The Human Organ Transplant Act (HOTA) allows for the kidneys, liver, heart and cornea to be recovered in the event of death from any cause for the purpose of transplantation.

From 1 November 2009, HOTA will cover all Singapore Citizens and Permanent Residents of 21 years and above, who are of sound mind, unless they have opted out. The upper age limit of 60 years has been removed.

Besides deceased organ donation, HOTA also provides for the regulation of living donor organ transplantation (i.e. the removal of organs from a living donor for transplantation into a patient).

For questions relating to Islam and Organ Donation, please visit MUIS website www.muis.gov.sg.

Yes, any gift of life is welcome. Medical (Therapy, Education and Research) Act (MTERA) is an opt-in scheme, where people can pledge to donate their organs or any body part for the purpose of transplantation, educto donate his organs under education or research upon their death.

Anyone 18 years old and above can pledge to donate his organs and/or tissues. Under MTERA, you can choose to donate all your organs and tissues or specify those you wish to donate.

In cases where a person had not pledged his organs under MTERA before passing away, the family members would be able to donate his organs under MTERA upon his death if they wish to do so.

For more details on MTERA, log on to http://www.liveon.sg

The Medical (Therapy, Education and Research) Act (MTERA) is an opt-in scheme, where people can pledge to donate their organs or any body part for the purpose of transplantation, education or research upon their death.

Anyone 18 years old and above can pledge to donate his organs and/or tissues. A pledge can only be revoked by the person who made the pledge. Upon death, the person’s decision will be respected, and his family members will not be able to revoke his pledge. Under MTERA, you can choose to donate all your organs and tissues or specify those you wish to donate.

In cases where a person had not pledged his organs under MTERA before passing away, the family members would be able to donate his organs under MTERA upon his death if they wish to do so.

From 1 November 2009, HOTA will cover all Singapore Citizens and Permanent Residents of 21 years and above, who are of sound mind, unless they have opted out. The upper limit of 60 years has been removed.

No. Those who have registered their objection to organ donation will continue to be excluded from HOTA and will not have to opt out again. However, an objection to HOTA can be withdrawn anytime.

With increasing life expectancy, healthier aging and improvement in health technology, it is now becoming clearer that the condition of an internal organ is not always linked to age. Hence, most countries in the world no longer have an upper age limit for organ donation.

There are internationally established protocols for evaluation of organs from older donors to ensure the suitability of the organs for transplantation. To ensure optimum transplant outcomes, the allocation of the organs will depend on the medical evaluation of organs and clinical parameters, such as blood group and tissue matching with potential recipients.

The upper age limit of 60 years for patients to be placed on the kidney transplant waiting list will be removed. This would mean that elderly patients suffering from organ failure will now have an opportunity to benefit from organ transplant if they are medically suitable.

HOTA regulates the removal of four organs – kidney, liver, heart and cornea. Anyone who decides against having his organs recovered upon death can do so by completing the pink "Objection to Organ Removal under Section 9(1)" form and send it to the National Organ Transplant Unit#.

# National Organ Transplant Unit (c/o Block 3 Level 1, Singapore General Hospital, Singapore 169608; Tel: 6321 4390). Forms can also be downloaded from the HOTA website at http://www.hota.gov.sg/forms

Yes. Anyone who does not wish to donate a particular organ can register his objections using the above same form and send it to the National Organ Transplant Unit#. In other words, he can opt out of any or all of the four organs under HOTA.

# National Organ Transplant Unit (c/o Block 3 Level 1, Singapore General Hospital, Singapore 169608; Tel: 6321 4390). Forms can also be downloaded from the HOTA website at http://www.hota.gov.sg/forms

Anyone who opts out of HOTA receives lower priority on the organ transplant waiting list should he require an organ transplant in the future. This will be specific to the organs which he opted out of.

