Singapore to repeal law against sex between men.

 The Guardian has the story:

Singapore to repeal law that criminalises sex between men. Scrapping of colonial-era section 377A law hailed as ‘a win for humanity’ by LGBTQ+ rights groups  by Rebecca Ratcliffe

"Singapore will repeal a colonial-era law that criminalises sex between men, a landmark decision described by LGBTQ+ groups as “a win for humanity”.

"In a national address on Sunday, the prime minister, Lee Hsien Loong, said that scrapping section 377A of the penal code would bring the law into line with current social attitudes and “provide some relief to gay Singaporeans”.

"However, Lee added that the government did not want “wholesale changes in our society”, including changes to the legal definition of marriage.

“Even as we repeal 377A, we will uphold and safeguard the institution of marriage. Under the law, only marriages between one man and one woman are recognised in Singapore,” he said.

"Section 377A, which was introduced under British colonial rule, criminalises “any act of gross indecency with another male person”. The law carries a sentence of up to two years in prison, though it is not believed to have been enforced for more than a decade."

Singapore court rules that only Parliament can approve gay sex

 The NY Times has the story, about a colonial era Singapore law that isn't presently leading to prosecutions, but remains on the books:

Singapore’s Latest Ruling on Gay Sex Is ‘Cold Comfort,’ Activists Say. Plaintiffs had hoped the Court of Appeal would overturn the colonial-era law. Instead, the top court said it was not “an architect of social policy” and that any change was up to Parliament.  By Richard C. Paddock

"The Singapore Court of Appeal, the country’s top court, declined Monday to overturn a law criminalizing gay sex, ruling that three men who brought challenges did not have legal standing because the government has pledged not to enforce the colonial-era law.

"Gay rights advocates had sought to overturn the law, known as Section 377A, arguing that it stigmatizes gay men and promotes discrimination. The law, enacted in 1938 during British rule, does not apply to women."

Surrogacy, same sex marriage, and other Singapore repugnancies

Yesterday I blogged about a court ruling in Britain that, although commercial surrogacy is illegal in Britain, it is legal for a British subject to have a child by legal surrogacy in California.  Today we turn to Singapore, where a court had ruled that a child born by surrogacy to a gay couple could not be regarded as the biological father's child (even by adoption).  A higher court this week modified the decision.  It turns out that in Singapore surrogacy is not legal for unmarried couples, and there is no same sex marriage. In fact, homosexual sex remains a crime in Singapore...

NBC has the story:
Singapore court allows gay man to adopt son in landmark ruling
The ruling comes amid a renewed public push to review Singapore's colonial-era law under which gay sex carries a maximum penalty of two years in jail.

"Singapore's high court on Monday allowed a gay doctor to adopt his biological son, a landmark ruling in the socially conservative city-state that comes almost a year after his initial bid was rejected.

"The decision overturns a 2017 ruling in which a court said the man could not adopt the boy because he was born by a surrogate in the United States through in-vitro fertilization — a procedure not available to unmarried couples in Singapore.

"The ruling also comes amid a renewed public push to review Singapore's colonial-era law under which sex between consenting males carries a maximum penalty of two years in jail, after a repeal of a similar law in India this year.
...
"The man, in a relationship with a same-sex partner, paid $200,000 for a woman to carry his child through in-vitro fertilization in the United States after he had learned he was unlikely to be able to adopt a child in Singapore as a gay man."
*********

It appears that the judge's ruling acknowledged Singaporean law against same sex marriage and same sex relations generally, but felt that the welfare of the child (who otherwise would not have had a legal parent) needed to be given priority.

Organ donation in Singapore: mandated choice?

Here's a commentary on deceased organ donation controversies in Singapore:

Mandated Consent – Not a Viable Solution for Organ Transplant in Singapore
Jing Jih Chin, Annals Academy of Medicine, February 2018, Vol. 47 No. 2, 71-73.

The final paragraph:
"While there is no denying the ethical value of a properly administered mandated consent policy, the practical solution for Singapore’s low rate of cadaveric organ transplant in the immediate and near future is unlikely to be found in such a system. What is critical to sustaining organ transplantation as a collective societal institution is to step up the efforts to change mindsets through sharing of knowledge and promotion of altruism and social compact between citizens. Ultimately, we need to negotiate an appropriate and sustainable balance between an individual’s right of autonomy and his obligation towards communal interests."

