In light of the health minister’s recent observation that family objections continue to act as obstacles to organ donations, the Galen Centre for Health and Social Policy echoes his concern and urges the government to consider adopting an opt‑out (presumed consent) system for organ donation.
It is heartening to know that more than 404,000 Malaysians have pledged to donate their organs. A person who donates all their organs and tissues can help to save up to eight lives.
However, the stark and sober reality is that 10,800 patients are on the organ transplant waiting list. There is a major gap between pledges and realising those pledges.
In the 1970s, Malaysia was one of the pioneering and groundbreaking countries that permitted organ donation. However, at one point, we had one of the lowest deceased organ donation rates in the world, with only 0.7 donations per million population (pmp) recorded in 2022. In 2024, it rose to 1.33 pmp.
Despite this, trend data from the past several years show a significantly lower number of kidney transplants from deceased donors. Malaysia is far behind neighbouring countries such as Singapore and Thailand which were at 2.03 and 4.51 pmp. Kidney, liver and heart transplants are among the most needed today.
The existing Human Tissues Act 1974, one of Malaysia’s shortest pieces of legislation, even when an individual has registered as a donor, permits next‑of‑kin such as family members to legally override the expressed consent of the deceased. This law is overdue for a revision as the current opt-in approach is not fit for purpose.
Malaysia should consider adopting an opt-out system, which presumes that Malaysians are donors unless they actively record their objection or opt-out, ensuring that their wishes are honoured and carried out, even if families hesitate or object.
Countries with opt‑out systems consistently achieve substantially higher donation rates. For example, Austria has around 99.98% consent rate, compared to Germany at just 12 per cent.
Studies show in countries that adopt opt‑out, there is typically 25 to 30 per cent higher donation rates over opt‑in systems. This shift could significantly reduce the waiting list of over 10,000 patients in need of transplants as more organs are available. It will also save thousands of lives.
Malaysia could adopt Spain’s successful “soft opt-out” system for organ donation, where, by default, all adult citizens are considered potential donors unless they have explicitly registered their refusal.
While there’s a presumption of consent, families of the deceased have the final say. Transplantation rates for Spain exceed 130 per million population.
Malaysia will also need additional investment in further development of the country’s well-trained and coordinated transplant system, including training hospital transplant coordinators.
Reforms should also include safeguards to ensure accurate donor registries, oversight and accountability mechanisms, centred on an emphasis on preserving dignity.
The current opt‑in system falls drastically short in meeting Malaysians’ need for life-saving organ transplants. Adopting a carefully designed opt‑out system preserves individual autonomy while dramatically increasing the pool of available organs.
Combined with sustained community education and infrastructure improvement, this approach can honour donor intent and save lives.
Azrul Mohd Khalib is chief executive of the Galen Centre for Health and Social Policy.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
