A Conversation with Dr. Makmor Tumin

On the morning of August 8, 2017, I had the pleasure of speaking with Associate Professor Dr. Makmor Tumin at his office at the University of Malaya. A prolific author of papers and books, his research focuses on public policy, politics, and management, as well as on organ donation. A two-time recipient of a kidney donation, Professor Tumin is passionate and critical of his work. He speaks professorially but warmly.  You can read his blog here and view his publications here. Our conversation focused on organ donation in Malaysia before addressing its intersection with political thought.

The following interview was edited for clarity and concision and subsequently approved by Professor Makmor Tumin. 

How would you describe your work?

At the University of Malaya, my department focuses on public policy, politics, and management. My primary focus is on political thought and philosophy. My interests lie in liberalism as well as in the importance of communitarians (i.e., Michael Sandals). I also hope to bring back the ideas of Marx, Hegel, and Islam to civil society in this country. I will be publishing a book on Western political economics and thought, written in Malay, so that it can benefit the non-English speakers in this country. Organ donation is part of my secondary focus.

How did organ donation become your secondary focus?

Number one, I understood that there is a serious problem of organ donation in this country. Number two, I, myself, received a kidney transplant twice. After receiving the transplant, I thought I should contribute to the cause.

Would you be willing to share your experience receiving a kidney transplant?

I knew that I had a kidney problem at the age of 23. I underwent two to three years of dialysis. In 1994, my brother donated one of his kidneys, which lasted me about 20 years. After the kidney deteriorated, I went back on dialysis, about two years ago. My wife donated her kidney to me three years ago. This, perhaps, encouraged me to understand the issues of organ donation as my secondary focus.

You’ve published prolifically on organ donation. Most of your papers have many collaborators. Who do you involve?

Normally, when I do organ research, I involve both religious and medical experts. One cannot fully understand the complex problems of organ donation unless all the backgrounds are brought together.

What is the current state of organ donation in Malaysia?

I can speak in detail about kidneys, but not so much, other organs. Kidneys are most commonly researched because it is difficult to go about other organs. Also, we have thousands of people, about 30,000, on dialysis. About 18,000, are eligible to receive a kidney donation. Unfortunately, the deceased donation rate is nearly 0.4%. The demand for organs is huge and the supply is nearly zero.

Are there different rates of donation among ethnic or religious groups?

Malaysia, in general, is a Muslim-majority country. The organ donation rate among Muslims, especially when you compare Malays to Chinese, is quite low. Most ethnic groups are not willing to donate, but Malays are less so. You must also understand that is difficult to isolate to the ideas of religion and ethnicity in this country, especially when you talk about Malays. Most Malays are Muslim. Whether you want to discuss the Malay attitude as an outcome of their belief or religion is difficult, because it is often the same. Malay and Muslim are basically identical.

There is also a trend to suggest the Chinese are more willing to donate. The elements of volunteerism among Chinese are higher, judging by the numbers of the registered organizations. Chinese organizations are more prevalent, in terms of the numbers. You could then assume the level of volunteerism is more prevalent in Chinese culture.

How would you describe the level of awareness around organ donation?

I think Malaysians, in general, are not interested to talk about these ideas unless someone brings their attention to these issues. I think we should explain first, whether we are talking about living or deceased organ donation. One of the hurdles in this country is that when you are asking people if they are willing to donate their organs, they are totally confused. We are used to the idea of blood donation, which happens when you’re still alive. People may have ideas that organ donation occurs when you are alive. Thus, it is very important to clearly explain what we mean by organ donation. Most efforts on organ donation are done by the government, where other organizations often only participate when the government launches their activities. There is a little extra effort by any group unless the people are like me and have decided to do something because of personal experience.

Are religious institutions one of those groups?

In my research, I have discussed the role of mosques in encouraging donation. Officially, mosques are willing to join any campaign activities because of the fatwa that decrees organ donation is permissible. But when you ask, if over the past 1 month, has any activity taken place, the answer is none. I still believe that organ donation in this country can be more successful if the doctors themselves speak about this issue. If you got a mosque, it should be a Muslim doctor. If you got a temple, then a Buddhist doctor, rather than religious people. Religious people should make the rulings, but doctors should try to change the attitudes. I base this on some of the work that showed that doctors are more influential in patient decisions.

How do people register to become organ donors?

If you are willing to donate your organ upon death, I would encourage you to talk to the relatives and express your interest. If the family says okay, then I will encourage you to fill out the form and submit it to the National Transplant Resource Center. You can also fill out the form online. What is important is not registering but to inform your family members. More often than not, 2 of 3 eligible donor’s families will reject the opportunity of donation.

Will family consent always be required in for organ donation to occur?

Family consent is necessary now, but maybe in 5 or 10 years time that will change.

You’ve written extensively about presumed consent systems. Is it possible for Malaysia?

Before launching a presumed consent system, there are two or three issues that must be addressed. In countries like Chile and Singapore, when the government launched the presumed consent, donations fell. I think that first, the general public level of willingness should be more than 70 percent, according to my gut and instinct. The level of willingness in these countries (i.e., which institute a presumed consent system) is around 30-35%. Second, the government needs to work on infrastructure: drugs, hospitals, etc. We don’t have enough surgeons in the public hospital. Third, medical trusts need to be assured. People need to trust the doctors who decide should receive the organ. The waiting list criteria are decided by doctors. This should be explained to patients, so patients don’t think the process is corrupt based on who you know.

