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UNIVERSITI TEKNOLOGI MARA FINAL EXAMINATION

COURSE COURSE CODE EXAMINATION TIME

ENGLISH FOR ACADEMIC PURPOSES BEL311 OCTOBER 2010 3 HOURS

INSTRUCTIONS TO CANDIDATES 1. This question paper consists of two (2) parts: PART A: SECTION 1 SECTION 2 PART B: (1 Question) (7 Questions) (7 Questions)

2. 3.

Answer ALL questions from all parts in the Answer Booklet. Do not bring any material into the examination room unless permission is given by the invigilator. You are allowed to bring in your English-English dictionary. Please check to make sure that this examination pack consists of: i) the Question Paper ii) an Answer Booklet - provided by the Faculty

4. 5.

DO NOT TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO

This examination paper consists of 9 printed pages
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PART A: READING COMPREHENSION (20 MARKS) Read the following articles and answer all the questions in the answer booklet provided. SECTION 1: Article 1 The Ethics and Law on Organ Transplantation in Malaysia

Organ transplantation is a form of treatment for serious and life-threatening diseases which has proven to be successful. It involves replacing diseased and defective organs and tissues with healthy ones from donors. Recent

advancements in surgical procedures and the availability of anti-rejection drugs have contributed tremendously to the success of organ transplantation. These 5 developments have made the transplant procedure a possible treatment for those suffering from various organ failure states. The commonly transplanted organs are kidneys, heart, eyes, lungs and pancreas while transplantable tissues are liver, bone marrow, skin and heart valves. Presently, organs for transplantation can come from either a living person - the live donor, or a dead person - the cadaveric donor. 10

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Live donors are an important source of tissues and organs for transplantation. Donors can be parents, siblings or close relatives who are genetically related to the recipients; or spouses and very close friends who are "emotionally related" to the recipients. They are collectively known as "live-related donors". Kidney, parts of the liver and certain tissues, such as bone marrow, skin and blood can only be obtained from live donors. Some of the ethical problems that need to be solved for live donations are questions of consent. There is a need to know whether the organs are given freely and not under duress, and whether the risks are explained to the donors. Another concern would be to ensure that no payments are involved in the procurement of the tissues and organs. 20 15

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Cadaveric organ donation is the donation of organs after the death of an individual. This would provide organs and tissues for all types of transplantations being performed in the country. Removing the organs from a dead person is usually not a problem, especially if the donor has given express consent prior to 25

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his death. Organs can also be taken from the deceased if no express consent has been given on condition that relatives do not object to it. An important ethical question in cadaveric organ donation involves the exact definition of death. In other words, at what stage death has occurred. Traditionally, a patient is pronounced dead when he stops breathing. However, in cadaveric organ 30 transplantation, organs are best removed when the heart is still beating but the patient is already technically dead, with irreversible loss of brain stem function - a situation called brain death. Generally, doctors accept that being brain dead is the same as being dead. However, the patient can be pronounced brain dead only by doctors who are not part of the transplant team or the team looking after the 35 recipient, using very strict criteria.

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As far as the law is concerned, transplantation of cadaveric tissues in this country is governed by the Human Tissues Act 1974. This Act, which is the first and only statute of its kind in the country, is based on, and almost identical to England's Human Tissues Act 1961. Our Human Tissues Act 1974 allows for the removal of 40 tissues from cadavers for therapeutic, medical education and research purposes. Removal of cadaveric tissues is allowed under two circumstances, namely: First, at the express request of the donor. The request may be given at anytime in writing or may be stated orally during the deceased's last illness in the presence of two witnesses; and Second, in the absence of objection from the deceased and with the consent of the next-of-kin. The person responsible for the body should take all reasonable steps to find out if the deceased had any objection and obtain consent from the next-of-kin. 45

There is presently no legislation in the country controlling the removal of organs from live donors. When there is no clear legal authority, live donations are legally allowed if there is valid consent obtained from the donor. This loophole in the system encourages human trafficking as the source of organs. With the increase in the number of patients in need of organ transplants, together with the scarcity

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of available organs, there is nothing to stop individuals from selling their organs 55 for a big sum of money. Since it is possible to live with just one kidney, and with
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the demand being so high, kidneys are among the most popular organs for commercial transactions.

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Rapid advancements in transplant technology over the years have made shortcomings in our Human Tissues Act 1974 become more evident. Accordingly, 60 the Ministry of Health is now in the final stages of reviewing the Act to address the weaknesses and bring it up-to-date. The Ministry is also in the process of developing guidelines on organ donation and transplantation from living donors. The amendments to the Human Tissues Act 1974 and the Guidelines on Organ Transplantation from Live Donors will herald a new era of organ transplantation in 65 Malaysia. Adapted from: Chua Jui Meng, NCD Malaysia 2004 Volume 3, No.1

Answer the following questions in complete sentences where appropriate.

