I Lost My Kidney/To a Guy Named Sidney

Across Asia, the going rate for a kidney is usually agreed in the backstreet surgery of some unscrupulous doctor but in Singapore the government will soon be setting the price for this much in-demand organ. A controversial amendment to legalize the payment of compensation to organ donors was put before the Singapore parliament this week and while the health ministry is yet to decide on the upper limit for reimbursement, it is expected to be at least S$50,000 (US$33,000).

The move is designed to help put an end to the illegal practice of organ trading that is prevalent in so many Asian countries, driven by a large supply of desperately poor people and a small core of wealthy individuals willing to pay any price to preserve their faltering health.

Organ trading is normally thought of as the preserve of shady businessmen in Dhaka or Manila but a number of high-profile recent cases in Singapore have stirred public debate in the normally quiescent city-state and encouraged the government to act.

Last year, local retail tycoon Tang Wee Sung, whose family founded the up-market department store Tangs (Singapore's answer to Selfridges or Saks Fifth Avenue), was fined S$17,000 and jailed for one day for trying to buy a kidney and lying under oath. The Indonesian man who offered his kidney to Tang and the middleman who put the abortive deal together were also jailed.

But the tale doesn’t end there. When a Singaporean gang boss named Tan Chor Jin who was known as the "One-Eyed Dragon" was hanged earlier this month after being convicted of murdering a nightclub boss, reports soon emerged that he had donated his kidney to Tang.

While Tang has not confirmed that he received a kidney from the executed gangster, the Straits Times and other local publications have reported that before he was hanged, the One-Eyed Dragon specified that Tang be given one of his kidneys. With Tang, whose family is known for its devout Christianity, remaining silent on where his new kidney came from, bloggers are speculating as to its origins and how he managed to secure it.

The story of the ailing retail tycoon, the executed triad and the kidney is so bizarre that you could not make it up. Yet, at its heart, lies a serious issue. With one of the most rapidly-ageing populations in the world and a severe shortage of transplantable organs, the Singapore government has been looking at ways to increase the number of organ donors and believes that legalizing the payment of compensation will help. The move is intended to allow altruistic donors to be reimbursed for their medical expenses and loss of earnings and is not meant to operate as an inducement.

Although the upper limit for compensation is still to be finalized, a survey by the Ministry of Health found that three-quarters of Singaporeans believe an appropriate sum would be at least S$50,000.

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Critics point out that while this sort of figure may be viewed as just compensation by a Singaporean professional who has to take months off work, the same amount would be an inducement to many less well-off people both within Singapore and from neighboring countries such as Malaysia and Indonesia. And, crucially, the government has insisted that it will not be bringing in a ban on foreign donors receiving compensation, which would be paid by the receiver or charities such as the National Kidney Foundation, as to do so would be discriminatory.

While the discussion about whether or not to move to a free market in organs rumbles on, in the latest macabre twist to the debate, Andy Ho, a senior journalist at the Straits Times, suggested in print that Singapore should take a cue from China and start routinely "harvesting" organs from convicts who are sentenced to death.

Campaign group Human Rights Watch has estimated that as many as 90 percent of all organs transplanted in China come from executed prisoners although the Chinese government has disputed this and attempted to clean up its own organ donation laws ahead of the Beijing Olympics.

Singapore, on the other hand, is believed to have the highest execution rate in the world, more so than Saudi Arabia, the next highest, according to Amnesty International. With a population of 4.6 million, the island republic has executed at least 420 people since 1991, a practice that goes largely unremarked in Singapore's largely tame press.

In an editorial piece, Ho went on to explain how hanging is not conducive to organ donation because the body is deprived of oxygen, damaging vital organs such as the heart and the liver and making them unusable for transplant. Similarly, he pointed out that the drugs administered by lethal injection are designed to destroy the vital organs one-by-one and that the gas chamber and electric chair also render most organs untransplantable.

That led him to suggest another option, which sounded like some dark, modern-day equivalent of being "hung, drawn and quartered". "Capital punishment by organ removal under anesthesia", as he put it, would allow all the organs to be removed in good working order. But, presumably, doctors would face just a few ethical issues if they became executioners as well as healers.

Ho's solution to this quandary? Get the prison staff to administer anesthetics to the death-row inmate in such a large dose that he or she is rendered brain dead and then let the team of transplant surgeons move in. An innovative suggestion, perhaps, but how many Singaporean doctors would be keen to get involved in such practices.

And since Singapore's ageing hangman Darshan Singh has reportedly been unable to find anyone willing to replace him, the prison service may struggle to find any executioners as well.

Although the amended organ donation bill is almost certain to pass into law after another reading in Singapore’s government-dominated parliament, it will come too late for some of the 1,000 people who lose the use of their kidneys in the city-state each year – only around 50 of these are lucky enough to get a transplant from someone who has died and the rest are forced to struggle on.

The advent of compensation may help increase the number of donors but it is bound to fuel the view that the government has merely legalized organ trading. For the Singapore government, the vexed question of how it can look after the health of its ageing population (and help them pay for it) looks set to rumble on.