IN September, MySejahtera launched the “organ donor pledge” registration feature to make it easier for Malaysians to sign up as organ donors. However, despite the government’s attempt to promote donor registration, the disparity between demand and availability of human organs for transplantation in Malaysia continues to grow.
Former health minister, Khairy Jamaluddin, stated that based on the Global Observatory on Donation and Transplantation, Malaysia was among the 10 countries with the lowest organ transplant rates in the world in 2021, with 2.84 transplant procedures conducted per one million inhabitants.
Currently, Malaysia implements the opt-in system for organ donations in which explicit consent from donors must be acquired prior to the removal of any organ. A donor has to express his authorisation of the use of body parts for medical purposes, medical research and education either in writing or orally, in order to perform organ donation under the Malaysian Human Tissues Act 1974.
Despite the new feature introduced in MySejahtera, which saw more than 4,500 pledgers, there have been controversial debates on the pledger’s consent due to lack of information on the list of body parts the pledger consents to donate and digital signature. This has led to discussions and examination of the potential ethical and practical ramifications of Malaysia’s opt-out organ donation law in resolving the issue of low organ procurement rate in relation to donor autonomy.
In certain countries such as the UK, Spain, Belgium and Austria, the opt-out system has been adopted to increase organ donation rates. Under the opt-out system, the default system presumes that a person consents to organ donation unless he explicitly registers his refusal.
According to the World Health Organisation, the opt-out system leads to higher donation rates. Based on research from Northumbria University, University of Stirling and University of Nottingham on 48 countries’ organ donation systems, in which 23 adopted opt-in system and 25 adopted opt-out system, they discovered that countries with opt-out organ donation regimes had a greater number of kidney donations.
Seeing the issue from a morality point of view, the increase of organ donation under the opt-out system is indeed a purposeful and altruistic act of giving, in which more lives are saved. It represents the hope of survival in which donating “life” has become a significant means of sustaining life, restoring health and regenerating life. The opt-out system, bringing a significant contribution to the organ donation rate, reduces the number of patients suffering and dying while on waiting lists.
However, the opt-out system is not a magic bullet as donor autonomy has to be included in the big picture. The opt-out system neglects the intention of the donor to donate his organ. This may lead to many organs being harvested without true informed consent, as consent is generally viewed as an active process and not as a result of inaction. Such an opt-out system shifts the balance away from the donor’s interests and towards the donee, which creates a disproportion in rights and liberty of the donor.
The fact that the opt-out system was repealed in Brazil only a year after it was implemented demonstrates the problems that could arise with such a system, particularly on patient autonomy and when families were not permitted to overrule decisions. The doctors are still permitted to remove organs even if relatives know that the deceased would have objected to the donation but had not opted out while still alive. These unresolved problems have shown that the opt-out system is not the absolute answer to address low organ procurement rate in the country.
In the writers’ opinion, implementing an opt-out organ donation system or passing opt-out legislation is insufficient to increase the organ donation rate in the country. The opt-out law in Malaysia is undoubtedly too presumptuous in neglecting donors autonomy and will not solve the organ scarcity crisis.
On the contrary, the opt-out paradigm will create a moral and autonomy imbalance for patients. The new feature in MySejahtera is a promising start, however, a few details need to be refined before the issue of Malaysia’s low rate of cadaveric organ transplants can be rectified.
The government should improve the underlying infrastructure for transplantation under the opt-in system in order to boost income and investment in healthcare, as well as to eliminate the social stigma and religious and cultural beliefs that plague the public.
Evien See, law student at National University of Malaysia and Dr Nabeel Mahdi Althabhawi, Senior Lecturer National University of Malaysia. Comments: letters@thesundaily.com