1. State whether the following statements are TRUE (T) or FALSE (F). a) "Live-related donors" must be genetically related to the organ recipient. b) Bone marrow cannot be procured from cadaveric donors. c) Malaysia's Human Tissues Act 1974 is identical to England's Human Tissues Act 1961. d) Under the Human Tissues Act 1974, removal of cadaveric tissues is only allowed if the donor requests for it. (2 marks) 2. What do the following words mean as used in the passage? a) states (line 7) b) express (line 43) c) trafficking (line 53) d) herald (line 65) (2 marks)

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3. The statement"... to ensure that no payments are involved in the procurement of the tissues and organs." (lines 20-21) means a) You can receive money for donating an organ. b) You cannot procure organs and tissues if there is no financial transaction involved. c) You cannot receive any compensation for donating an organ or tissues. d) You cannot receive payment unless you donate an organ or tissues. (1 mark)

4. What are some of the ethical problems related to procuring organs or tissues from living donors? List two (2). (2 marks)

5. "This loophole in the system encourages human trafficking as the source of organs." (lines 52-53). What does "this loophole" refer to in the above statement? (1 mark)

6. Why are kidneys the most popular organ for commercial transactions? (1 mark)

7. Why is it necessary for the Ministry of Health to review the Human Tissues Act 1974? (1 mark)

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SECTION 2: Article 2 Saving lives, one pledge at a time

More than 100,000 people have pledged to donate their organs, but due to a lack of awareness, many of these potential donors are lost. According to Tan Sri Lee Lam Thye, the Chairman of the Health Ministry's public education sub-committee on organ donation, when the pledger is certified brain dead and his family members are approached by the hospital authorities, they refuse and accuse the 5 doctors and nurses of being heartless at their time of mourning. Although a person has pledged his organs, doctors cannot harvest them or take his tissues and bones without the consent of his family or next of kin. Because of this, several problems have arisen in connection with organ transplantation.

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The first problem is that, the organ pledger does not inform his family of his pledge to donate his organs when he dies. It is important that he does this so that his noble intentions will be honoured. It is, therefore, deemed necessary for a public forum to discuss this issue because it is sensitive, especially with Malaysia being a multiracial country. Malaysians are now very open and very forthcoming about donating organs, including the Malays. In recent cases, most of the organ donors were Malays and many benefited from the organs donated. There have also been cases where the organs of non-pledgers were donated due to the generosity of their families. Since the 1970s, 215 people have donated their organs. The harvest included 128 kidneys, 20 hearts, 25 livers, 4 lungs, 86 heart valves, 143 corneas, as well as skin and bones.

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Another problem is the disparity between the supply of organs and the need for organ transplants which is increasing throughout the world. This explains the need for a pledge to donate organs. Despite the support of major religions, low organ donation rates still prevail because among other things, there is distaste among people thinking about their mortality, and fears of dismemberment after death. 25 Hospital staff hesitate to burden grieving relatives with a request for organ donation from their dead loved ones. Relatives may be too shocked at the time of

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their loved ones' death, and are simply incapable of making any decision. Public understanding of brain death is also limited. While on artificial respiratory support, the deceased's heart continues to beat for a time, the body feels warm and looks 30 as if alive. This makes it difficult for relatives to accept that their loved one is actually dead. Preferences for organ donation may not have been discussed beforehand among family members making it even more difficult for the relatives to decide.

IV

Apart from this, organ donation rates are low due to a constant barrage of 35 negative and fallacious stories about organ donation. Only a few television shows or movies portray transplantation in a positive manner and even fewer of these bother to give an accurate description of the process of procurement and surgery. While these shows may be fiction, even viewers who can totally ignore unbelievable and absurd story lines seen on the screen may develop a negative impression that organ donation is potentially harmful. It is also unfortunate to see messages on organ thefts being passed around the globe by e-mail and word of mouth. Asking people to consider organ donation is already a difficult task and therefore, it should not compete with false and outrageous organ donation stories. 40

Hence, a public forum to discuss the issue on organ donation will definitely help. 45 This will not only ensure that an organ pledger's wish is fulfilled but will also increase the number of pledgers and organ donations among non-pledgers. The nation needs about 1,200 kidneys, 450 hearts, 450 corneas and 200 livers a year to save patients' lives. The Health Minister stated that it was disheartening that despite many fatal accidents occurring in the country every year, the number of organs saved for donation was negligible due to objections from victims' families. Therefore, a change in mindset is very much needed. Society needs to view organ donation as a standard aspect of patient care. With this change in mindset, it is hoped that donating organs will become the custom for Malaysians to save the lives of others after death rather than letting their organs go to waste. 55 50

Adapted from: Annie Freeda Cruez New Straits Times, 2 June 2008

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1. What do the following phrases refer to? a) b) noble intentions (line 12) negative impression (lines 40-41) (1 mark) 2. State four (4) reasons for the low rate of organ donation. (2 marks)

3. What can happen if an organ pledger does not inform his family of his intention to donate his organs when he dies? (1 mark)

4. In your own words, state the main idea of paragraph IV. (2 marks)

5. What view should society take concerning the pledge for organ donation? (1 mark)

6. In your opinion, do you think the public forum will be effective in dealing with the issue of organ donation? Give two reasons to support your opinion. (2 marks)

7. In your opinion, why do you think the Malays have now become more willing to donate their organs? (1 mark)

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PART B: WRITING (20 MARKS)

QUESTION 1 You are a member of the health committee of the university and you have been asked to write an article for the campus bulletin in conjunction with Organ Donation Awareness Week. Based on these two articles "The Ethics and Law on Organ Transplantation in Malaysia" and "Saving lives, one pledge at a time", you have developed the following opinion about the issue:

"Organ donation should be encouraged among Malaysians"

Using information from the two articles, write an article of about 300 - 400 words to support your opinion. Include three main ideas with supporting details for your article. (You must use information that you have gathered from reading the two articles but marks will be deducted if you copy sentences from the articles.) In-text citations and proper acknowledgement of references used must also be included.

END OF QUESTION PAPER

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