IVF: Experience suggests there's room for some regulation

The Guardian has the story: IVF mix-up: wrong sperm may have fertilised eggs of 26 women
Dozens of women may have had eggs fertilised by sperm cells from someone other than the intended father, say Dutch authorities

"A Dutch medical institution has launched an investigation after discovering that up to 26 women’s eggs may have been fertilised by the wrong sperm at its IVF laboratory.

"A “procedural error” between mid-April 2015 and mid-November 2016 during the in-vitro fertilisation was to blame, the University Medical Centre in Utrecht said.

"“During fertilisation, sperm cells from one treatment couple may have ended up with the egg cells of 26 other couples,” said a statement.

“Therefore there’s a chance that the egg cells have been fertilised by sperm other than that of the intended father.”

Although the chance of that happening was small the possibility “could not be excluded”, said the centre.

Half the women who underwent fertility treatment had become pregnant or given birth.

“For some of the 26 couples frozen embryos are still available but the chance remains that they [too] have been fertilised by the sperm from a man other than the intended father,” the UMC said.

"The couples had been informed, the centre said.

“The UMC’s board regrets that the couples involved had to receive this news and will do everything within its powers to give clarity on the issue as soon as possible.”

...

"Mix-ups do occur, including one in 2012 when a Singapore mother sued a clinic for alleged negligence after it mixed up her husband’s sperm with that of a stranger.

"The ethnic Chinese woman first suspected that something was amiss when her baby, who was born in 2010, had markedly different skin tone and hair colour from her Caucasian husband, news reports at the time said."
***********

Here's are two recent updates on the Singapore story (and subsequent legal proceedings) from the Straits Times: the first has some details of how the error happened, the second speaks about the legal issues associated with possible damages that might be assessed, and if so for what...
IVF mix-up at Thomson Medical: A look back at the case of 'Baby P'

IVF mix-up at Thomson Medical: Court continues to hear appeal of woman who conceived baby with stranger's sperm

Organ donation in Singapore: not rocking the boat

The Singapore Medical Journal publishes an extremely cautious article on Policy options for increasing the supply of transplantable kidneys in Singapore

It concludes with these
"Recommendations:
In order to increase the number of LDs within the existing regulatory framework, non-repugnant incentives can be considered, such as an organ donation award that not only recognises the significance of the donor’s act but also creates meaningful conversation on the importance of organ donation in saving lives. In addition, local online platforms can be created to help ESRD patients appeal to the public for directed kidney donations.

Meanwhile, in order to increase the number of DDs, it is critically important to establish administrative incentives for healthcare professionals to take responsibility for improving the organ transplantation process through QI programmes. Therefore, measures that can be considered include stronger incentives and training for personnel involved in donor-identification, coupled with greater transparency for both individual hospital DD actualisation rates and DCD statistics. Finally, potential donors and their immediate families can be further incentivised through a transplant priority system which favours donors’ families.

In conclusion, greater measures to encourage and facilitate donation can be implemented at all levels to meet society’s transplantation needs. Moving forward, all relevant institutions in Singapore are encouraged to contribute their insights and experience in increasing the supply of kidneys for transplantation so that a meaningful national conversation can commence and best practices adopted to address this urgent shortage."

First paired kidney exchange transplant done in Singapore

Here's the story from the Straits Times, about a short non-directed donor chain:  First paired kidney exchange transplant done in Singapore

"Ms Siti was put on dialysis while waiting for a donor, but time was running out. It was then that doctors put forth a novel proposal, known as a paired kidney exchange transplant.  Under this arrangement, a good Samaritan would donate his or her kidney to Ms Siti. In exchange, Madam Rafidah would give one of her own kidneys to someone on the national waiting list.

"While this procedure has been approved since 2009, it has never been carried out due to the lack of a donor who is both willing and medically fit.
...
"Every year, said Professor A Vathsala, who is co-director of the National University Centre for Organ Transplantation at the National University Hospital, only two or three healthy people come forward to donate their kidneys. And of these, only one would be assessed as medically fit.

