The Human Tissues Act, passed in 1974, can be considered a forward-looking piece of legislation for its time. In that era, organ transplant was a developing medical technology, and the number of transplant surgeries that could be performed domestically was countable on one’s fingers. The primary objective of the act was to regulate the procurement and use of human tissues.

More than 50 years have passed, and medical technology has long since stepped into a completely new era. Today, liver, kidney, heart, and lung transplants have become essential treatments in modern medicine, and brain death now has a mature medical definition.

As organ preservation techniques continue to advance, cross-border organ transplant, organ trafficking, and medical tourism have also given rise to new ethical and law enforcement challenges.

Yet, we still rely on a statute containing only a handful of sections, enacted half a century ago. Therefore, the Parliamentary Special Select Committee on Health’s recommendation to comprehensively review the Human Tissues Act and replace it with a brand-new Organ Donation and Transplantation Act is a correct choice that comes at just the right time. What truly needs reform today is the governance model of the national organ transplant system.

As of the end of June this year, the nation has cumulatively completed over 3,600 organ transplant surgeries, but more than 10,000 people remain on the waiting list. Concurrently, more than 1,000 cases that meet the medical criteria for organ donation are lost each year because the families withhold consent. These figures tell us that the bottleneck is not that our doctors lack the surgical skill, but the system remains incapable of converting goodwill into saved lives.

Many people view organ donation as an act of charity, but from a public policy perspective, it is more akin to a matter of national resource management. Every successfully transplanted kidney can potentially free a patient from lifelong dialysis. Every successful liver or heart transplant can reduce long-term consumption of medical resources and restore a family to a normal life.

If the state spends billions of ringgit annually caring for long-term dialysis patients, raising the organ donation rate is, in fact, one of the most cost-effective healthcare investments.

Therefore, reform cannot stop at merely encouraging citizens to pledge as organ donors; it must build a system that truly commands people’s trust.

The committee proposed strengthening the role of the National Transplant Resource Centre to centrally coordinate nationwide organ allocation, clinical standards, training, and data management.

While this is a sound recommendation, I believe Malaysia can go a step further. We should consider establishing a statutory National Organ Transplantation Agency through the new legislation, tasked with planning, oversight, auditing, and public disclosure of information regarding national organ transplants.

This move would reduce overlapping responsibilities among different institutions, while enhancing system transparency and public trust.

A mature organ transplantation system relies on a governance structure that is nationwide consistent, open, transparent, and subject to public scrutiny.

Furthermore, the new legislation must respond to the medical developments of the past 50 years. For instance, it should formally recognise the legal status of brain death and donation after circulatory death (DCD), allowing doctors to carry out clinical work within a clear legal framework.

Naturally, the law must also preserve sufficient space for professional judgment. In medicine, not every circumstance can be neatly codified into statutory clauses—especially those involving end-of-life determinations, which particularly demand respect for clinical expertise.

 Thus, while the law can establish principles, final medical decisions should still be made by qualified professional teams based on medical evidence, rather than being rigidly dictated by legal text.

In addition, the new law is obligated to establish a unified national organ allocation system. All organ allocations must be based strictly on clinical need—rather than the hospital, region, or other non-medical factors—and must be subject to independent audits.

Another issue worthy of our serious discussion is whether the law should grant clearer legal validity to registered organ donors.

 Currently, even if an individual has explicitly expressed his wish to donate organs during their lifetime, family members can still overturn this decision at the final moment. This results in many life-saving organs ultimately going to waste.

In modern medical ethics, an adult possesses the right to bodily autonomy. Since the law recognises an individual’s capacity to sign medical consent forms, refuse treatment, and create advance medical directives, corresponding respect should also be accorded to their explicitly expressed lifetime wish for organ donation.

Of course, this does not mean ignoring the feelings of family members; rather, it means establishing a social consensus that “respects the donor’s autonomous will” under a refined counseling and communication mechanism.

Additionally, the new legislation must strengthen the crackdown on organ trafficking, regulate cross-border organ transplants, protect the rights of living donors, and promote the development of transplant medicine specialties to nurture more professional talent for our country.

A successful organ transplant system is built on the public’s belief that the system is fair, just, and transparent.

Ultimately, the revision of the Human Tissues Act represents a healthcare legislative reform that must reflect how a nation confronts a future marked by an aging population, rising chronic illnesses, and finite medical resources.

Over the next 20 years, the number of people waiting for organ transplants will only grow. If we continue to rely on half-century-old laws today, what we will ultimately lose is systemic efficiency, as well as individual lives that could have been saved.

Therefore, I hope parliament can swiftly replace the Human Tissues Act with a brand-new Organ Donation and Transplantation Act to build a national organ transplant system that is modern, transparent, aligned with medical advancement, and worthy of the people’s trust.

When a law has fulfilled the mission of its era, the best tribute is not to keep using it, but to courageously let it retire, and welcome the next 50 years with a more robust and complete system.

(Dr Sean Thum Chern Choong is a medical doctor with over seven years’ clinic experience. He is currently serving as Special Functions Officer to the Deputy Minister of Communications)