Singapore: Harvesting organs from death row "donors"

Singapore's Changi Prison

In his 12 years of practice, urologist Dr Lim (not his real name) has harvested kidneys from death row inmates a total of 6 times.

As 1 of the 15 doctors in the Ministry of Health's renal transplant team, he is occasionally rostered for duty whenever there are cadaveric kidneys to be harvested.

While most of the kidneys come from brain-dead stroke patients in hospitals, members of the renal transplant team are sometimes required to make a trip to Changi Prison to harvest the kidneys of a prisoner to be hanged.

The harvesting is a voluntary service and doctors do not get paid, he said. If a doctor is not available, he will be replaced by another assigned by a transplant coordinator.

Since hangings at Changi Prison take place on Fridays at 6am sharp, the 2 renal transplant surgeons - a junior and senior doctor rostered - will have to be at the prison by 5.30am.

Said Dr Lim, who was last rostered for duty a year ago: 'By 6am, the whole place will be very solemn and the gates will be closed. There is minimal movement in the prison complex. I'm not sure if this is out of respect for the person to be hanged.'

Also present will be the transplant coordinator and a team of nurses who would have with them the necessary surgical instruments.

If the prisoner wants to donate other organs, an eye doctor for the corneas, a plastic surgeon for the skin and an orthopaedic surgeon for the long bones will also be present.

While waiting for the hanging to take place, the group of doctors will wait in the prison cafeteria and have an early breakfast of roti prata and coffee, said Dr Lim.

Once the hanging has taken place, a flurry of activity will follow.

According to doctors, inmates who have been hanged must be pronounced dead and can be harvested for their organs only after cardiac death, or when their heart stops beating.

When this happens, blood and oxygen will no longer be circulating in the body and the organs will become damaged quickly. In hospitals, on the other hand, organs can be harvested after brain death.

Once the prison doctor has checked the inmate and pronounced him dead, the inmate will be taken from the noose, wrapped in a piece of cloth and put on a stretcher.

Prison guards will carry the body to an operating room nearby, a new feature in the new Changi prison complex.

Said Dr Lim: 'At the old Changi prison, we operated from an air-conditioned container room. It had two little operating tables, a changing area and a wash basin.'

Sometimes, when there is more than one hanging in the same morning, the doctors can be harvesting organs from 3 bodies at one go.

Once the body is laid on the operating table, the 2 urologists will be the first to 'rush in' because kidneys are most susceptible to damage, said Dr Lim. The heart and liver are usually not harvested as they get damaged very quickly after cardiac death.

The kidney surgeons are followed by the eye surgeon, then the plastic surgeon, and last will be the orthopaedic surgeon who will harvest the long bones, which are any of the several elongated bones from the limbs that contain marrow.

Said Dr Lim: 'Sometimes, the eye doctor will come in and we would harvest the organs simultaneously. There is a hive of activity in the operating room.'

He said he tries not to look at the face of the dead inmate when the face mask is removed. Most of the time, the face will look flushed from the hanging and sometimes, the tongue will stick out, he said.

Kidney surgeons are usually done extracting the organs within 20 minutes. The kidneys are individually and carefully packed into two ice boxes which are then passed to waiting courier vehicles. They are then delivered to the hospitals where the recipients will be waiting.

In the past, doctors had to deliver the kidneys to the hospitals themselves using their own cars, said Dr Lim.

'The junior doctor will usually be the driver. But we made noise. We have already done our job harvesting the kidneys and after that we still have to deliver them,' he said.

The courier service was brought in to perform the task about 2 years ago.

When asked if he was ever traumatised by the task of harvesting organs from death row donors, Dr Lim said: 'It is not a very difficult or complicated job. We are just like technicians, cutting and removing.'

No coercion

Prisoners on death row are not forced to donate their organs. Neither is the idea put to them by prison officers.

It is understood that those who request to donate their organs do so of their own initiative. The prison will then act as a facilitator. It will inform the health authorities about the prisoner's request, and the rest of the procedure will be arranged by the Ministry of Health.

Prisoners also have to declare which organs they wish to donate. The One-Eyed Dragon, for example, chose to donate his kidneys, liver and 1 good eye.

Source: Asia One, January 14, 2009