More than 1,100 potential organ donations in Malaysia cannot proceed due to family consent requirements under outdated laws, despite over 10,000 patients on waiting lists.
PETALING JAYA: Malaysia’s organ donation drive faces a critical challenge with more than 1,100 potential donations unable to proceed due to consent requirements, despite thousands of patients remaining on waiting lists for life-saving transplants.
The issue has renewed calls for clearer laws to bridge the gap between a person’s decision to become an organ donor and the process required for donation to proceed after death.
Malaysian Society of Transplantation president and Kuala Lumpur Hospital transplant nephrologist Dr Mohamad Zaimi Abdul Wahab said the current framework under the Human Tissues Act 1974 (Act 130) still requires consent from next of kin, even when an individual had registered as an organ donor during his or her lifetime.
He said the legislation, which he described as limited in addressing the needs of today’s transplant system, requires amendments to provide greater clarity on organ donation and transplantation procedures.
“Since 2009, we have tried to change this Act. From 2009 until now, we are still at step one. There are still another eight steps to go through. The final step is tabling it in Parliament.
“The Human Tissues Act 1974 has very little on organ donation. It does not specifically cover living organ donation either. That is why we want to include many things in it,” he told theSun.
Zaimi, who spoke before the Health Parliamentary Special Select Committee on organ donation and transplant issues on Oct 29 last year, said the existing legal framework places emphasis on obtaining consent from the next of kin because the deceased can no longer provide consent.
He said while a person’s decision to register as an organ donor reflects his willingness to donate, the current law does not clearly state that the pledge can proceed without family consent.
“In our (Act 130), it mentions consent from the next of kin, because the person has died. How do you take consent from the person after death?
“For us, if the person has already pledged, then others should not be able to overrule it because that person had already made the pledge. But right now, we do not have an Act or policy to enforce that. That is the issue.”
During a Dewan Rakyat sitting on July 6, Special Select Committee on Health chairman and Pulai MP Suhaizan Kaiat said Malaysia had carried out only 3,657 organ transplant procedures, despite 10,170 patients remaining on the waiting list for organs from deceased donors as of June 30.
He also said more than 1,100 potential organ donations could not proceed because consent from family members was not obtained, while more than 55,000 patients are dependent on dialysis, a figure projected to rise to more than 104,000 by 2040 at a cost of nearly RM2 billion a year.
Zaimi said decisions by families not to proceed with donation were often influenced by a lack of understanding, cultural beliefs and concerns that organ retrieval could affect the dignity of the deceased.
He said the National Transplant Resource Centre had also found that some families declined because they “did not know the deceased wishes”, while others were unable to reach agreement among relatives.
“One of the main reasons is that they do not want to hurt the person who has died. The second reason is that they do not know the wishes of the deceased.
“There is also no consensus among family members. For example, one person agrees and another does not. We also do not want conflict within the family. Usually, if there is no consensus, we do not proceed.”
Zaimi said Malaysia was working towards a model where a donor’s pledge could be given greater recognition, but stressed that any changes must be supported by public confidence in the transplant system.
He said people needed to understand how organs were allocated, who qualified for transplants and why one patient might receive an organ ahead of another.
“If the transplant ecosystem is not transparent, people will ask who gets the kidney, who gets the liver, who gets the heart and how the selections are made.
“So we need to make sure all this is okay first. Once there is public trust, it will be easier to implement policies.”
He said the system should continue encouraging organ donation while respecting families’ concerns and avoiding measures that could create further resistance.
Under the national kidney allocation policy, he said a first-degree relative of a deceased donor who is on dialysis may be prioritised to receive the next suitable kidney.
“It is not a reward – it is like an incentive for people to donate.”
