SINGAPORE As members of Sim Tee Hua's family sat at his bedside to pray for his recovery, they were horrified to learn that the hospital staff were about to turn off his life-support machine and use his organs for transplants.
The scenes that followed have shocked and upset not just Sim's family but many other Singaporeans, sparking a debate over the country's organ donor policy, which assumes that all citizens are willing donors, unless they have registered with the government that they wish to opt out.
Doctors at Singapore General Hospital had declared Sim brain-dead and said they could not delay switching off life support any longer because of the risk of damage to Sim's organs.
Sim's family had no objection to his organs being used for transplants but wanted doctors to wait one more day before turning off the life support machine.
But as Sim's 68-year-old mother and about 20 other relatives knelt weeping before the doctors, begging them to wait, nine police officers entered the ward and restrained the distraught family while Sim's body was quickly whisked away.
"The hospital staff were running as they wheeled him out of the back door of the room. They were behaving like robbers," said Sim Chew Hiah, one of Sim's elder sisters.
The Sim family's experience has prompted a wave of letters to the local media, with some people saying they would opt out in protest, and added fire to a debate about organ trading.
Lee Wei Ling -- a prominent doctor who is the daughter of Lee Kuan Yew, the first prime minister of modern Singapore -- last month urged the government to legalize organ trading, or the buying or selling of human organs for cash.
"Organ trading is frowned upon and usually not allowed in countries where political correctness reigns," said Lee in a letter to the Straits Times.
"If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that ?"
Her views have some support from the public.
"If I can sell my organs, give my children a better life, and save someone else's life too, why not? Not everyone drives a Mercedes," said Khalid, 32, who gave only his first name.
Currently, anyone caught buying or selling human organs in Singapore may be jailed up to a year or fined up to US$6,500.
Those who oppose the trading of human organs say it promotes greater social injustice.
"To trade it and sell it for a 100 pounds, 200 pounds, or to the highest bidder, that is to prostitute your organ," said Dr Choi Kin, president of the Hong Kong Medical Association.
Such donors are likely to be the poor and uneducated people from countries such as Brazil and India, who can sell a kidney for as little as $1,000, the World Health Organization said.
And they are usually exploited by organ traffickers, who can charge wealthy clients up to $100,000 to $200,000 for a new organ, according to the WHO.
The chronic shortage of organs available for transplant is a global problem. In the U.S. alone, more than 6,200 patients die each year while waiting for an organ, according to the United Network for Organ Sharing, a U.S.-based non-profit medical group.
The shortage has forced doctors and governments to look for alternatives, such as the use of pigs' kidneys, hearts and lungs, or the purchase of human organs.
Many patients have also traveled abroad for transplants, notably to China, which has been accused by rights groups of harvesting organs from executed prisoners.
Since 1995, more than 270 Singaporeans have gone abroad, mostly to China, for organ transplants, the Health Ministry said.
DEFINITION OF DEATH
To ease the organ shortage, Singapore amended its Human Organ Transplant Act in 2004 to expand the pool of organ donors and the type of organs that could be donated.
Hospitals can remove the kidneys, liver, heart and corneas of all non-Muslim Singapore citizens or permanent residents when they die, unless they have objected.
Muslims can choose to donate their organs, as in Iran and Malaysia, although many believe that the dead should be buried with all their organs intact.
Doctors say a system which assumes all citizens are organ donors is necessary because even though many people are in favor of donating their organs, few actually come forward.
While many European countries, including Belgium, Denmark, Norway, Switzerland, and Spain, have laws similar to Singapore's Transplant Act, it can still be a sensitive issue.
When Brazil passed a similar law in 1998, it triggered a public outcry. The Federal Attorney later conceded that families could prevent the removal of organs for transplant.
Critics say laws which assume all citizens are organ donors are inadequate because the definition of death is debatable. Others are concerned that life-support may be turned off prematurely or that people may be unaware of the opt-out option.
"It should be up to the citizens to decide. These are their bodies, their organs, and therefore their decisions," said Dr Choi Kin. "If an accident should occur, it would be too late for them to opt out, even if they do not agree to donate."
In Singapore, some doctors had urged amending the Transplant Act, giving families the right to block such donations.
After the outcry over the Sim family's forced donation, the hospital and health ministry said in a statement that they would "continue to find practical solutions to minimize the emotional distress of families and staff in such situations."
Sim's kidneys went to patients who had waited six to eight years for donor organs, the ministry said.
His parents were offered five years of subsidized hospital fees -- and his family received a thank-you letter from the ministry for their "generous organ donation."