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Life on hold: the price of Malaysia’s donor shortage

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Religious and cultural concerns as well as lack of trust have kept many Malaysians waiting for a liver, kidney or heart transplant that may never happen.

For instance, many people, particularly those in the Malay-Muslim community, believe that organ donation is forbidden because the body must remain whole after death.

“In many communities, there is a cultural or religious obligation to ensure that a person’s remains is not mutilated, modified or taken advantage of,” Azrul Mohd Khalib, CEO of think tank Galen Centre for Health and Social Policy, told FMT.

Then, there are cases where the family decides not to allow the harvesting of organs despite the deceased having made a pledge to donate, he added.

These are some of the concerns that, experts say, must be addressed to promote a practice that can save lives.

Too little too late

The numbers tell the story, and it is not a happy one. Less than 2% of Malaysians, or just about 700,000 in a country of 35 million people have pledged to donate their organs as of 2017, according to the National Transplant Resource Centre (NTRC).

Given that in the same year just over 21,000 Malaysians were on the transplant waiting list, it would appear that there would be more than enough to go around.

Unfortunately, the situation is more complicated. While the medical capabilities are available, the real obstacles lie beyond the operating theatre. It is a matter of mistrust, perception, and policy shortcomings.

For instance, the family’s refusal to honour the pledge made by a deceased person has denied many a second chance at life.

Data from the NTRC shows that as of February 2025, a total of 10,239 individuals, mostly kidney patients, were still waiting for a transplant.

But the number of new pledges has been declining. Only 15,486 pledges were made in 2024, a drop of 45% compared with 2022.

Changing perception, boosting pledges

Steps have been taken to ease people’s minds. For instance, the National Fatwa Council had ruled in 1970 that organ donation was permissible in Islam if done ethically.

Hindu, Christian, Sikh and Buddhist leaders have expressed similarly supportive views, but a general reluctance persists.

Under the current system, making a pledge does not guarantee that someone else’s life will be saved when the time comes.

Malaysia has adopted a “soft opt-in” model that is overseen by the health ministry. It not only requires individuals to register voluntarily but also make family consent mandatory upon death.

As a result, the NTRC said, many pledges have not been honoured.

Compounding the problem is the lack or trained transplant coordinators at most hospitals, as highlighted in a 2024 National Institute of Health (NIH) study.

Efforts to increase public awareness has also been fragmented, and sustained funding is not available especially in rural areas.

The way out

Azrul said education could help people overcome their fears and misconceptions, especially for those in the more conservative communities or those suspicious of medical advances.

“A lot of these barriers are due to ignorance, as well as cultural or religious resistance or misinformation,” he said.

On the positive side, organs have never been treated as a commodity for sale or purchase in the commercial sense.

Azrul said Malaysia could move forward with a “soft opt-out” policy, where all adults are considered to have consented to donate their organs upon death unless they have gone on record to stay that they did not wish to.

This would put them in the same category of underaged individuals, or those who lack the capacity to understand the policy as a result of mental or other disabilities, making them ineligible to make such pledges.

This will require an amendment to the Human Tissues Act 1974.

A person donating an organ or part of an organ before death may also help to boost pledges.

Why this matters

These figures are not just numbers. They are lives. Families left in limbo. Patients enduring dialysis for years while waiting for organs that may never come. Children growing up watching their parents grow weaker.

Of course there have been moments in Malaysia’s transplant history that include powerful examples of what’s possible. In 1993, a 14-month-old baby, Afiq Ikmal, received part of a liver from a 23-year-old civil defence officer at Hospital Kuala Lumpur.

It was Malaysia’s first successful paediatric liver transplant, a moment that inspired the now-iconic phrase “satu hati,
dua jasad” — one heart, two bodies. Afiq passed away in 2021 at Selayang Hospital, after nearly three decades of life that would not have been possible without donation.

These stories should not be rare. They should be the norm.

What we must do next

To bridge the donor-recipient gap, Malaysia must:

  • Link organ donor registration with MyKad, driver’s licence, and passport;
  • Launch targeted education campaigns at schools, clinics, and houses of worship;
  • Establish a central real-time registry accessible by hospitals;
  • Engage religious and community leaders to clarify fatwas and encourage support, and
  • Reform laws to shift to a “soft opt-out” system with ethical safeguards.

Organ donation is not about loss — it’s about saving lives. The medical capacity exists. The religious guidance is clear. The urgency is real.

What’s missing is public understanding — and political will.

Just one pledge can save multiple lives. The power is already in our hands. The question is whether or not we will use it.

 

Rania Khaleqyar is an intern at Free Malaysia Today, majoring in pharmacology and physiology at the University of Westminster.

The views expressed are those of the writer and do not necessarily reflect those of FMT.

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