MRCP PACES The Human Organ Transplant Act (HOTA)
  • HOTA makes provision for the removal of organs for transplantation, for the prohibition of trading in organs and blood, and for purposes connected therewith
  • HOTA allows the removal of four organs in the event of death for transplantation
    • Cornea
    • Heart
    • Liver
    • Kidneys
  • HOTA covers all Singaporeans and PRs who are at least 21 years of age and who are not mentally disordered
  • Any individual may opt out of HOTA
    • Individuals who opt out of HOTA have a lower priority on organ transplant waiting lists
  • The designated officer of a hospital may authorize, in writing, the removal of an organ from the body of a patient who has died in that hospital, for the purposes of transplantation into a living person
  • The order may not be given if:
    • The deceased has registered an objection to HOTA during his lifetime
    • The deceased is neither a citizen nor a PR of Singapore
    • The deceased is, or is suspected to be, mentally disordered during his lifetime
    • The deceased is below 21 years of age, unless his parent or guardian has consented on his behalf
    • The death is made a Coroner’s inquest, unless the Coroner has given permission to do so
  • No one other than an authorized medical practitioner shall remove an organ for the deceased
    • Doing so is a criminal offence
  • Definition of death:
    • Cardiac death: heart stops beating spontaneously; all vital bodily functions stop
    • Brain death
      • Legally and medically the same as death in Singapore and other countries
      • Different from a coma, where there is still evidence of brain function
      • For organ donors, requires certification of brain death by two doctors who are:
        • Not involved in the care of the patient
        • Not on the organ transplant team
        • Are not involved in the selection of the proposed recipient
        • Are not involved in the care of the proposed recipient
        • Accredited in the certification of brain death
      • Must not have any confounding factors (e.g. hypoglycaemia, hypothermia, drug intoxication)
      • Neurologic examination
        • Coma
        • Complete absence of central motor response (e.g. to pain)
        • Fixed, dilated pupils
        • Absent corneal reflex
        • Absent vestibulo-ocular reflex
        • Absent jaw jerk
        • Absent gag, sucking or rooting reflex
        • Absent cough reflex with tracheal suctioning
        • Apnoea (no response to increase in ETCO2 when ventilator stopped)
  • Donor’s body to be treated with utmost respect
  • All incisions repaired
  • Living organ donation also covered under HOTA
    • Donor must fully understand the nature and consequences of organ donation
    • Must give full, informed consent
    • There must be no coercion or financial incentive for the donor
      • Except reimbursement of costs, expenses or loss of earnings as a result of organ donation
    • Organ trading is a criminal offence
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