What is HOTA all about? 1. What is the Human Organ Transplant Act? Under the Human Organ Transplant Act (HOTA), four organs, namely the kidneys, liver, heart and corneas, can be recovered in the event of death for transplantation... 21 Aug 2013 13 Nov 2018 Listen HOTA mockup1. What is the Human Organ Transplant Act? Under the Human Organ Transplant Act (HOTA), four organs, namely the kidneys, liver, heart and corneas, can be recovered in the event of death for transplantation. The organs will give patients with organ failure another chance at life. All Singaporeans and Permanent Residents who turn 21 years of age and who are not mentally disordered will be covered under the Act. Those who choose to remain under HOTA will have a higher priority in receiving an organ if they need a transplant in future. 2. How will I be informed of the Act? All Singapore Citizens and Permanent Residents who turn 21 years of age will receive an introductory letter from MOH informing them about HOTA and their responsibilities under the Act. They will also be informed that they can opt out if they object to donation of their organ(s) upon death. The public will also be informed of HOTA through periodic advertisements in the newspapers and on television. 3. What if I do not feel comfortable being covered under the Act? If you want to opt out of HOTA, you can download and complete the "Objection to Organ Removal under Section 9(1)" form on the Liveonwebsite or MOH's website and send it to the National Organ Transplant Unit. You can also opt out of donating specific organs. Should you change your mind about opting out, you should complete the "Withdrawal of Objection to Organ removal under Section 11(1)" form found here to indicate your choices. 4. What is brain death? What has brain death got to do with HOTA and organ transplant and how is brain death certified? Under HOTA, stringent clinical criteria and steps must take place before organ recovery: the deceased must be certified brain dead before retrieval of organs can proceed. Brain death is diagnosed only when there is catastrophic irreversible brain injury. When brain death has occurred, blood flow and oxygen delivery to the brain ceases irreversibly and all brain functions are lost and will never return again. Once diagnosed it is recognised both medically and legally as death of the person in Singapore. Brain death is determined according to strict clinical criteria. The neurological criteria for diagnosing brain death in Singapore are based on current best medical evidence and knowledge and are similar to those adopted by other countries such as USA, Australia, and UK. For organ donors, two independent doctors who are not involved in the care of the patient are required to certify brain death. Doctors accredited to certify brain death in our hospitals are specialists who have had appropriate training. 5. When a patient is declared brain dead, how are are family members of the deceased informed about organ donation? After brain death has been certified, the attending doctor will meet up with the family to inform them of the patient’s medical status. After which, the patient’s status as an organ donor would be verified against the Organ Donor Registry. If the patient has not objected to organ donation previously, in accordance to HOTA, the wishes of the patient to donate his or her organ after death must be upheld. The hospital and healthcare team deeply empathise with the family members who have lost their loved ones. In situations where families have expressed concerns about the donation of organs by the deceased, healthcare professionals (transplant coordinators, social workers, and medical team) would attend to their concerns, clarify any related issues that they may have, explain the legal requirements under HOTA and the process involved, as well as provide emotional support and active counselling to the family. 6. What if I want to do more than what HOTA prescribes? The Medical (Therapy, Education and Research) Act (MTERA) is an opt-in scheme, where people can pledge to donate their organs and tissues (e.g. lung, bone, skin, heart valves, etc) for the purposes of transplantation, education or research after they pass away. You may wish to read more about: Facts and real-life stories on organ donation HOTA legislation MTERA legislation This article is accurate as of Aug 2013.