Malaysia Boleh is not a proclamation we can claim to make when it concerns the issue of organ donation. It seems that Malaysians are less affected by the plight of fellow citizens who make desperate pleas to undergo organ transplants.

It is almost every other day we read in the newspapers the plight of people in need of various organs, be it the heart, kidney or the lung. Their cries for help remain caged within the pages of the newspaper concerned. No wonder then that Malaysia has little to boast about when it comes to deeds like pledging one's organs, unlike Spain which is recognised as the only country which has sustained a year-on-year increase in organ donation for the 10 years - following the implementation of a comprehensive national procurement system.

In Malaysia, each year 3,000 patients need corneal transplants, 200-300 people need liver transplants and 40-60 people need heart transplants. A cadaveric donor can save up to seven lives, as it is not just the heart and corneas but various other tissues that can be harvested from one cadaver.

For the unaware, pledging one's organs does not automatically "qualify" her or him to become a donor. In reality, only two to three per cent of donors who have pledged their organs will actually end up donating them because the organs can only be harvested from a brain dead person in an intensive care unit, and who is aided by a ventilator which pumps oxygen into her or his system to keep it going.

A doctor has to certify that the donor is brain dead in accordance to a very strict criteria. Six hours later, another doctor from a different unit will again certify that the donor is brain dead. Then only is it deemed permissible to harvest the organs. As the heart is the most perishable of organs, it will be the first to be removed, followed by the liver and other organs.

Once the organs have been removed, they are kept in a preservative and taken to the hospital where the transplant is to take place. The heart has to be used within four to six days after it has been harvested while corneas can be harvested up to seven days in a non-hospital setting. If the donor is in a comatose state, the organ transplant cannot take place as the brain stem is alive and can kick back any time.

Think again

With this stringent process in place, it is befuddling to figure out why Malaysians are very reluctant to pledge their organs or give their blessings to their loved ones to do so. If an article in New Sunday Times May 8, 2005 entitled "Organ donation waiting game" is any measure of our inability to lend that helping hand, then perhaps we should think many times before preaching kindness and compassion to the world.

The article related the disappointment and frustration faced by the National Heart Institute-Kuala Lumpur Hospital Cardiothoracic Transplant Team when families of organ donors backed out at the last minute and refused to honour the pledge made by the deceased.

The refusal of many Malaysians to pledge their organs has been pin-pointed to two factors. One is the notion that the spirit of the deceased would 'suffer' if the physical entity was tampered with.

This is a belief held closely to chest by the Malay Muslim community, eventhough a decree was issued in the 70s by the National Fatwa Council that it is absolutely alright for Muslims to donate the organs of a deceased to help a fellow being in need. Needless to say, this fatwa has failed to create the desired effect.

Last year, figures from the National Transplant Resource Centre released to the media by Lee Lam Thye, chairperson of the National Organ Donation's public awareness committee showed that the majority of the 78,150 people who had pledged their organs with the centre were still the Chinese and Indians, between the ages of 21 and 30. The Chinese pledges stood at 51,784 (66.3 per cent) and the Indians at 17,070 (21.8 per cent). Another three per cent (2,288) comprised people of other races. While pledges from the Malays rested at a dismal 6,948 or less than 10 per cent.

It has been accepted that convincing the Malay community, especially its youngsters on the importance of pledging their organs remains a arduous challenge. The myths surrounding the issue of organ donation and the absymal interest in raising awareness on the topic of organ donation has resulted in a chronic supply of pledges. Ignorance on just what entails the organ donation system has also worsened matters. And clinging on to religious sentiments has paradoxcially become the 'straw the broke the camel's back'.

Time for a change?

With Malaysians' below satisfactory performance in responding to organ donation requests, perhaps it is time that Malaysia, with as little excuses as possible, consider with all seriousness the need to take the "opt out" approach. At present organ donation is by consent i.e. "opt in" which means that even after the organs have been pledged, the last say still belongs to the donor's next-of-kin before the organs can be removed.

In Singapore, it is the reverse. The "opt out" system adhered to automatically makes every Singaporean an organ donor, unless she or he declares otherwise. For a multi racial nation like Malaysia, this system was deemed not feasible and could lead to eruption of racial tensions. Maybe that is why when in 1995 when the topic of "opt out" was broached by the then Health Minister Lee Kim Sai, the religious officials wasted no time in shooting it down. The idea of coercing Malaysians to donate their organs upon death was and still is a notion too ghastly for the religious organisations to consider.

A decade later, Malaysia is still grappling with the problem of shortage of organ donors. With passing days, the number of people on the waiting list for transplants is increasing and there is still no firm action adopted to tackle with utmost sincerity the severity of the negligible number of organ donors.

What really is holding us back in applying the "opt out" system? Is the multi racial society "excuse" justifiable? Does race and religion take precedence when it concerns a life and death matter? Are Malaysians after all a selfish bunch of people who place no value in the life of others? Is saving the life of another not an act preached by all religions?

It now appears that the "opt in" system's altruistic approach to organ donation is in need of a serious review. The "opt out" system might seem "hard" as in the case of Austria where the views of close relatives are not taken into account or "soft" as in the case of Spain where relatives views are sought. Still, the "opt out" system is able to relieve relatives of the burden of crucial decision-making at a tragic time.

In Malaysia's case, one has little say but to ponder just how long more the Government intends to hold the country's multi-racial society at ransom in offering a ray of life to another? If being a part of a multi-racial community entails being helpless in saving the life of another, then it is time that such a nation's warped view in providing that gift of life to another be demolished.

Maybe learned citizens like the vocal Harussani Zakaria, the Perak Mufti, can play a role in educating the Malay youngsters in adopting a more caring and empathetic attitude towards issues such as organ donation. Religion should not be misused to put in place fear and subjugation of one race over the other, for what goes around eventually does come around, to put it mildly.

As for our politicians, they should be setting an example by coming to the forefront and suppporting the organ donation campaign. Other public figures too should make the effort to register as organ donors and take the initiative to spread word on such a move through their works.

While corporate entities should cast aside their eye for profit and embrace the spirit of volunteerism by creating ways to raise awareness among the people on the importance of pledging one's organs. A regular text message on one's mobile phone or on the utility bills stating "do you care? save a life, pledge your organs" etc will go a long way in producing that paradigm shift in dealing with a controversial issue like organ donation.

Then and only then can we rightfully make that claim of Malaysia Boleh !

JJ RAY started her career with a mainstream publication. A non-conformist, she soon saw the barriers that went up whenever, through her writing, she tried to make the world a home for one and all.