MARCH 26 — Organ transplants are impossible in Malaysia, and our legislators share a large blame.
We have performed 3,106 transplants here. Which is a decent number if it represented 2025. It does not. It represents every procedure since 1976, or 50 years or half a century. Which averages 62 annually in a country of 34 million.
And at least 70 per cent of those are from living donors, mostly kidney and some liver. About 18 transplants from the deceased, like heart, lungs or corneas occur. It’s grim for those waiting for those types of organs.
Safe to say if there was a World Cup for organ transplants, Malaysia would not qualify for the finals.
So, it is not inspiring to know, the compulsory adoption of MySejahtera health tracker, pumped up the donor list to over 400,000 but to no end.
Almost half a million people say if they die others are free to have their organs, only to not know post-death, that’s not what happens.
Good news of record number of donors translates to not good enough because their wish — their last lasting contribution to humanity — is nullified by family. For here, an organ pledge is only facilitated with family consent.
A pledge is only facilitated if the family agrees also.
There, mystery solved.
Ramping up the donor list is a fool’s errand since the dead don’t get their way. So around 62 people agree to give hope to strangers, which is wonderful, except only 62 strangers benefit.
When there are over 10,000 people in the waiting list, they have less of a chance to have the winning number than those lined up outside lottery shops.
The Health Minister Dr Dzulkefly Ahmad’s team in its usual ingenious manner came up with a winner of a solution, a public awareness campaign. Warisku, Hormati Ikrarku or My Family, Respect My Pledge. Launched in August 2025.
The masterplan: We’ll ask them, nicely. And wait. Brilliant.
It is doing the bare minimum to appear as though a real effort is being expended.
At this juncture, comparing apples and apples, gives perspective. Or organ box with organ box, though boxes without organs ever in them are not organ boxes, just merely boxes.
To compare, a short trot across the causeway.
Hota, eh Hota
Singapore’s Human Organ Transplant Act (HOTA) 1987 was amended in 2004 to include the liver, heart, and corneas, and expanded to cover all causes of death, not just accidental death, and further amended in 2008 to include Muslims.
Therefore, all Singaporeans and permanent residents are donors. Tonight, 4.2 million people are present on the island as potential donors, except for those who explicitly removed themselves from the list.
Opt-out and by choice one is relegated below those who remain put in the list. If you don't want to give, you won’t likely receive.
It is not a heartless episode, the steps to harvest organs in the eventuality.
Donors’ families are consulted but in general the process is not compromised.
Considering the chasm between the countries, Malaysians in Singapore with permanent residency, are strongly recommended to access the island’s healthcare if they require an organ.
Singapore’s legislators felt compelled to lead their people in the matter, rather than hope that one, people sign up to be donors they are automatically co-opted and second, not allow the system to disintegrate into paralysis because families turn reluctant.
All bioethics is heartbreaking by its very nature, but the Singaporeans chose the path of help rather than woeful indifference to not look bad.
Hey, family
One of the worst kept secrets about death is that the dead are incommunicado.
The living must cope. Few of us are spared the grief death brings to families.
To hand over a brochure to a family in their despair — the most suitable donor is a brain-dead person in the intensive-care-unit (ICU) — after discovery that the dear departed is a registered donor, is likely to be met with resistance.
Families are embroiled in their own pain and are too stricken to consider the plight of a different family.
The reaction to the knowledge that the person they loved — and now is no more with them — wants to part with his insides to help others cannot be other than upset.
Medical professionals can comfort them in the minutes after since the decision is out of the families’ hands like in Singapore, but it is a different kettle of fish to expect the doctors and nurses to persuade the families to respect the donor’s decision.
There is the delicate matter of time. Organs need to be removed within hours. Tissues (skin, corneas, heart valves) can be donated up to 24 hours after death.
The family has no time for these cold things since they are in the midst of funeral arrangements.
Which is why asking families to take the responsibility even though the individual has already decided is rough.
Don’t ask the family to respect the pledge, tell them they are legally obligated to oblige and morally beholden to the wishes of the deceased. Which is only possible if there is a Malaysian version of the Singaporean Hota.
It is a bridge too far in novice Malaysia to enforce an automatic opt-in but a first stage law can defend the opt-in decision.
The decision is better out of the hands of the family. If the donor made a wilful choice while alive, it should be respected by default, not debated in a hospital corridor.
A family is always many, and there will be enough who hesitate. Rational discussions are non-starters.
A divided house would also result in the safer choice not to donate. It would have to be a family inundated with Vulcans to think of the recipient and his family rather than stay in their personal emotional roller-coaster.
In this hallowed chamber
This is Dr Dzulkefly’s second go as health minister, after a four-year gap.
If the bravest his ministry can offer to this predicament is a campaign, then excuses rather than solutions are the go-to for this government.
To be absolutely clear, the other guys, those who claim clairvoyance and a monopoly over good, and ready to take over are just as afraid to moot bold policies.
Our politicians are mired in minimalism. They are happy to take all the credit but they will not do more than the absolute minimum in a brittle national political landscape.
These are matters that Dewan Rakyat is supposed to debate. Because it is a real issue suffocated by the fact a largely ignorant society only feels the pain when they have a family member in the 10,000 plus recipient list.
This is where leadership must emerge. In championing the practical even if it is easily manipulated by those wanting to score cheap points.
To say families know best, or that living wills are western constructs which negate eastern values.
Yet, a Bill to allow donor pledges to have legal protections when they are activated is exactly the kind of legislative measures which reflect a progressive society.
Only allowing 62 persons a year on average the benefits of life-saving modern medicine disappoint.
It seems crude to be impersonal about the family of the deceased when they are distraught but if they are guided by the state through a firmer law, they can enable another family to avoid a death or suffering, when their family member is a successful organ recipient.
The advancements in medicine only quicken and our present policy on organ transplants and meek efforts to cheerlead people into being OK with it will yield very little.