Yes, an objection can be withdrawn at anytime. The withdrawal forms are available from the National Organ Transplant Unit#. Alternatively, the form can be downloaded from the HOTA website at http://www.hota.gov.sg/forms

# National Organ Transplant Unit (c/o Block 3 Level 1, Singapore General Hospital, Singapore 169608; Tel: 6321 4390). Forms can also be downloaded from the HOTA website at http://www.hota.gov.sg/forms

All Singapore Citizens and Permanent Residents who turn 21 years of age, or foreigners who obtain Singapore Citizenship or Permanent Residence status*, will receive a letter from Ministry of Health, Singapore (MOH) informing them that they will be included under HOTA. They are also told that they can opt out if they object to having their organs recovered upon death. MOH also informs the general public of HOTA twice a year through the main local newspapers in the four official languages.

* Muslims will be included under HOTA from 1st August 2008.

For questions relating to Islam and Organ Donation, please visit MUIS website www.muis.gov.sg, or contact them at 6256-8188. Thank you.

Organs that are recovered under HOTA are intended for donation to the common pool of patients on the respective organ transplant waiting lists. It is therefore neither possible to specify the recipients of organs recovered under HOTA, nor specifically exclude certain people from receiving organs. It is also not possible to release donor information to organ recipients.

The donor’s body will always be cared for with the utmost respect by the transplant team. The same surgical standards being applied to any living person undergoing surgery are also applied to organ donors. Any incisions made during the removal of organs are carefully repaired after the procedure. In the case of cornea donation, an artificial lens will be inserted after the cornea is recovered. In cornea donation, the eyeball is never removed and is left intact.

The medical care of potential donors will not be compromised. Organ donation will not be considered until all efforts have been made to save the life of the patient, and only after brain death has been legally declared by two well-qualified doctors who are not involved with the care of the patient.

The hospital bill for any organ removal-related procedure and test is not charged to the donor’s family.

No, HOTA only applies to death in hospitals.

Organs will be recovered only if the following conditions are fulfilled:

• Firstly, the donors must be within the age group of 21 to 60* years, be of sound mind, and not an objector.
  *From 1 November, HOTA will cover all Singapore Citizens and Permanent Residents 21 years old and above, who are of sound mind, unless they have opted out. The upper age limit of 60 has been removed.
• Secondly, the organs must be suitable for transplantation.
• Thirdly, there must be a suitable recipient to benefit from the organ to be recovered.

Cardiac Death
The death as we are normally familiar with is technically called cardiac death. This happens when the heart stops beating irreversibly. At the point of cardiac death, all vital functions of the body stop. The vital organs quickly become unusable for transplantation after cardiac death. however tissues such as bone, skin, heart valves and corneas can be donated within 24 hours of death.

Brain Death
In some cases, when there is a brain injury (for e.g. due to accident or stroke), the brain may stop functioning before the heart. Brain death means there is no flow of blood or oxygen to the brain and therefore, the brain cannot function in its capacity and never will again. Other organs, such as the heart, lungs, kidneys, pancreas or liver, may function for a brief period of time after brain death if person is supported on a ventilator. Unless damaged by disease or injury, these organs may benefit other individuals in need of organ transplants.

Donation of vital organs such as kidneys, heart, and liver is usually possible only after brain death. Brain death is accepted as the legal definition of death in Singapore and in other advanced countries. It is determined based on a standard, well-defined set of clinical criteria. This definition is similar to those used in countries such as Australia, Canada, Denmark, the United Kingdom and the United States of America.

There are well-defined and internally accepted clinical criteria and tests for certification of death, including brain death. The clinical criteria for death must be met in the patient, as observed by two doctors, before death can be certified. Should the two doctors have differing opinions, death would not be certified. The two doctors who examine the patient must:

1. not have been involved in the care or treatment of the patient being certified;
2. not belong to the team of medical practioners who will remove the organ from the body;
3. not have been involved in the selection of the proposed recipient of the organ; and
4. not be involved in the care or treatment of the proposed recipient of the organ during his hospitalisation for the transplant.

