Archive for October 13th, 2007

Organ transplantation…brain death and financial implications (3)

by FK-506

In reply to Carpe Diem’s cherry picked quotes to the letter, ‘Organ transplant: Are we on the right track?’, the writer’s attempts to endorse this country’s nascent transplant program by trying to downplay key issues in any transplant program — financial implications and controversies surrounding brain death is reprehensible.

Quote : “… … … isn’t quite right to place patients on VADs which have a limited life of their own into patients, not knowing if they are ever going to get a heart. This cannot be ethically correct.”

“Is it more ethical to deny me this option, based on not knowing whether I will get a heart in time, if the expertise is available and I am more than willing?”

For how long and at whose cost? Is Carpe going to pay this out from his or her own pocket? Clearly this person doesn’t realize the economic costs of such programs on government expenditure, unless of course, Carpe thinks that it is the state’s moral duty to transplant everyone with end-stage heart failure, liver failure, renal failure, etc. Chua Soi Lek moaned only last year that the MOH couldn’t afford to pay the RM900 million pharmaceutical bill for patients being treated by the Ministry. But miraculously he today is quoted to have said that the Cabinet, which has never shown respect for tax-payers money, is willing to provide even up to a billion ringgit for a transplant program. Incredible. Where is the set of priorities? Why don’t the cabinet approve the billion ringgit so that patients get better care, better follow-ups, better education programs, home nursing and of course better medicines, so that less patients end up in heart failure, renal or liver failures.

The age old idiom “prevention is better then cure” must hold true for this country based on the economy that we have unless Carpe is advocating American style healthcare, in which case, I would like to suggest that the technology be kept going but all transplants be borne by private funds. And I do hope Carpe fathoms the economic consequences of transplant programs. I hope he/she realized what happened to Barnard’s pioneering transplant work at Groote-Schur in South Africa. Transplant programs were immediately shut down by incoming President Nelson Mandela in 1994 when he realized that precious and limited health resources that could be used for Soweto’s populace suffering from cholera, typhoid, malaria and an AIDs incidence of almost 14% in some provinces, were being channeled to a glamorous transplant program. Are we in Malaysia any different if the startling statistics provided by our own MOH are anything to go by? In Sabah alone, even decades after independence, we have still not eradicated malaria and TB.

Quote: “Merican howled that what SJMC and Tan did were improper as ignorant patients may “not have been briefed about complications”. Tan, who pioneered liver transplant techniques at King’s College, London, of course left, preferring to base himself in “less ethical” Singapore, leaving Merican to focus on traditional medicine back here in Malaysia.”

That Merican howled is a fact. It is also a fact that K.C. Tan announced in the media that he was not willing to work in the ethical environment imposed on him. But the end result of this entire episode was clear. Malaysia’s liver transplant program in the private sector, supported quite earnestly by the media even then, was dead in the water. No RM30 million, 100 million or 1 billion ringgit boost to this program, although it was led by a Malaysian surgeon and the incidence of patients requiring liver transplants were equally a concern. Even private donations collected to help patients in this program were ultimately taken over by the Ministry. Why the double standards? Was it because K.C.Tan was a private surgeon working at a private hospital? Or was it due to something else? Yes the insinuation is direct. I am sure readers can make their own conclusions. Read the rest of this entry »