by Dr. Helmy Haja Mydin. First published in The News Straits Times 19 July 2014

THE local newspapers recently carried a story on Malaysia’s first cardiac death organ donor. Shelly Mahoney, a tourist from Australia, tragically passed away when in Penang but two patients with end-stage kidney disease were given a new lease of life when they received her kidneys.

Organ transplants are complicated procedures, but the concept is not new. Kidney transplants were first performed in the 1950s; Malaysia had her first in the 1970s. A number of organs can be transplanted — the kidney, lungs, heart, liver and even the intestine. Recipients tend to have failing organs with poor outlook, but many thousands have been saved by the gift of a new organ.

I had the privilege of training at the Freeman Hospital, an internationally-renowned transplant centre in Newcastle upon Tyne, United Kingdom.

The adrenaline rush of a 3am phone call to assess a patient’s suitability for transplant after months of intense work by a multidisciplinary team was matched by the often challenging and topsy-turvy recovery period during the months after surgery.

However, it was always sobering to know that for each success story, there were many more patients who died waiting for an organ.

Waiting times for transplants vary widely internationally, and between different organ types. For example, the average time to a kidney transplant in the UK is three years. Patients in Malaysia wait for more than 10 years, according to Datuk Dr Ghazali Ahmad, the head of nephrology at Kuala Lumpur Hospital. Khamisah Othman, the recipient of one of Mahoney’s kidneys, had waited for almost 20 years.

It is unsurprising that many countries are keen to introduce policies that may assist in increasing the number of organ donors. Malaysia has a particularly low rate of 0.7 deceased donors per million population (pmp), according to the World Health Organisation’s Global Observatory on Donation and Transplantation.

This compares unfavourably with our neighbour Singapore (5 pmp) and more developed countries like the UK (13 pmp) and Spain (34 pmp).

Many Malaysians are unaware of the organ donor register. Others are reluctant due to cultural norms and a misconception that organ donations after death are against religious edicts. On the contrary, all the major religions are supportive of organ donation.

The National Fatwa Committee declared as long ago as 1970 that organ transplants are allowed under Islamic law. This was decided on the basis of the sanctity of life, as transplants are performed to preserve and extend the life of another human being. It is stated in the Quran (Surah Al-Maidah, verse 32): “if anyone saves a life, it will be as if he saves the life of all mankind.”

Similar principles are upheld by other religious governing bodies:

The Christian Federation of Malaysia encourages organ donation as a reflection of Christ’s physical sacrifice for others, the Hindu mantra Lokah Samastah Sukhino Bhavantu is a prayer for the happiness of all mankind and in Buddhism, organ donation is encouraged under the Virtue of Dana (charity and generosity).

A key feature of any transplant is the full, informed consent of the donor. Most sign up to a donor register, pledging the use of organs for transplant in the event of death. This system is called the “opt-in” system. In contrast, the “opt-out” system assumes that individuals are willing to donate unless they explicitly object beforehand.

Generally speaking, countries with the opt-out system have higher organ transplant rates, as demonstrated by Spain.

The advantages are obvious: the number of donors automatically increases and doctors do not have to chase paperwork detailing consent prior to transplant.

In Singapore, all adult citizens and permanent residents of sound mind are automatically enrolled as donors. The Health Ministry sends a letter informing them of their inclusion with a form to fill in should they choose to withdraw. As an incentive, individuals who remain on the register are given a higher priority on the waiting list should they require a transplant themselves.

The reality on the ground is never as straightforward. Even among individuals who have given written permission to transplant their organs, it is always good practice to ensure that their loved ones agree to the procedure. The death of a loved one is naturally fraught with emotional turmoil, particularly in an unexpected death of a young individual. Discussions with family members regarding the use of organs for transplant need to be done in a considered manner by an experienced professional.

Although an opt-out system is likely to yield more donors, I personally believe that Malaysia is culturally not ready. The public needs more education and exposure to the concept of organ transplantation. The combination of public campaigns by medical professionals and health authorities, alongside the quelling of individual doubt by religious leaders, are likely to yield the best outcome.

Individuals also play a key role by raising awareness locally or through petitions. Most importantly, we can pledge to make a difference to someone else’s life by registering as an organ donor today and by making our loved ones aware of our intentions.

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Dr. Helmy Haja Mydin is a founding associate of IDEAS

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