Being comatose is being in a state where a person is unarousable but tests confirm that some brain functions are still present. A comatose person may still recover or regain consciousness. Organs are never taken from a person in coma. Brain death is when a person is unarousable and tests confirm that all brain functions have stopped irreversibly. Persons declared brain dead cannot recover or regain consciousness again.

Brain death can be confusing, particularly for families who are confronted with the sudden death of someone they love because a brain dead person on a ventilator can feel warm to the touch and look "alive". The heart still beats and the ventilator is pushing oxygen and air into the lungs making the person's chest rise and fall. When this happens, some families expect the person they love to be kept on the ventilator in hope that their condition may improve. However, to be brain dead is to be actually dead and no improvement or recovery is possible. there is no method to jump-start or revive a brain that has been deprived of blood and whose cells have died.

There is no clinically documented case where a patient who has been declared brain dead following proper procedures, is later restored to a normal life.

Anyone above 18 years old can sign up as an organ pledger to donate any organ and/or tissue for the purpose of transplant, education, or research under MTERA. You can do so by completing the yellow “Organ Donation Pledge Form” and send it to the National Organ Transplant Unit#. You are encouraged to discuss your decision to pledge your organs and/or tissues with family members so that they will be aware of your wishes.

# National Organ Transplant Unit (c/o Block 3 Level 1, Singapore General Hospital, Singapore 169608; Tel: 6321 4390). Forms can also be downloaded from the HOTA website at http://www.hota.gov.sg/forms

Yes, foreigners can choose to pledge their organs under MTERA. This pledge is effective only in Singapore, i.e. if the foreigner were to pass away in Singapore, his organs would be considered for donation. However, if a pledge has not been made, the next-of-kin could be approached for consent to organ donation.

Living donor organ transplants are transplants in which a living person donates an organ (e.g. a kidney) or a part of an organ (in the case of liver) to another person. One concern in such transplants is that living donors do face a small chance of developing complications following surgery or sometimes even death after donating their organs.

Prior authorisation from the hospital’s Transplant Ethics Committee (TEC) is required before a living donor organ transplant can proceed. The TEC has to be satisfied that two major professional and ethical concerns are adequately addressed. Firstly, the donor must thoroughly understand the nature and consequence of the medical procedures and has given his or her full informed consent. Secondly, there must not be any emotional coercion or financial inducement to donate an organ. This applies to all living donor organ transplants, regardless of whether the donor and recipient are related or not.

Since living donors have to undergo surgery for organ donation, there are risks involved. These risks can differ among donors and also according to the type of organ donated. Based on international studies, kidney donation is considered to be a generally safe procedure. There may however be other minor long-term medical problems such as back pain associated with organ donation in small proportion of donors. Liver donation carries a higher risk of death and complications.

All living donors are encouraged to seek full information about the donation process, outcomes and risks from their doctors before deciding to proceed with donating their organ.

Prior HOTA will allow for payments to altruistic living donors, only for reimbursing or defraying the costs or expenses or loss of earnings that may be reasonably incurred as a result of organ donation. This will include costs for health checks, laboratory tests, donation operations, follow-up visits and limited indirect costs such as loss of earnings by self-employed or daily-wage workers.

It is important for a donor to fully understand the medical and financial implications of donation. Once this is done, the donor may choose to seek reimbursement for expenses incurred in relation to donation. However, this will not be complusory. Donors can waive the right to receive reimbursement or payment from the recipient.

Proposals are being considered in which VWOs will work with hospitals to support needy recipients who cannot afford to provide minimal donor welfare such as payments for the donor's medical evaluation, surgery and follow-up care. This will be limited to Singaporeans/PRs.

Prior HOTA prohibits the selling or buying of organs. Any person who is involved in the buying and selling of organs shall be liable on conviction to a maximum fine of $100,000 or a maximum imprisonment term of 10 years or both.