"On the other hand, the average person on the national waiting list for a new kidney would have to wait nearly a decade for a new organ."
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Other coverage:
First living paired kidney exchange in Singapore performed at NUH (news broadcast with a video.)
Posted 29 Feb 2016 15:50

Organ Allocation Policy and the Decision to Donate

That's the title of a paper that Judd Kessler and I recently finished, motivated by one aspect of organ donation in Singapore (and recently also in Israel), namely that registered donors receive priority for organs should they need a transplant themselves:
Kessler, Judd B. and Alvin E. Roth, Organ Allocation Policy and the Decision to Donate," June 2010.  (As an added bonus, Judd is on the jobmarket this year.)

Here's the abstract: "Organ donations from deceased donors (cadavers) provide the majority of transplanted organs in the United States, and one deceased donor can save numerous lives by providing multiple organs. Nevertheless, most Americans are not registered organ donors despite the relative ease of becoming one. We study in the laboratory an experimental game modeled on the decision to register as an organ donor, and investigate a variety of strategies for increasing the donation rate. We find that an organ allocation policy giving priority on waiting lists to those who previously registered as donors has a significant positive impact on registration.

And this is from the concluding section
"Before further considering the benefits of the priority rule, it is worth noting that there are other ways to change policy that could positively affect the number of registered organ donors. For example, one proposal that has received a good deal of attention would change the current “opt in” registration method used in the United States to an “opt out” system in which everyone is presumed to be a donor unless he or she actively indicates otherwiseAnother proposal, “mandated choice” would require everyone (e.g. who applies for a driver’s license) to specifically indicate whether they wished to be a donor or not. We want to briefly argue here that the priority rule that we consider may create a more direct link between registration as an organ donor and subsequent successful organ recovery and transplantation than policies that change the procedure by which individuals register as organ donors.

Attempts to increase organ donation rates by changing the default organ registration status (and adopting an “opt out” policy) would surely generate more registered organ donors since those who do not take any explicit action would automatically be registered as donors (see Johnson and Goldstein 2003, 2004, who find direct evidence that registration rates are higher with an “opt out” system).[2] However, such a policy may weaken the link between the registration decision and the legal clarity of the potential donors’ last wishes. Under current United States gift law, changing the default status is likely to have legal consequences that could be detrimental to organ retrieval.

Since the Uniform Anatomical Gift Act of 1968 (UAGA), an individual can make his or her own legally binding decision to be an organ donor after death, which does not require the consent of next of kin (Glazier 2009). However, a donor symbol on a driver’s license has not been considered sufficient evidence of the deceased’s intent to donate in order to proceed without permission from the next of kin. Aside from the fact that the driver’s license is often not available in a timely way, the law allowed that a registered donor could have changed his or her mind about donation subsequent to the issuance of the driver’s license (Glazier 2006).

In recent years, computer registries have allowed for fast checks of organ registration status. They also provide individuals with a way to easily change their organ donor status online, which allows the presence in the registry to be interpreted as intent to donate. The legal status of the anatomical gift has meant doctors can recover donated organs without receiving explicit permission the next of kin (see Glazier 2006). In contrast, a donor registration that does not reflect a positive decision to donate (as under an “opt out” policy) may not be taken as evidence of the deceased’s intent in the legally compelling way that registration does currently. Under an opt out policy, approval from next of kin might again become necessary for an organ to be transplanted.[3]

A "mandated choice" system would also change the way in which individuals became registered donors (see Thaler and Sunstein 2008 and Thaler 2009). Under “mandated choice,” every individual who registered for a driver’s license (or potentially other state or federal documentation) would be required to indicate that he will be an organ donor or that he will not. While there is evidence that a “mandated choice” policy would (like “opt out”) generate more registration of organ donors (Johnson and Goldstein 2003, 2004), similar concerns arise about whether a change to mandated choice would lead to more donated organs and transplants. While the UAGA makes registering to be a donor legally binding under an “opt in” policy, failing to register as an organ donor is not a legally binding decision, whereas registering as a person who declines to donate would likely be legally binding on the next of kin. Discussions with the staff at the New England Organ Bank suggests that they are able to recover organs from about half of all non-registered potential donors in New England by approaching next of kin. This means that more than half of the people who are not currently registered under “opt in” would need to choose “yes” in mandated choice to increase the recovery rate.[4] Consequently, it remains an empirical question whether a change to “mandated choice” would generate more organ transplants.

