KUALA LUMPUR, August 27 — Senator Dr RA Lingeshwaran has called for amendments to the Human Tissues Act 1974 (Act 130) to implement an opt-out organ donation system or to ensure fulfilment of organ donors’ wishes despite family objections.
Dr Lingeshwaran told the Dewan Negara during a debate on the 13th Malaysia Plan (13MP) yesterday that Malaysia spent RM1.65 billion in 2016 to treat patients with end-stage renal disease (ESRD).
About 94 per cent, or RM1.55 billion, was used for dialysis, whereas only 6 per cent went to kidney transplants that are actually more cost-effective and provide a better quality of life.
“Today’s reality is even more worrying. Every year, 9,000 to 10,000 new patients are added to dialysis programmes,” Dr Lingeshwaran said in Parliament.
“Combined with annual medical inflation of 8 per cent to 9 per cent, these costs rise far faster than the growth of the overall health budget.
“If this trend continues, gross projections show that the cost of dialysis can reach at least RM4 billion a year by 2030, comprising nearly 10 per cent of the Ministry of Health’s (MOH) annual allocations.”
He noted that a single organ donor has the potential to save up to eight lives and increase the quality of life for more than 50 people through organ donation. Organ transplants involve not just kidneys, but also heart, liver, lungs, pancreas, and eye corneas.
“The questions that we need to answer in the 13MP framework are whether we want to continue expensive and unsustainable disease management? Or are we willing to engage in legislative reform by amending the Human Tissues Act 1974 to save more lives and to use public funding more wisely?”
Dr Lingeshwaran also highlighted a shortage in transplant surgeons, asking the MOH for data on the number of transplant surgeons by subspecialty in the government health service and the number of successful organ transplants conducted in the past three years.
When contacted for comment, Dr Lingeshwaran confirmed that he was proposing for Act 130 to be amended to mandate either a shift to an opt-out organ donation system or to respect organ donation pledges.
“We need to relook the Act; it’s too old,” he told CodeBlue.
“Maybe you can go for opt-out or amend certain clauses to ensure that for pledges for organ donation, the family should not resist.”
Health Minister Dzulkefly Ahmad told reporters last August 17 that objections from the next-of-kin of deceased organ donors were hindering organ transplants.
More than 10,000 kidney disease patients are on the waiting list for transplants as of July 31 this year, besides separate waiting lists for liver, heart, and lung organ transplants.
Dzulkefly said the organ donor rate from cadavers remained very low last year at only 46 cases or 1.33 donations per million population.
Although 3,359 organ transplants were carried out in Malaysia between 1997 and July 31, 2025, including transplants from 1,121 cadavers, a total of 404,925 Malaysians had pledged organ donation in that period.
Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib has also proposed that Malaysia replace its current opt-in organ donation system with an opt-out (presumed consent) system.
In a statement last August 18, Azrul noted that Act 130, one of Malaysia’s shortest pieces of legislation, permits a deceased registered organ donor’s next-of-kin to legally override their expressed consent.
“Studies show in countries that adopt opt‑out, there are 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,” said Azrul.
“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.”
He noted that in Spain, while there’s a presumption of consent, families of the deceased have the final say. Still, organ transplantation rates for Spain exceed 130 per million population, far higher than Malaysia’s rate of 1.33.
