Making an organ donation in Singapore

In Singapore, the Human Organ Transplant Act (HOTA) and Medical (Therapy, Education and Research) Act (MTERA) were established to allow better medical access for Singapore citizens and Permanent Residents (PRs) who require organ transplants. However, it was reported in 2019 that Singapore still faced a severe shortage of organs. In 2015, Singapore’s combined (both deceased and living) organ transplant rate was 20 per million population (pmp).

Before 2004, the law in Singapore states that unrelated individuals cannot make living organ transplants. However, in 2002, Mediacorp actress Andrea De Cruz was an exception to the law when she suffered from liver failure due to the Slim 10 saga.

Deceased donor transplant

In 2004, the HOTA was amended to include donations of the liver, heart and cornea. Infographic from Visual.ly, credits to Simon Ang.

Deceased donor transplant refers to the transplantation of organs retrieved from a donor whose death has been medically certified. The donated organs will be matched to the blood group, weight and urgency of the common pool of patients on the respective organ transplant waiting lists. The cost of any organ donation procedures and tests will not be charged to the donor’s family.

The donor’s body will be treated with the same surgical standards applied to any living person undergoing surgery. However, organ donations from a person contacted with an infectious disease such as Tuberculosis, Hepatitis B, Hepatitis C or HIV are not allowed.  

Human Organ Transplant Act (HOTA)

Introduced in 1987, HOTA is a compulsory organ donation system which allows for the kidneys, liver, heart and corneas to be harvested in the event of death from any cause for transplantation. All Singaporeans and PRs who are above the age of 21 and not suffering from mental disorders will be automatically covered under the Act unless they have opted out. It should be noted that HOTA only applies to deaths that occur in hospitals.

Individuals who wish to opt out of any or all 4 organs under HOTA may do so by submitting the completed Objection To Organ Removal form (PDF form) to the National Organ Transplant Unit via post. It should be reminded that anyone who opts out of HOTA would receive lower priority for receiving an organ on the national waiting list should an organ transplant be required in the future.

Individuals who have opted out of HOTA and wish to withdraw the earlier objection may do so by submitting the completed Withdrawal Of Objection To Organ Removal form (PDF form) to the National Organ Transplant Unit via post.

Medical (Therapy, Education and Research) Act (MTERA)

Enacted in 1974, MTERA is an opt-in scheme where people can choose to donate organs that are not covered under HOTA. Examples of organs that can be donated include bone, skin or even the entire body. Besides serving as a gift of life, these donations will also help to support research and advancement of medical science.

Anyone regardless of nationality and who is at least 18 years old can pledge to donate their organs and/or tissues. In the event where a person had not pledged his organs under MTERA before passing away, the family members are allowed to decide on behalf of him upon his death if they wish to do so. Interested individuals can submit the completed Organ Donation Pledge form (PDF form) to the National Organ Transplant Unit via post.

Living donor transplant

Mr Peter Lim Kok Seng (above) was the first Singaporean to donate part of his liver to a complete stranger. Photo from The Straits Times.

It is proven that living organ transplants yield better results compared to cadaveric transplants. However, only the kidney and liver are suitable for live organ donation as the human body can function just as well with one kidney and that the liver can rebuild itself to its normal size within two months.

Organ matching

Most living donations occur between direct family members due to the lower rate of organ rejection. However, there have also been living organ donations from unrelated persons and strangers in Singapore. In such cases, the identity of the donor and recipient will be made known. In 2016, Mr Lim Kok Seng became the first person in Singapore to donate part of his liver to a stranger.

On 6 January 2004, laws on living donor transplants were amended to allow more Singaporeans to benefit from organ donations. Before that, Singapore law did not allow living organ donation from a living unrelated person. An exception was made in May 2002, as Mediacorp actor Pierre Png donated part of his liver to his girlfriend, former TV celebrity Andrea De Cruz, who was a victim of the Slim 10 Pills scandal suffering from liver failure. This was the first living liver transplant between two unrelated people in Singapore.

Financial and legal concerns

Organ donations are purely altruistic and there should not be any monetary incentives or forced compliance. However, the HOTA allows for reimbursement of all medical expenses and loss of earnings incurred as a result of organ donation for altruistic donors. Organ trading is also illegal in Singapore and any person guilty of this offence is liable to a fine not exceeding S$100,000 or to imprisonment for a term not exceeding 10 years or both.