Mr Speaker, Sir, I will move on behalf of my Minister. Sir, I beg to move, "That the Bill be now read a Second time." In 1985, 218 Singaporeans died of kidney failure. Many of these people could have been saved if only there were enough cadaveric kidneys available for transplantation. The Human Organ Transplant Bill seeks to do something about this problem. Kidney disease respects no individual and recognizes no boundaries. It strikes down men and women of all ages and of all races, the rich and the poor, the educated and the illiterate. Many are mothers and fathers of dependent children. Before their illness, they had been working and helping to look after their families. Treatment for kidney disease is either by dialysis or by transplant. Without treatment, death is inevitable, often within two to five months. Dialysis is not a suitable treatment for kidney failure. It has to be continued for as long as the patient lives. The patient's life is precarious. He is subject to infections and medical complications. Kidney dialysis is also disruptive. The patient has to be hooked up to a machine three times a week, six hours each time. It invariably leads to loss of employment. Consequently, the whole family is placed under tremendous stress, both emotionally and financially. Mr Speaker, Sir, transplantation is the treatment of choice for any kidney patient. The success rate for kidney transplants is good and it continues to improve. This is due to proven transplant techniques as well as new drugs which help to reduce tissue rejection. In Singapore, our very first patient to receive a cadaveric kidney transplant is today alive and well. She received her transplant 16 years ago, in 1970. Today, she leads a normal life. All she needs to do is to take three tablets a day, and that is the biggest and most important benefit for kidney transplants. It allows the patient to go back to a normal, active and productive life. The only problem is the lack of cadaveric kidneys for transplantation. For the whole of 1985 we only had one cadaveric kidney transplant. The question is: could we have done better? Mr Speaker, Sir, every year more than 700 people die as a result of accidents. These lives were unnecessarily lost and wasted. Many of the victims were healthy people and they were in the prime of their lives. But in these tragedies lie a rare opportunity for us to turn a negative event into a positive one. We estimate that between 40 and 45 of these 700 victims of fatal accidents would have been suitable as kidney donors. They could give life to over 80 people each year, people who would have died otherwise of kidney failure. Recognizing this, we have been encouraging Singaporeans to pledge their kidneys for the past 14 years. The Medical (Therapy, Education and Research) Act of 1972 enables the donations to be made. Unfortunately, it has been a dismal failure. Only 27,000 pledges have been received to date. For the scheme to be successful, we need a total of 800,000 people to pledge their kidneys. But Singapore is not alone. No country in the world has succeeded with this system of active consent for kidney donation. It has been found that people just shy away from thinking about their own possible death. And surveys have shown that even those who are really willing to donate their kidneys have been apathetic about sending in their kidney pledge forms. Mr Speaker, Sir, we have also tried seeking permission from the families of accident victims at the time of death. Unfortunately, this too has not been successful. The reasons are quite understandable. The family members would be under extreme emotional strain and anguish. It would be very difficult for them, in their moment of extreme grief, to be able to come to a rational decision. It is usually easier to say no. Mr Speaker, Sir, the existing system has failed. Lives will continue to be lost. It is pointless and wasteful for us to continue in this futile manner. This is a sad situation, especially since surveys have indicated that Singaporeans generally support the concept of kidney donation. It is acknowledged as a noble, a humane and an admirable act. The major religions have also acknowledged that organ donation is a very laudable act of charity. In fact, several religious leaders in Singapore have recently come out openly in support of organ donation in order to save lives. Mr Speaker, Sir, as I have mentioned a few minutes ago, Singapore is not alone in its lack of success with the present system of active consent. Europe has also faced similar problems. Consequently, in 1976, the Council of Europe recommended to European countries to gradually modify their organ donation laws towards the presumed consent system. Following this recommendation, 14 European countries have now adopted this system of presumed consent, and they include countries such as France, Italy and Switzerland. Belgium is the latest country to adopt this system, having enacted the relevant laws only in June this year. All these countries are forward-thinking, very enlightened and progressive countries. The Bill I am presenting this morning is also based on the concept of presumed consent. The Bill seeks to authorize the removal of only the kidneys of victims of fatal accidents for transplant in kidney failure patients. Unless the accident victim had objected to this donation in his life-time, it will be presumed that he had consented to the donation of his kidneys. Mr Speaker, Sir, the Government is aware of the different cultural backgrounds of our people and of their sensitivities and anxieties. We have therefore put in a great deal of thought in drafting the Bill. Care has been taken to ensure that all issues raised have been addressed and that all possible safeguards and precautions have been taken. Let me now go into the main features of the Bill. The Bill affects only victims of fatal accidents who are citizens or permanent residents of Singapore. Various categories of people have been exempted from this Bill. Firstly, minors under the age of 21 years of age and people of unsound mind are exempted. These people may not realize or they may not be aware of the implications of the Bill. They may not be aware that they have to opt out should they decide that they do not want to donate their kidneys. People over 60 years of age will also be exempted from this Bill. Unfortunately, our organs do deteriorate with age. Even under our present system of active consent, people over the age of 60 years of age have not been considered for the donation of their kidneys. Singaporeans of the Islamic faith have also been exempted under this