Donating organs in multicultural Malaysia

THE International Registry on Organ Donation and Transplantation has ranked Malaysia among the lowest for deceased organ donation with a rate of a mere 0.9 donors per one million population.

Why is this so?

The Malaysian “opt in” organ donation system requires voluntary pledging by an individual to be listed as part of the national registry. Even for a society that is so diverse and multicultural, the concept of ethical and consensual removal of organs and tissues from a donor for transplant into recipients is not foreign or new in Malaysia.

Globally, countries have adopted various systems to suit their populace.

Malaysia’s Human Tissues Act 1974 clearly states that a transplant procedure can only be lawfully pursued if the donor authorises the removal of specific body parts either in writing or verbally in the presence of two or more witnesses. The law includes a “family veto” by the surviving spouse or next-of-kin allowing these individuals the right to object and overrule the deceased’s wishes, which then immediately terminates the donation process.

The “opt out” system presumes all individuals are organ donors unless the living individual objects or family members of the deceased object.

Adoption of the opt out system in Spain a decade ago resulted in an increase in organ donation rates. This is attributed mainly to the start up of a network of transplant coordinators across donor hospitals. They underwent professional training to improve communication, empathy and technical and administrative skills.

The increase in positive public perception towards organ donation in Spain was not only encouraged by skillful personnel with a willingness to approach bereaved families but also by accessibility to worldwide and adequate healthcare resources.

However, in most countries, the “opt in” approach is practiced.

The 2018 Annual Report by Malaysia's Health Ministry expressed interest in researching the possibilities of shifting from the opt in to the opt out system. With the many societal, economical, educational, spiritual and cultural factors to consider, it is important to see how such a shift could impact the number of organ donors.

To help address concerns such as religious issues, the Health Ministry has also worked with the Department of Islamic Development Malaysia to increase acceptance of organ donation among Muslims.

Dr Farida Islahudin, an associate professor at the Faculty of Pharmacy, Universiti Kebangsaan Malaysia, has been researching attitudes towards organ donation in Malaysia.

She discovered that many individuals and communities lack awareness and harbour a negative image of organ donation. Developing culture-specific programmes to target communities with concerns is vital, she emphasises. Promoting and improving overall health literacy could also change the narrative of organ donation.

Dr Farida stresses the importance of genuinely educating people without forceful and opinionated debates. Instead, it is important to have open discussions and conversations across different communities and social groups to objectively discuss the fundamentals, benefits and concerns regarding organ transplants.

Research published by Dr Farida and her colleagues in 2020 studied the willingness of Malaysians to donate their kidneys. They found that the number of kidney donors varied across ethnic groups with Indians having a 72.7% willingness rate, the Chinese were at 61.8%, and other ethnic groups at 33.3%, outweighing Malays at 10.6%.

Ethnicity appears to be a significant factor affecting organ donation rates in Malaysia.

Other challenges identified which affect low organ donation rates include (but are not restricted to) knowledge, attitude, beliefs, religion, culture and spirituality. Even with justification by religious leaders, individuals holding on to strong sociocultural beliefs and traditions are, unfortunately, of the opinion that organ donation mutilates the body.

Attitude is very often linked to knowledge, which many try to improve through appropriate dissemination of knowledge, say the researchers, emphasising the need to improve understanding and support for organ donation.

With Malaysia facing a crisis of non-communicable diseases, there is an increasingly large burden of need for more viable organs. The need to increase the number of donors is critical and should be addressed promptly.

More organs are needed, but there are few donors available. Nonetheless, this situation can be improved with more education, awareness and informed decision-making. Multiculturalism should be an advantage rather than an obstacle to increasing organ donations.

GURKIRET KAUR

Research Officer

Galen Centre for Health & Social Policy

The Galen Centre is a research and advocacy organisation focused on health and social issues.