The 18-member committee, led by Dr Lee Suan Yew, had no issue with reimbursing donors so long as the sum is not so large as to become 'an undue inducement, nor amounting to organ trading'.

It supported the principle of 'comprehensive reimbursement', and spelt out what donors can expect to get.

This includes being paid for expenses relating to the donation, such as transport and medical costs, and for loss of earnings that come as a result. Also, the donor should be covered for follow-up medical costs and higher insurance premiums as a result of losing a kidney.

To ensure the donor can be looked after properly following the operation, it suggested that the reimbursement scheme start with donors who are Singapore citizens and permanent residents.

'Comprehensive reimbursement of verifiable and reasonable expenses of kidney donation does not constitute payment for that organ, and may be viewed as part of the legitimate costs of treating the recipient,' it said.

The committee, set up in 1994, was asked to look into the ethical dimensions of the proposal, mooted by Health Minister Khaw Boon Wan in the wake of a high-profile organ-trading court case in July.

Retail magnate Tang Wee Sung was convicted of trying to buy a kidney from an Indonesian, who was to have been paid $23,700.

The case aroused much debate, as well as renewed focus on the reluctance of people to give up one kidney to save a life.

Dr Lee said the committee spent close to three hours debating the subject because 'everyone was so excited and keen to express their opinion'.

The decision, he said, was unanimous.

There are about 600 patients waiting for a kidney, despite changes to the Human Organ Transplant Act to increase the pool of cadaveric organs, such as including Muslims who die.

Mr Khaw has said the reimbursement will be at least a five-figure sum, possibly even six-figure.

Mechanics such as who should disburse the sums and how have yet to be firmed up, but the National Kidney Foundation (NKF) is likely to take on the role.

NKF chairman Gerard Ee said he hopes the scheme will encourage more family members to come forward 'by removing the reasons for not wanting to donate'.

The reimbursement could take the form of NKF paying for hospital treatments or higher insurance premiums. Aside from making up for loss of income, no cash should change hands, he said.

He also wants a cap on the number of years for which medical treatment is paid for. This is because medical problems caused by giving up a kidney are unlikely to occur decades after.

In its statement yesterday, the ethics committee said it looked at guidelines from the World Health Organisation and the Declaration of Istanbul on Organ Trading and Transplant Tourism promulgated in May this year to draw its conclusions.

But it also stressed the importance of greater efforts to prevent kidney failure, and increasing the cadaveric organ donations.

Said Dr Lee: 'Transplant is just a solution to a problem. The real answer is to prevent the need for transplants.'

Madam Halimah Yacob, who chairs the Government Parliamentary Committee on Health, said carrying out the proposal will be 'the real challenge', since the line between organ trading and reimbursement is 'tenuous'.

She also referred to the committee's recommendation that donors be drawn from the ranks of citizens and permanent residents to facilitate post-operative care. The ministry, she suggested, could tie up with hospitals overseas to ensure that foreign donors are cared for.

But Dr Lee was adamant that including foreigners could lead to 'backdoor trading'. This, he said, would damage Singapore's reputation as a medical hub.

salma@sph.com.sg

How much should kidney donors be reimbursed? Donors and recipients weigh in, in a Special Report in The Sunday Times tomorrow.