A laudable decision. Saya sokong, Yang Arif!


A Muslim rethink on organ donation - Religious leaders propose that Muslims come under opt-out organ harvesting scheme by Loh Chee Kong cheekong@mediacorp.com.sg
TODAYonline Friday 27 July 2007

THE list of Muslim patients needing a new organ just keeps growing. And the dismal response from Muslims pledging to donate their organs has prompted Islamic religious leaders to do a rethink.

Faced with a dire situation that requires an urgent fix, a religious decree has been issued to permit Muslims to be included under Singapore's opt-out scheme for human organ harvesting. And the Islamic Religious Council (Muis) is proposing the inclusion.

Because of religious considerations, the 500,000-strong Muslim community is excluded under the Human Organ Transplant Act (Hota), which allows for kidneys, livers, hearts and corneas to be removed from the dead, as well as brain-dead patients.

There are currently 118 Muslim patients on the waiting list for organs. Between 1993 and 2000, 130 Muslims died while waiting for transplants.

Due to compatibility issues, no organs have been harvested from the 16,148 Muslims who have pledged to donate their organs since 1987 under the separate Medical Therapy, Education and Research Act, or Mtera.

According to Ministry of Health (MOH) estimates, it would take 250,000 pledges to possibly produce four to five actualised donors.

More worryingly for the Muslim community, the number of pledges have dropped drastically in the last three years, after the Muslim Kidney Action Association cut back on its publicity drive.

On Wednesday, Singapore's fatwa (religious ruling) committee — made up of eminent religious leaders and chaired by the Mufti of Singapore, Mr Syed Isa Mohd Semait — announced its decision, which it had deliberated on intensively over the last two months.

The committee referred to historical religious texts and considered contemporary issues and developments in the Islamic world before arriving at the decision. And the overriding consideration was the interests of the Muslim community, said Mr Nazirudin Nasir, who heads Muis' Mufti office.

The religious considerations that exclude Muslims from Hota — enacted in 1987 — include contentious issues over delays in funeral rites and whether a Muslim who is brain dead could be declared dead and have his organs removed.

Mr Nazirudin pointed out that a recent Berita Harian survey showed that 70 per cent of Muslim respondents were in favour of inclusion under Hota. Feedback from three public forums held this month also indicated the community's support, he added.

Said Mr Nazirudin: "There were questions on operational and procedural matters, on how the transplantation was conducted and issues such as whether those who are brain dead are considered dead from an Islamic standpoint."

Muis will work with the MOH to resolve the community's concerns about several technical issues, such as shortening the time it will take to remove a deceased's organs, to ensure the burial process is not delayed.

But it was the issue of consent by default that split opinions among the Muslims Today spoke to.

Said Ms Dian Melati, 26: "I'm of the view that you should be a donor by default. Parts of our body should be put to better use when we are no longer alive."

But polytechnic lecturer Hafidz Abdullah, 34, argued: "To say that I'm already in the scheme before I do anything — how can that be?"

This principle of presumed consent — a main reason why Muslims were not included under the amended Hota in 2004 — came under the spotlight again in the latest discussions, according to deputy Mufti Fatris Bakaram.

He said: "Islamic laws insist that in (an organ) donation, explicit consent has to be made. But because the response (to the pledging scheme) is not as forthcoming as expected ... and bearing in mind that any difficulties must be overcome, we accept the opt-out system as a form of consent."

Through extensive public education programmes and various means of outreach, the Muslim community will be told of the option to opt out of Hota, Mr Fatris added.

The Muslim Kidney Action Association, which looks after some 300 kidney patients, has been lobbying for Muslims to be included under Hota since 2000. Its president Ameerali Abdeali told Today the drastic drop in the number of pledgers coincided with its decision to cut back on its massive publicity drives.

These campaigns — which chalked up costs of up to "several million dollars" each — were funded by the old National Kidney Foundation (NKF), before it was involved in the scandal over its misuse of public funds, said Mr Ameerali.

Since then, the association has met with the new NKF and both organisations have decided to focus their resources on helping patients, such as through job placements and tuition for their children.

Typically, a Muslim kidney patient who had not previously pledged to donate his organs would have to wait 10 to 15 years for a transplant.

Medical compatibility notwithstanding, the waiting period could be halved if the patient is under Hota, said Mr Ameerali.

The MOH said the "very positive development" would "potentially enable many more Muslims to benefit from Hota and save lives".

"We look forward to the community supporting the Fatwa position," said a ministry spokesperson, who added that the MOH would "study the Fatwa in detail with Muis and consult the Muslim community".

Amendments to Hota are expected to be tabled at the next Parliamentary sitting, followed by a public consultation.

Today understands the inclusion of Muslims under Hota could be formalised in the first quarter of next year, at the earliest.

Cooling on HOTA

Year Hota Muslim pledgers opt-outs under Mtera2

2004 3771 924

2005 1525 496

2006 2526 87

2007 1 7574 89

The number of people who opted out of Hota so far this year has hit a high, nearly reaching the combined total of those who did so over the last three years.

As of July 21, 7,574 people have opted out this year – more than twice the 3,771 people who did so for the whole of 2004.

In February, there was a public outcry against Hota after a highly-publicised incident in which a brain-dead man's organs were harvested despite violent objections from his family.

A month later, Health Minister Khaw Boon Wan revealed in Parliament that the opt-out rate had spiked following the incident, and added that his ministry would be stepping up public education on organ donation.