Even though registration under “opt out” and “mandated choice” systems may raise legal concerns about the intent of registrants under the UAGA, changing the procedure by which individuals register as donors may still be a fruitful avenue to pursue to increase organ donation and recovery.[5] Gift laws can also potentially be changed to address any legal concerns that might arise from new policies. We simply see these legal issues as additional hurdles to monitor and overcome in successfully implementing a change in registration policy. One attraction of the priority rule is that it seems to avoid these additional hurdles since it preserves the current donor registration process as is (and thus is consistent with current United States law regarding donor intent at time of death).

While comparing the different mechanisms in our experiment, the priority rule, rebate, and discount all generate an incentive to donate that offsets the costs of donation. But the priority rule has two advantages over the rebate and discount both inside and outside of the laboratory. First, the simplicity and elegance of the priority rule (as suggested by its outperformance of the rebate and discount at the start of the game) suggests that its benefits are particularly clear and salient. Second, and more importantly, the priority rule is feasible to implement and can be implemented without any additional costs to the system. In contrast, decreasing the costs of registering to be an organ donor is difficult (it is difficult to both understand the costs and to decrease them) and providing a rebate through the form of monetary incentives is not currently allowed by the U.S. National Organ Transplant Act and by similar legislation in many countries.

...

The priority rule used in Singapore appears to be a powerful policy tool. Results from this experiment suggest that it performs as well as or better than discounts and rebates that are of a similar magnitude to the benefits of priority. It is a plausible mechanism to increase rates of registration, and policy makers should consider allocation policy along with other policies to generate more organ transplants."

---

Corruption and kidneys in New Jersey and Brooklyn

The NY Times reports on a corruption investigation resulting in 44 arrests in New Jersey and Brooklyn: In New Jersey Case, Nervous Jokes and a Cereal Box of Cash

Almost as an aside, the story reports that a broker for transplant kidneys was caught in the net:

"Another man in Brooklyn, Levy-Izhak Rosenbaum, was accused of enticing vulnerable people to give up a kidney for $10,000 and then selling the organ for $160,000. Mr. Dwek pretended to be soliciting a kidney on behalf of someone and Mr. Rosenbaum said that he had been in business of buying organs for years, according to the complaint."

Part of the repugnance to the transaction seems to be the buying and selling prices. (Would we/should we feel differently if the kidneys were bought for $100,000 and sold for $115,000?)

Steve Leider points me to an Indiana Jones connection: Anthropologist's 'Dick Tracy moment' plays role in arrest of suspected kidney trafficker. (The anthropologist in question, Nancy Scheper-Hughes, writes frequently about black markets for kidneys, and apparently indentified Mr Rosenbaum some years ago, although the story doesn't suggest to me an immediate connection to the recent arrest.)

Parag Pathak points me towards Benyamin Cohen's story in Slate, following up on the Jewish connection: The arrests of rabbis who trafficked body parts uncover more complicated issues, that suggests some of the nuances of Jewish religious jurisprudence about organ donation and sales.

Trying to figure out Jewish law directly from the Bible skips a couple of centuries of subsequent interpretation. Here's what I wrote about kidney sales in a footnote of my paper Repugnance as a constraint on markets:

3 While there is no central authority on the application of Jewish law to modern concerns such as transplantation, the most authoritative opinions are contained in various “responsa” or answers to particular questions by rabbis acting as legal “deciders” (poskim), whose authority arises from the respect of their peers. The consensus on the matter of live kidney donation, for example, seems to be that live donation is allowed (since it saves lives), but it is not required (since the donor becomes wounded and takes some risk to his own life), and hence it falls into the category of things for which compensation could be offered and accepted (unlike actions that are either forbidden or required). See, for example, Eisenberg (2006), Grazi and Wolowelsky (2004), Kunin (2005), and Israeli (1997) who cite eminent modern poskim such as Rabbi Shlomo Zalman Auerbach and Rabbi Moshe Feinstein."

