Organ transplant technology in Taiwan has been mature and of an international standard for some time.
However, because the number of organ donations is well below demand, those who need organ transplants have not enjoyed these technological advances.
To address this long-standing problem, Department of Health Minister Yaung Chih-liang (楊志良) recently suggested that organ donation legislation be amended so that unless people explicitly state that they do not want to donate organs, their consent will be assumed.
In general, Taiwanese still consider the concept of a complete corpse at death as important. If the absence of explicit rejection of organ donation is rendered equivalent to donor consent, it would amount to stealing.
It would also be difficult to pass such a law. In practice, utter confusion would ensue if large numbers of Taiwanese were to rush to sign a statement denying access to their organs. So there are better methods that we can apply.
We could start by teaching children that it is admirable to save a life through organ donation, thus offering an alternative to the view that completeness of a corpse is important.
We could also employ a method similar to that used at accredited hospitals in advanced cardiac life support, making it a requirement that a proportion of doctors in each department have training in brain death verification, a skill that neurologists acquire as part of their specialist training.
Amending the Organ Transplant Act (人體器官移植條例) is the most practical option.
To prevent the disadvantaged from privately selling their organs, Article 12 of the Act states that donors should not receive compensation for donating organs.
The intentions of this article are honorable, but the effect is to limit the number of organs available for transplant.
FUNERAL COSTS
Thus, to encourage people to donate organs, Article 10.1 states that the central health authority shall pay funeral costs for the families of the deceased who donate organs and that the benchmarks for this should be decided by the health authorities.
Article 15 then states that the family of the deceased who donated an organ should be publicly recognized by the applicable special municipality, city or county government and that poorer families should receive funeral subsidies.
Obviously, when these laws were made, legislators wanted to have some way of offering reparations to the families of organ donors. They therefore decided to name these payments “funeral costs” to rationalize the reality that a family would get paid for the organs of the deceased.
Central, city and county governments issue these funds, but it is not mandatory for them to do so.
At present, the maximum amount that the central government can issue is NT$100,000, regardless of the number of organs donated.
At the local government level there are no such measures, save for a partial waiver for funeral fees in Taipei City. In other words, the subsidies that ought to be offered by city and county governments exist only in name.
Talking about subsidies seems to negate the goodwill that donating organs entails. However, we must remember that most of those who meet the criteria for organ donation are relatively healthy and young. They are therefore less likely to have substantial assets to pass on, and their sudden demise can a have a big financial impact on their families.
If we place ourselves in their position, maybe the knowledge that their organs may help other human beings could bring them happiness as they prepare to leave this world.
Still, they would be very worried about their family in their absence. Under such circumstances, can we claim that it is inappropriate and even greedy to use organs to provide financial support to those left behind?
In addition, patients who cannot wait for organ transplants in Taiwan may be forced to go to China, where human rights are violated and medical standards are lower. Such patients are willing to spend NT$1 million to NT$1.3 million for organs of unknown source and quality, with less-than-ideal follow-up treatment and the risk of ongoing disputes.
This shows that patients are primarily concerned with their health, quality of living and their lives as opposed to money, of which many of these patients have enough to spend.
USER PAYS
Therefore, the minuscule subsidies in the Organ Transplant Act do not only fail to improve the long-standing problem of a lack of organs, they also run counter to the universal principle of user pays.
Taiwan’s organ donors and their relatives, patients who need transplants, the medical community, the Bureau of National Health Insurance and the government will always lose out under this regime.
To increase practical benefits for organ donors and those waiting for organ transplants and to increase the number of sources for organs, Article 12 of the Act, which states that donors should not receive remuneration, needs to be reassessed.
Kao Ko-pei is vice superintendent at Chutung Veterans Hospital.
TRANSLATED BY DREW CAMERON
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