ALLOW me to express myself from a dialysis patient's point of view.

More than 90 per cent of dialysis patients die within five to 10 years while waiting for legal kidney transplants. If we do get the chance for a legal transplant after nine years of waiting, most of us will be too weak for the operation. Most dialysis patients die a costly and slow death besides being a burden to their families and society. Unless these patients are fortunate like myself who have a living donor within the family, the options open to them are either to purchase a kidney in the open market or to commit suicide. Unfortunately, both of these options are illegal in Singapore. Therefore, these poor patients are forced to suffer meaningless lives against their will due to flaws in our legal system.

It is easy to say that we must follow the law and let self-righteous groups express their opinions on ethics. We must understand that all of us have survival instincts. If I have not been in a fortunate situation of having a legal donor, my first instinct would be to buy a kidney in the open market, failing which I may terminate my life. The cost of a kidney is equivalent to about four months of dialysis. Compliance to an imperfect legal system is of secondary importance and stupid.

Where is justice for these poor dialysis patients who, on the one hand, are not permitted to buy kidneys for transplants and, on the other hand, are not permitted to end their misery by assisted suicide? For those self-righteous people, please question your conscience when our imperfect legal system forces these patients to live a life that most of them do not want and to have to pay for dialysis which most could not afford.

Cheong Wing Lee

Patients deserve a second chance

THE law of organ transplant may not have kept up with the rapid progress of medicine. The mortality of surgery to donate a kidney, which is already very low (less than 0.1%), will continue to improve with better trained surgeons doing laparoscopic nepherectomy. Standing in the way are the ethical issues which are easy for detractors to hang on. If we are able to tackle the IR issues, I do not see why we can not resolve these issues, albeit with similar imperfections. Families will continue to lose their loved ones and their bread winners, if we keep taking the moral high ground.

The solvable parts of the ethical issues are: prevention of exploitation by middlemen, safety of donors, after-care of the financial health and medical health of donors, and to ensure that Singapore does not become an organ trading hub.

An organisation similar to the NKF could be set up to register the details, including genetic characteristics, of patients requiring transplants. It will also keep a list of interested donors with their blood groups, etc, screened and kept under a period of surveillance. All would-be donors should be thoroughly counselled on any potential risk and immediate post-operative disabilities.

There should be only one sum of money awarded, and disbursed at appropriate instalments. The sum should be fairly substantial, say equivalent to the total cost of three to five years of renal dialysis. They should also be offered basic financial planning, as the money could be a windfall to some donors. The advantage of making it transparent is to wipe out the necessity of middlemen. Keeping a list of the clinical details of both recipients and donors will provide the best matching transplant criteria. To safeguard Singapore from being an organ trading centre, the law could limit kidney recipients to citizens and residents of our country. We could also add the condition that such a transplant will be approved only if investigations confirm that the patient's siblings and children are medically unfit as donors.

I do not pretend that the issues at hand are that simple to tackle but I urge the authorities to re-explore the possibilities. Eventually should we still find it not feasible, we could at least feel that we have given the dying patients a second thought if not a second chance.

Dr Lim Ah Leng

A solution that meets most needs can be attained

I REFER to the articles, 'Get off your high horse, moral arguments a luxury' and 'Don't buy into kidneys for sale argument'.

First kudos to Michelle Tan for a forthright down-to-earth account of what the issues really are about. My father died 12 days after my final exam paper at university, having been afflicted with leukaemia for about a month and never lived to see me graduate. He was 59.

Almost 20 years later and yet it still hurts - it had meant a lot for him to have me graduate a lawyer and for me to have had him at my graduation. So Michelle was fortunate and the fact that it took the purchase of an organ is a side issue; but a very important one as it bettered the lives of everyone around her and the donor.

She is right to say that unless one has gone through the experience, one cannot fully comprehend the trauma and anguish that comes along with such a life and death matter. Yet at the same time Alan John is not wrong in recognising the dangers of legalising organ transplant.

But every one of the concerns that are raised by Alan is a concern that exists whether or not organ transplant is legalised or otherwise. Legalising only brings the concerns into the forefront and we need to deal with them head-on. And perhaps it is time that we do this rather than behave as ostriches.

Yes, perhaps it is time we do this for all the other organs that he lists. The issues are not new. Twenty years ago, for instance, I wrote a paper on surrogacy and the ethical issues surrounding the sale and purchase of eggs and embryos. Twenty years hence no solutions have been found. I doubt they ever will be.

The only point I am trying to make is that perhaps we need to review the situation once again, recognise what is indeed going on, face up to it and see how best to deal with it. Avoidance will not prevent what is already illicitly going on and which will continue to do so. Addressing the issue will be wrought with difficulties, but a solution that meets most needs can be attained. There are always two sides - let's engage and debate again. Who are we really protecting, if at all?

Kala Anandarajah (Ms)

Let's create a Kidney Bank

THE law as it stands in Singapore and almost all other countries is clear. It prohibits the trade of human organs. And until such time a review is made and the law amended, it is for the court to enforce the law.

Defending and enforcing the law is one thing. But, what do we do going forward in an ever changing society and an ageing population? There are now over 2,000 dialysis patients at NKF alone. The number is likely to grow and so are the manpower and operating costs. It is difficult for a third party to comprehend the extent of the pain and anguish faced by the patients and their families.

Like a growing number of Singaporeans, I feel it is time to take an open, objective and compassionate review of the law. The complexity of the issue will require time and close consultation among interested parties before a favourable conclusion can be reached.

The opponents of a law-change may well argue against opening the so-called Pandora Box because of the potential implications. Some of their misgivings are not unfounded. Obviously, adequate safeguards must be put in place to prevent abuse or exploitation. Showing compassion, saving lives and reducing distress and anguish among medically-ill Singaporeans and their families should be our earnest call.

Many times Singapore have demonstrated that it was prepared to make hard decisions on critical issues. Take, for example, the eventual approval of the Integrated Resorts with their gaming facility. It was a classic case of strong economic benefit versus the social costs. Ultimately, many people accepted the strategic argument while others must have felt reassured by the commitment to put in place safeguards to effectively manage the potential social fallout. Similarly, I believe the pragmatism and wisdom of our Government to make a serious review of the kidney issue.

I support the concept of creating a Kidney Bank. I hope some of the suggestions below are useful towards realising change in the law:

>>To allow a Kidney Bank with strict rules and regulations to be set up by a government or quasi-government agency. We must affirm that direct trade of kidneys is not permitted by law.

>>Donors of kidneys will be given a fixed monetary award (net of necessary medical procedural and related costs). The amount will be determined by the agency in consultation with experts. This will prevent a 'bidding frenzy'.

>>Recipients of donor kidneys shall be based on a queuing system.

>>The agency will fix the amount to be paid by the recipient. The level can be categorised depending on, for example, an 'economic means-test' of the patients. This is to ensure that the poor are not disadvantaged because of their financial situation.

>>Hopefully, it is self-funding with support from a government grant. Funding boost can also come from charitable foundations, etc. In time, the role and focus of the NKF and similar organisations can be redirected.

>>Ideally, the supply and demand in the Kidney Bank will be bridged and life enhanced for all concerned.

Michael Tan