Bill. The Islamic religion specifically prohibits organ donation under the presumed consent system. In deference to their religious teachings, the Muslims as a group have therefore been exempted. However, Islam does permit donation of kidneys if it is to save lives. Individual Muslims can therefore pledge their kidneys through the existing Medical (Therapy, Education and Research) Act. Mr Speaker, Sir, some people have expressed their concern that this Bill will deny a person the right to decide what is to happen to his own body in the event of an accidental death. Nothing could be further from the truth. Each person under this Bill fully retains his right to decide what he wishes done with his body. If he objects to having his kidneys used for transplantation, all he has to do is to register his objection. His wishes will be respected, without question and without protest. He will be able to register his objection in a very convenient way. All he has to do is to fill in a form and send it in to the Ministry of Health. In fact, the forms will be pre-addressed and postage paid, and will be available everywhere. We will maintain a computerized Register of Objectors. This register will be checked in every case before any kidney is ever removed. This is to ensure that the accident victim who has passed away has not in his life-time registered his objection to his kidneys being used for donation. The register will also be kept totally confidential. Only the designated senior doctor in each hospital will have access to this register, and it will be his duty to check to ensure that the accident victim is not registered on the Register of Objectors. Those people who do not wish to donate their kidneys will be given the grace period of six months after the Bill is passed to register their objection. During this grace period, no kidneys will be removed under this Act. After the grace period people can still send in their objections at any time. Their names should appear on the Register within 24 hours of their forms being received. Each objector will then receive an acknowledgment card. This card will be of wallet size and it can be conveniently carried around with him. The card will confirm that his objections have been received and, secondly, that his name has been entered in the Register of Objectors. Mr Speaker, Sir, some people have also expressed the fear that kidneys may be removed from an accident victim who has passed away before he is truly dead. This is a very natural anxiety and I would like to assure Members that this is totally unfounded. The sole responsibility of doctors is to save lives and the Bill in no way changes this. The doctors looking after the accident victims will be battling to save the lives of their patients. However, should all their efforts fail, extreme care will be exercised to ensure that the certification of death is properly carried out. To ensure that this certification of death is properly done, only experienced doctors with specialist qualifications will be allowed to certify death in these cases. And it must be done by two separate doctors. To eliminate any conflict of interest, these two doctors will not be the ones looking after the accident victim. Neither will they be members of the transplant team, nor will they be involved in looking after kidney failure patients. The two specialists will specifically and strictly adhere to a standard and internationally-accepted protocol to check for the slightest indication of life. They will check to ensure that there are no circumstances which may give rise to a suppression of body functions and which may result in wrong certification. All removal and transplantation of kidneys under this new law will initially be permitted only in Government hospitals. There will be no monetary considerations involved. No one will stand to gain in any way except the kidney recipient. Mr Speaker, Sir, the kidney donation system in a way resembles an insurance system. The pool of people who consent to donate their kidneys form an insurance pool from which some kidneys may be available in the future. Like any insurance system, it is only fair that those who join are the ones who are more likely to enjoy the benefits from the system. The Bill therefore provides for those who form the pool of potential donors to have priority in receiving kidneys. It is only fair that they will have priority over people who have consciously chosen not to join the pool and not to donate their kidneys in the event of accidental death. Any person who has objected may withdraw his objection at any time. He will then have equal priority again with the non-objectors two years from the date of his withdrawal of objection. This delay is to prevent any possible abuse of the system by persons who opt out with the intention of rejoining the pool as and when they find out that they have kidney disease. Muslims who pledge their kidneys under the existing Medical (Therapy, Education and Research) Act during this six months' grace period will also have priority similar to non-objectors. Those who do so after the grace period will then have priority in the same manner as persons who have withdrawn their objections, and for the same reasons. This ensures consistency and fairness for everybody. Mr Speaker, Sir, the sale or trafficking of human organs is repugnant. The Bill will prohibit the buying and selling of human organs. This section of the Bill will apply to all human organs under all circumstances and not only to kidneys. This is to correct a gap in the existing legislation in this area. Finally, let me reiterate that much effort has been put into the drafting of this Bill to build in all possible safeguards for the protection of everyone who come under its ambit. It has been drawn up to ensure consistency and fairness. The Bill is deliberately restrictive to apply only to kidneys, and upon accidental death. It does not seek to deprive anyone of their right to decide or to take anything away from them against their will. It will not change anyone's lifestyle, nor will it take advantage of anyone's ignorance. Mr Speaker, Sir, this Bill is motivated by the desire to save lives, lives that would otherwise be lost unnecessarily. We can do this at no cost to anybody. So let us have the willingness to accept a new idea. Let us have the courage to adopt a new approach to helping our fellow Singaporeans in need. Let us give them the gift of life. Mr Speaker, Sir, I intend to commit this Bill to a Select Committee to give an opportunity for members of the public to present their views. Sir, I beg to move. Question proposed. 12.46 pm