"For example, Avraham (2004, p. 271–2) reports the opinion of the eminent Rabbi Shlomo Zalman Auerbach that someone who sells a kidney with the intention of saving a life does a good deed “even if he would not have donated his kidney only to save life.” But he goes on to note, “[I ]n spite of all that has been said above, it seems to me that it is the community that needs soul-searching for allowing a person to reach such a depth of despair that he must sell a kidney, either because of poverty, debts, or the inability to pay for a relative’s medical expenses.”

Although mainstream Jewish authorities support organ donation, some streams of ultra-orthodox Judaism do not: here's a disturbing article brought to my attention by Miran Epstein, from Yediot: Heart recipient's father: We'll never donate organs
It goes on to note
"The father's words angered Prof. Yaacov Lavee, director of the Heart Transplantation Unit at the Sheba Medical Center. "This is outrageous," he said. "I've heard such statements from many of my candidates (for a transplant), who weren't ashamed to admit they wouldn't donate organs.
"Such statements led me to initiate the bill that prioritizes transplants for people who have signed an organ donor card. This is clearly immoral behavior," he added.
The new transplant law, which will go into effect in May, states that any person in need of a transplant and who has had an organ donor card for at least three years will be given priority on the organ transplant waiting list. "

This makes some aspects of Israeli transplant law resemble parts of Singapore's transplant law, which also gives priority for organs to those who are registered as donors. (I wrote about this near the end of an earlier post.)

Update: Sally Satel's take is in the WSJ: About That New Jersey Organ Scandal It’s not surprising when 80,000 Americans are waiting for kidneys, and a background piece from Time magazine: How Does Kidney-Trafficking Work?

Singapore kidney update

To follow up on my post yesterday about Organ donation and compensation in Singapore: new legislation, Sally Satel points me to The Human Organ Transplant (Amendment) Bill-Closing Speech by the Health Minister, Khaw Boon Wan.

It contains a number of points, not least of which is that the new legislation will legalize Kidney Exchange in Singapore. (It's interesting to note that they are thinking of legislating simultaneous exchange.) More interestingly, the speech elaborates on the manner in which the legislation is meant to continue to prohibit "organ trading," while allowing the reimbursement of donor expenses by the recipients.

All of this will make it interesting to see how procedures in Singapore evolve. Will willing donors become abundant, and will they thrive in the long term? Will the availability of compensation crowd out the familial donors who drive kidney exchange? Will it be possible to restrict payments to expenses and lost wages? As Jeff Ely noted yesterday in his post Organs for Money, "Whether or not the new laws truly legitimize organ sales, markets have a way of organizing themselves around and in-between the cracks of legislation."

Some excerpts from the speech (emphasis added):

"(II) Allow Paired Matching4. All supported the proposal to allow paired matching. Dr Fatimah called for the establishment of a “systematic, proactive and well-organised living donor registry” to support paired matching. I agree. The National Organ Transplant Unit of the Ministry of Health will take charge of this.
5. The same unit will also take charge of setting up a Donor Care Register to monitor the health of the donors. Mdm Halimah and some other Members are curious about the long term health of the living donors. If the donors are well selected, there is good medical evidence overseas to suggest that there are few adverse medical impacts. But there is little local research on this. The proposed register will help us track long-term clinical outcomes and allow us to better understand the long-term impact of organ donation, if any.
6. Prof Thio asked how “pair matched” organ transplants will be regulated. She noted that in other jurisdictions, the transplant surgeries are carried out simultaneously to avoid situations where one of the donors decides to back out. Dr Lim Wee Kiak stressed the need to carry out such procedures simultaneously. Indeed, this will be the requirement for paired matching, that the surgeries will all have to be done simultaneously. Our Bill includes provisions for subsidiary legislation to be made to regulate organ transplant arrangements, including mandating that paired transplants be simultaneously performed, if this is necessary. We can achieve such an outcome administratively since the operations are carried out in our hospitals, but we will study if there is a need for an explicit regulation."
...

