The public response was good, with a total of 227 comments, comprising 213 from individuals and 14 from organisations.

The public consultation was in relation to the following proposed changes to HOTA:

1. Extend HOTA to include all brain deaths
2. Extend HOTA to include liver and cornea
3. Extend HOTA to include the regulation of living donor organ transplants.

The public was supportive of organ donation and organ transplantation, in order to save lives and reduce the suffering of those with organ failure. The majority was in favour of the proposed amendments. However, some concerns were also raised during the consultation process:

At present, HOTA applies only to brain deaths due to accidents. The proposed amendment seeks to extend HOTA to include all brain deaths, accidents or non-accidents.

The majority of the participants supported this proposed amendment as more lives could be saved. Only 2 persons were not in favour. There were also some people who questioned if doctors would not try their best to save their patients if they felt that their organs could be used to save other lives.

At present, HOTA applies only to kidneys. The proposed amendment seeks to extend HOTA to include livers and corneas.

The majority supported the inclusion of livers and corneas. However, there were some (3) who expressed reservation about cornea donation either because cornea transplants were not life-saving, or because of their cultural and religious beliefs regarding cornea donation.

At present, HOTA applies only to cadaveric transplantation. The proposed amendment seeks to extend HOTA to regulate living donor organ transplantation.

The majority supported living donor organ transplantation provided there is proper safeguard through strict regulation. There were 2 persons who were not in favour of the amendments. But all agreed that organ trading should not be allowed in Singapore and that there should be strong deterrents to prevent such occurrences. In this respect, many respondents agreed that there should not be any monetary exchanges or benefits in living donor transplants.

On living unrelated organ donations, some respondents felt that this should not be allowed as there would be the potential for financial transactions in such donations, while others felt that this could be allowed as long as there were sufficient measures in place to prevent organ trading.

Many respondents pointed out the importance of public education (especially students and the less educated) and dissemination of information to allay the public’s fears and clear up any misconceptions about HOTA and organ donation, as well as to encourage more people to sign up as organ pledgers. Many felt that students should be taught about organ donation in school so that they would be more familiar with this subject. There were also suggestions that religious organisations needed to reassure the public that organ donation was not contrary to their religious beliefs.

There was support from at least 40 respondents that HOTA should be expanded to include all organs, such as hearts and lungs, and not just kidneys, livers and corneas, as it was felt that this would benefit more people and save more lives.

The Academy of Medicine, representing the medical specialists in Singapore, also advocated the expansion of HOTA to include other organs. The Singapore National Heart Association also recommended that heart and lung be included under HOTA as heart transplantation had been performed in Singapore for as long as liver transplantation, and was no longer experimental and the need for heart transplants was as pressing as for kidney and liver transplants. Including lungs would facilitate further development of the lung and heart-lung transplant programmes in Singapore.

Several respondents brought up the example of Ms Tanya Liu, the Taiwanese newscaster who was allegedly declared brain dead after a railway accident in Britain and who subsequently regained consciousness. This was however a mis-reporting. MOH verified with the doctor in charge of Tanya Liu’s case that she was never certified brain dead, and that she was only unconscious. As a result of this mis-reporting, there was some initial confusion about the concept, definition and certification of brain death.

MOH assured that there were stringent criteria for the certification of brain death and it has to be performed by two independent doctors.

Some members of the public queried the exclusion of Muslims from HOTA and they felt that this might not be fair to the other religions in Singapore. MOH explained that the Islamic Religious Council of Singapore (MUIS) had advised that for Muslims, the consent of two waris (paternal next-of-kin), and not just the consent of the organ pledger only, was required before organs could be donated. Hence, Muslims could not be included under HOTA. However, individual Muslims could opt to pledge their kidneys under the Medical (Therapy, Education and Research) Act by obtaining the consent of his or her waris.

MOH welcomes continuing feedback and comments on the proposed amendments as drafted. We encourage the public, professional, community and religious organisations to provide specific feedback on the draft Bill.

The public consultation for the draft Bill will last for 6 weeks, from 15 Sept 2003 till 31^st October 2003.