Health Ministry should adopt a more professional approach before banning
living donor liver transplantation (LDLT) by establishing a Living Donors
Organ Transplantation Review Committee to study and make policy
recommendations to government and Parliament
Media Conference Statement
by Lim Kit Siang
Sunday): The director-general to the
Ministry of Health, Tan Sri Dr. Mohd Taha Arif sparked off a controversy
when Thursday's papers reported his announcement of a ban on live donor
organ transplants in government hospitals because of the negative
implications for both the donors and society.
He said his ministry also discouraged private hospitals from doing the same,
adding that it was against medical ethics although several such transplants
had been carried out at private hospitals in Malaysia and other parts of the
He also warned that "If something goes wrong, disciplinary action can be
taken against the surgeons" when asked about several liver transplants which
had been performed in the country.
The immediate reaction was the Malay Mail report the next day (28.2.03),
under the headline "Liver Surgeon Opts Out of KL Ops" which said:
"LEADING Asian liver transplant surgeon
Datuk Dr K.C. Tan will cease all operations on liver patients in Malaysia,
saying that he cannot work under a threat from the Health Ministry.
"The Malaysian-born hepatobiliary surgeon, based in Singapore, has decided
to shelve his work in Malaysia after the Ministry threatened to take
disciplinary action against any surgeon who performed organ transplant from
a living donor if the operation goes wrong.
'"I cannot operate under such a threat, more so before such a surgery is
being carried out,' he told The Malay Mail in a telephone interview
"'Until and unless the threat is removed, I will not operate in Malaysia.'"
Dr. Tan, a consultant surgeon at the Subang Jaya Medical Centre
(SJMC), had carried out 40 liver transplants in Malaysia since 1995. He has
performed more than 450 liver transplants since 1987.
SJMC executive director Dr. Jacob Thomas announced on Friday that SJMC will
temporarily cease all operations related to liver transplants and asked the
Health Ministry to draw up clearer guidelines on such operations.
The manner the controversy over the ban on live donor organ transplants
erupted was most unfortunate and unwarranted, raising anew the question of
the lack of seriousness and professionalism of the Health Ministry in its
approach to both medical and health issues and problems.
Firstly, Dr. Taha made the announcement in response to allegations that the
Health Ministry had not released funds for a liver transplant for
18-month-old Muhammad Nabil Hakimin Muslimin, who died on Monday at the
Universiti Malaya Medical Centre before undergoing the transplant. The
child's parents claimed that the transplant could not be done because the
Ministry did not release the funds.
Whatever the right and wrongs, merit or demerits of the allegations of
Muhammad Nabil's parents, why should such an important public policy issue
as the ban or otherwise on live donor organ transplants be made as an
incidental response to these allegations?
Secondly, why the threat by Dr. Taha to take disciplinary action against the
surgeons who performed live donor liver transplants at private hospitals in
the country, and was he directing his warning specifically at Dr. Tan?
I fully support Dr. Taha's concern about "the risk of morbidity and
mortality" faced by the donors and the need for a policy approach of "Even
one donor death is too many" - except that Dr. Taha would be more convincing
and credible if he had adopted a similar position of "Even one dengue death
is too many" in the worst dengue epidemic raging on in the country for the
past nine months, claiming at least 100 lives last year and as high as 20
lives in the first two months of this year.
Thirdly, in zeroing in on living donor liver transplantations (LDLT) in the
private hospitals, is Dr. Taha drawing a line between live liver transplants
from other live organ transplants, where the former is "No, No" while the
latter are in "a no man's land"?
Dr. Taha is right that live organ transplants present grave medical and
ethical issues and dilemmas, but to impose a sudden ban on live organ
transplants is not only a misjudgment but a disservice to Malaysia, as it
sends the wrong message to the world of a major retrograde development in
Malaysian medicine in direct contradiction to the professed claim that
Malaysia wants to be at the very forefront of global ICT, scientific and
bio-medical developments and advances.
The first organ transplant in the world was carried out 50 years ago in
1953, and since then, major advances and breakthroughs have been made in the
field, including those involving living donors.
Living donor transplantation, which began with kidneys, has been extended to
livers, pancreas, intestines and lungs. It has been reported that in the
United States, kidney transplants using organ from live donors exceeded
those from cadaveric donors for the first time between 2000 and 2001. In
2001, 6,485 people donated a kidney for a transplant, compared with 6,081
cadaveric donor kidneys.
Liver donation is generally riskier than kidney donation. Although there is
at present no official living donor liver registry, it is estimated that
more than 2,500 living donor liver transplantation (LDLT) had been performed
It has been reported that the largest LDLT programme in the world is at
Kyoto University in Japan.
Although LDLT represents a number of positive medical and economic benefits,
including shorter hospital stays and a faster recuperation time, it poses
decidedly tough ethical and medical questions and dilemmas, such as:
Whether live organ transplantation will unwittingly violate the
Hippocratic Oath to "first, do no harm", as it is said that "to do a live
donation, a physician must harm someone".
The profit incentive that motivates some surgeons and medical
centres to establish transplant units.
Lack of clarity as to what qualities constitute a competent
donor and which healthcare professionals should make that determination.
Who in the transplant community can best serve as the donors'
advocate - "Whose primary duty is the transplant team to - the donor or to
These issues and the need for safeguards, in particular on
donor safety, uncoerced consent, and to ensure that there should be no
financial arrangements between receipients and donors, need to be
addressed.through candid discussions, disclosures and policies.
The Health Ministry should adopt a more professional approach
before banning living donor liver transplantation (LDLT) or other forms of
live organ transplants, whether in government or private hospitals, by
establishing a Living Donors Organ Transplantation Review Committee to study
and make policy recommendations to the government and Parliament.
This Review Committee should provide for a tripartite composition - the
government, the medical professionals (the Association of Private Hospitals
Malaysia and Malaysian Medical Association) and the Malaysian public, to
represent directly the interests of the donors and receipients of such
Lim Kit Siang, DAP National