"(III) Allow Payment for Living Donors
7. Let me now address the more controversial issue of payment for living donors.
Safeguards against Organ Trading
8. While all Members supported the good intention to reduce the financial losses incurred by donors through reasonable payment, Members were concerned that it might lead to organ trading, and Singapore becoming a regional organ trading hub. For example, Miss Sylvia Lim was concerned that the reimbursement value could become a backdoor to organ trading. During the public consultation stage, the World Health Organization and many Singaporeans expressed a similar concern.
9. Let me reiterate that this Bill does not legalise organ trading. During the public consultation, decriminalising organ trading and the Iranian model were often cited. But this Bill is not to legalise organ trading. Hence, Mdm Halimah’s concern about the Bill affecting Singapore’s relationship with its ASEAN neighbours does not arise. Our Bill in fact contains an amendment to raise the penalty on syndicates involved in organ trading. The Bill is to catch up with what many OECD countries have already done for many years. In drafting our amendments, we took reference from similar legislations in several of these countries. We are correcting our current extreme position of criminalizing all kinds of payment to the donor. For example, currently donors are charged by the hospitals for all their transplant-related medical and surgical expenses. The recipients are prevented by HOTA from reimbursing the donors for these expenses. The proposed amendments will bring us in line with jurisdictions such as the US and UK to allow some payments to be made to the donor.
10. Let me also clarify that we are not making it compulsory to reimburse living donors. We are merely allowing organ recipients, if they wish, to make some payment to cover the financial losses incurred by their donors. In fact, I will not be surprised if many living donors continue the current practice of not requiring any reimbursements from the recipients. This would address the concern of some members that low income recipients may not be able to afford such payment. But in the event that some donors may need such reimbursements and the recipients agree to do so, the law should not prevent it from happening.
11. I must also explain that reimbursement only applies to living donors. It does not apply to cadaveric donation where allocation of organs will continue to be based on tissue matching, time on the waiting list and other clinical factors as objectively determined by an expert committee. Hence the concern of Mdm Halimah and Mr de Souza about rich patients jumping the queue for the cadaveric organs does not arise. Indeed, as carefully pointed out by Mr Sam Tan, the Bill does not discriminate against the poor. Among living donors today, there is a mix of high and low income donors.
12. But as Members put it, the real challenge in donor reimbursement lies in the practical difficulties of making a distinction between what is reasonable payment and what is inducement. I agree with Members that the key lies with putting in place appropriate safeguards. ..."
...

"21. Some of the Members asked who would pay the donors. The organ recipients would make the payment. Some Members suggested that a third party should administer the payment. Some payments will indeed be via a third party. For example, reimbursement for hospital expenses incurred by the donor can be done via the hospital. But there will also be payments which are made directly between the donors and the recipients, without going through a third party. Mdm Halimah suggested that part of the payment can be made via the donor’s Medisave Account. I think it is a good idea, provided the CPF rule allows such a voluntary contribution. Mr Ang Mong Seng suggested having a trust to hold half of the money received by the donor to ensure that it is not frittered away. But such arrangements are best left to the donor and recipient to decide."

Organ donation and compensation in Singapore: new legislation

A new law was passed on March 24 in Singapore, allowing compensation for live organ donation. It's not yet clear what this will mean in practice: I excerpt below from a number of stories.

Singapore allows payment for living organ donors
"After a heated two-day debate, in which some legislators raised concerns that the new law might lead to open organ trading, four of the 84 members of parliament abstained the final vote and one voted against, the Straits Times newspaper reported.
...
"Not all legislators were convinced, although Health Minister Khaw Boon Wan had assured parliament that the new law "is not to legalise organ trading."
"We are correcting our current extreme position of criminalising all kinds of payment to the donor," Khaw said.
Singapore already had a legal system to prevent organ trading, he said. "And we will be strengthening it," Khaw added.
The new law, which also contained some other changes, allows living organ donors to be reimbursed the costs for items like travel, accommodation, costs of domestic care and child care, loss of income and long-term medical care.
..
"Another dissenter, Halimah Yacob, said that many foreign workers in Singapore, who are hit hard by the recession, could become "a ready and vulnerable pool of organ donors to be exploited and abused.""To a desperate foreign worker, even a reimbursement of S$10,000 would be attractive compared to going home empty-handed with a huge debt waiting for him," the report quoted her as saying.
The Singapore government proposed to change the law after ailing retail magnate Tang Wee Sung was jailed for a day and fined S$17,000 in June last year for trying to buy a kidney from an Indonesian donor.Tang finally received a kidney from former organised crime boss Tan Chor Jin, who was hanged in a Singapore prison in December for the killing of a nightclub owner."

