Datuk Dr Noor Hisham Abdullah to set up death audits makes little sense to solve a growing problem in this country.
One argument against live kidney donation is that only the poor will donate. But Dr Ghazali must accept that this is how the world is. Only the rich can afford expensive houses, exotic cars and first-class air travel. So why not let some poor people become rich by safely selling something they possess?
But for poor intending recipients of kidneys from unrelated donors, there is a possible solution. Why not reorganise the National Kidney Foundation to become a charitable organisation that tops up the fee paid to the donor in unrelated kidney transplants?
In making this suggestion, I refer to Dr Ghazali’s statement that the “Iranian model cited by Jacob involves a state regulated price tag of US$1,200 which is paid to the live kidney donor, with options of topping up by some charitable organisations if needed.”
Dr Jeyaindran has stated that the Health Ministry is planning to pay RM19,000 to each patient with kidney failure to buy and use a Continuous Ambulatory Peritoneal Dialysis (CAPD set). Instead of paying for a CAPD set, the money could become an initial payment to the donor like in Iran.
The balance of up to, say, RM600,000 would come from the National Kidney Foundation to which the public and the government can contribute. I picked this figure from the report “Illegal kidney transplant dilemma” (The Star, July 27) on the 59-year-old kidney patient who spent over US$100,000 for an illegal transplant probably in China.
Because the volume of kidney transplants done in China is high, transplant doctors there have become professionally skilful. If we raise the number of live kidney donor transplants in this country, our transplant surgeons could also become similarly competent. They need the numbers both for experience as well as for a reasonable remuneration for their skills.
So, if a donor can find a recipient willing to pay an undisclosed sum, would Dr Ghazali agree to perform the operation? I do not know of any law that will prevent him from doing so.
LOONG SI CHIN
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