Another important thing is information. People lack knowledge what is organ donation, especially living versus deceased and the ethnic and religious identity of who receives the organs. A lot of work needs to be done before we can talk about presumed consent. We don’t expect all people to donate organs, but if one person passes away, you get two kidneys. The rate of driving accidents is one the highest in the world; there’s a huge potential there. If you put presumed consent, it assumes 30% will opt-out and 70% will stay in the same. If 70% stays, then you will likely have enough organs donated.

I’ve heard that organ donation is rarely done in private hospitals. Why is that?

Organ donation needs to be done within public hospitals because the government can have more oversight and regulation there. If it’s done in private hospitals, there is a potential for economic exploitation. In this country, there was an accusation that surgeons in some private hospitals may have exploited, and thus the government stopped most organ transplantation activities in private hospitals.  In the 1980s and the early 90s, most people went to China and the Philippines to buy organs. The government strongly discourages people from going overseas, but there is no jurisdiction. The Malaysian government does not want the poor in China or in the Philippines or elsewhere to be exploited.

Do people have concerns about their organs going to someone of a different ethnicity of religion?

The official policy states that there is no issue of Malays donating to Chinese, or elsewhere. In general, people may be concerned about this thing. The basic rule for organ donation is that the organ needs to be useful to continue life. I think you can allow the donation of an organ if the doctor says it’s necessary. According to the basic Islamic ruling, if the benefit outweighs the harm, then it should be permissible.

Do people have the political right to know from whom they get their organ?

If they want, but people here don’t think much about their rights, as long as they can live a happy life. The issue of the right to know everything is not so much a concern. The idea of liberalism and civil rights is not so strong in this country. We don’t talk about having or not having rights. We talk about if we’re happy. This is a bit biased from the male point of view, but I’ve heard my colleagues say: “If the women can have the right, but if you don’t have a family, how can you exercise your family rights?” Therefore, I think it is important to talk about the right of family and community, instead of individual rights. If your individual rights make you happy, that’s fine. You may want to talk about human rights, a lot of people want to talk about God rights. You may have a right to your body, but you don’t have a right over God.

Is there an idea of a public good in Malaysia?

Of course, if you talk about public goods as opposed to private goods. Most people don’t talk about public or private goods, but common goods. Privacy is not a huge issue in Malaysia unless you’re among the upper class. If you are just a simple man, you may not be interested in the right to privacy.

How about the concept of greater good?

This is a question of the middle and upper class. If we look at organ donation, are we seeing that the body belongs to the commons or belong to certain ethnic groups or whatever? This idea is not being fully debated, unlike in China where the body decidedly belongs to the state. In Malaysia, the body belongs to the family, which has a strong power to decide. In America, your family does not have much a say. Here, your family and your society, such as your extended family, have to agree. In most cases, the family will say no.

Some countries engage in organ trade. Is it possible in Malaysia?

The idea of buying and selling organs should not be encouraged, as far as the living donation is concerned. In the majority of cases that I know, it is very difficult to control. Individual are often exploited because they do not receive the full explanation of what the surgery entails. Until and unless you have the mechanism to properly monitor organ trade, which is not an easy task, we cannot consider the possibility.

Switching over to your primary focus, both Hegel and Marx didn’t exactly like religion. Why are you studying them in the relationship of Islam?

Religion is a question of inspirations. You can’t discover God through nationality. God is not in the realm on nationality; God is in the realm of spirituality and practice. I think faith comes in a test, different for people.

What do you think Malaysians have to benefit from reading Marx and Hegel?

I have begun to notice that some Malays cannot understand why some people don’t believe in the existence of God. What I want to provide is an understanding of Western thought and aims through political theory and thought.  I also like to share the work of people like Marx and Adam Smith, because God gave them this knowledge.  

How do you see the connection between religion and the thought of this philosophers?

There are three ways of thinking. Many philosophers, including Adam Smith, understand Nature and try to come up with ideas the mirror Nature. If we say, men, by Nature, are evil, then we need to look at how societies without governments function.  Why should we follow Nature, if societies are still not happy? In the second way of thinking, we remove Nature, as no one knows it but just have perceptions about it. We then follow tautology and look at what society wants and maximize that. The third involves looking at what God wants, through ontology. You can follow Nature, society, but also what God wants.

How do you involve your faith in your work?

I think we are slaves and working on this earth, with our master is overseeing. This isn’t logic, but feeling. As a slave, I think I should share the indirect knowledge that God gave Adam Smith. We need to combine the indirect knowledge of Adam Smith and the direct knowledge given to Prophets, to figure out what God wants. But we don’t know for certain. So, as long as you make the effort, that should be enough. You don’t know what is right and wrong in this world. You will know in the hereafter. Because I don’t know, I want to make sure that I believe that thing that I do is right. Otherwise, I have no motivation. If what I am doing is wrong, then I must ask for forgiveness. This is more less, what I hope to teach in philosophy. I always want to be with God, though this may not work in our logic.

How do you view logic in the current age?

People are moving into new realms, where logic and rationality is the only way forward. We may end up in a society where we have the best logic. I would like to write a book called, “The Dictator of New Rationality.” Through logic, someone can become a dictator. People have different capacities of rationality, based on the age, environments, gender, or education. People who benefit from it the most from logic (i.e., who are most capable of practicing it), can become dictators.

In our dreams, we may believe everything is true. The moment we wake up, we realize all that we saw is not true. If we continue using our logic only, we continue living in our long dream. If we can be a bit awakened from this long dream, maybe we can see that the world is not only about logic. People need to understand why we need to be rational and need to consider why we think the way we think. Then we have the threat to become half-human, if we ignore our intuitions, our feelings, and rely on our rationality only. We only use one type of endowment.

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