A tough moral choice : Slew of safeguards promised as MPs approve recompense for organ donors, though five remain unconvinced.
"IT WAS a moral dilemma Health Minister Khaw Boon Wan apologised for imposing on Members of Parliament, after two days of intense debate.
Their tough choice: Should they correct the unfairness against: altruistic organ donors by allowing them reimbursement for their financial losses, but at the risk of opening a backdoor for abuse? "

Singapore allows financial payment to organ donors
"Previously, it was illegal for a living donor to be financially compensated but the issue came to a head last year when a local tycoon was jailed for one day for attempting to pay off a prospective Indonesian kidney donor.
"This is a bill about fairness, being fair to donors who do suffer financial consequences as a result of their act of donation," Health Minister Khaw Boon Wan told parliament Tuesday during the final debate on the issue.
"I know the controversial nature of paying donors," Khaw said. "But we also realise that it is unfair to allow genuine donors to bear all the financial consequences of their altruistic acts."
Khaw said he disagreed with the suggestion made by some lawmakers that foreign donors be barred from accepting financial compensation to prevent exploitation of nationals from poor countries.
"How can we discriminate against the foreign donors in this fashion?" Khaw said.
"Once we decide that some payments can be ethically made, our law cannot unfairly discriminate against organ donors based on their nationalities," he said."

Singapore's Human Organ Transplant Act dates from 1986, when it instituted an opt-out system for all of the country's non-Muslim citizens. Under the law, citizens could opt out of becoming organ donors, but all those who did not would be considered as organ donors upon their death, and would in turn receive priority (over those who opted out) for receiving deceased organs. Unusually among countries with opt out policies, organ donation has been enforced even over the objections of next of kin.
As amended in January 2008, the Human Organ Transplant Act (HOTA) now includes Muslim citizens of Singapore.

A word for unraveling in Singapore: "Choping"

"Choping" is Singapore English slang for reserving something well in advance, i.e. a place in school for your child, etc. That is, it is one of the actions involved in the unraveling of markets, the process by which transactions are arranged increasingly far in advance of when they will be carried out. Sometimes this has been a cause of market failures that lead to new market designs, with a prominent example being medical labor markets.

In some cases, the unraveling of a market has caused serious inefficiencies, as when college football bowl games used to be decided before the end of the regular season (which made it harder to arrange the kind of championship games that draw high television viewership), or when gastroenterologists used to be hired long before they finished their internal medicine residencies (which caused the national market to collapse into lots of regional markets). But, in most unraveled markets, data are lacking to directly determine if a particular set of market arrangments and timing are inefficient.

Tyler Cowen at MR has a (characteristically) very interesting post on choping at Singapore food courts, where patrons reserve seats by placing tissue papers on them, and then go to stand in line to get their food. He suggests (maybe just to be contrarian) that this is efficient. As one of the comments to his post points out, this would be the case in a model in which having to look for a seat once you have your food is incomparably more costly than any other outcome. Of course it is easy to see how (with different parameters) reserving seats in advance could be inefficient (although still an equilibrium). E.g. if it takes 15 minutes to get your food, and 15 minutes to eat it, then each chair could serve four people in an hour if people looked for a chair after getting their food, but only two people per hour if people reserve a chair before getting on line.

The discussion of all this in the Singapore press is satisfyingly nuanced. After a demonstration against choping by some students (Wiping out bad habit of 'choping' seats with tissue pack), the Straits Times has a story (Is this rude?) that explains both points of view.

On the one hand:
"But many people reckon there is nothing rude about reserving one's spot with a packet of tissue paper. Indeed, Mr Wong, who arrived in Singapore last month, said: 'It is a practical and creative way to reserve seats instead of standing around with a tray of food turning cold.' "

On the other:
"Tissue 'choping' seems to be uniquely Singaporean. Housewife Ivy Ong-Wood, in her late 30s, a Malaysian now living in Hong Kong, told LifeStyle: 'At the tea cafes or cha chan tengs in Hong Kong, people queue outside and are told where to sit. In Malaysia, there is no problem getting seats at the food centres.' "

Whatever the truth of the matter, this will not be an easy equilibrium to displace. The story notes: "It is so pervasive that companies even have tissue packs specially made with the word 'chope' for marketing purposes. "