Christie Callia Sardjono, 16

School: CHIJ St. Nicholas Girls’ School

Topic: Are youths apathetic towards organ donation?

Award: Distinction, Senior Category, 2021

Organ donation, the process of surgically removing an organ or tissue from a donor and transplanting it to a recipient (Cleveland Clinic, 2016), has been a highly debated topic in medicine and ethics, yet it is still a prevalently shrouded topic among Singaporeans. This can easily be attributed to certain Asian socio­ cultural customs or simply the lack of knowledge on relevant legislation. ln Singapore, deceased organ donation rates are strikingly low at 6.6 per million population, as more than 400 patients stand waiting for suitable organ transplants (Baker, 2021) despite organ donation policies such as the Human Organ Transplant Act (HOTA). Nevertheless, with increased awareness and the gradual shift to a more progressive outlook saturated among the youth, it is seen that youths are largely not apathetic toward organ donation, but often lack the access and information to act upon their enthusiasm. More publicity, especially through mainstream education channels, needs to be done in order to meet the rising demand for organs by increasing youth participation in organ donation.

A. Youths aren’t actually apathetic - they want to help.

The numbers are clear: youths are more receptive to donorship than their older counterparts. It was found that 81.9% of citizens under 30 were willing to donate their organs, significantly larger than those between 30 to 60 (60.3%) and above 60 (22%) (Tan, 2014). Similarly, in the UK, a 2013 study found that nearly 65% of millennials were agreeing towards donating an organ (Coad, Carter & Ling, 2013), and young people (born in the 1990s) have been the backbone of Chinese organ donations, accounting for over 53% of registered potential donors (Xu, 2019). On a local and international scale, youths are generally more accepting of the idea of organ donation and becoming donors themselves.

A1. The Media and the Campaigning Youth

There is no doubt that the world of social media is dominated by the youth, with 89% using the internet for obtaining information (NYC, 2020). It is perhaps due to this consumption of information and instantaneous interactions on social media that creates the asynchronous and encouraging environment of the internet world for prosocial actions (Armstrong-Carter & Telzer, 2021), motivating youth to speak out on various social issues. Moreover, the broad array of medical information and media outreach accessible to the youth was something lacking in the past, giving current youths the advantage of acquiring and sharing information on the pressing need for organ donors more easily. ln New York, USA, teens have founded the Youth Coalition for Organ Donation (YCOD) proposing a bill to increase the rate of organ donation (YCOD, 2021). Similarly, in Singapore, National University of Singapore (NUS) Medical Students have organised the 2017 Game of Survivors event to raise awareness on organ donations (NUS Yong Loo Lin School of Medicine, 2017), while other events such as the Live On Festival have garnered enthusiastic participation from students from over 30 schools (National Organ Transplant Unit, 2020).

Among youths, there is a general trend toward a culture of outspokenness and pro-activeness in initiating the spread of awareness on organ donation, which can be attributed to youth’s passion for social issues coupled with the diverse information readily available on the internet. However, it is important to note that they must have been highly motivated by something (perhaps an event, awareness on an important social issue, or personal experience) in the first place to become proactive. This is where public education and the media are key in bringing attention to issues that should be discussed and acted upon by the community.

A2. From Superstition to Science

There has also been a gradual erosion of tradition and superstition among the youth, with fewer younger adolescents believing in superstition than middle/older adolescents, studies have shown (Sagone & Caroli, 2014). While it might be a concern to some that youths are showing a growing sense of disinterest in their culture, the rising interest in the other end of the spectrum - science and technology, could potentially lead to more youths being more willing to support medical advancements such as organ donation than subscribe to opposing traditional beliefs. Research has shown that the younger generation showed significantly stronger opinions on topics such as global warming and gene modification compared to those older than them (Borenstein, 2015). The increased popularity of science among the youth, along with the declining belief in tradition hence propels youths to prioritise saving lives through procedures such as organ transplant despite traditional beliefs.

B. Factors that bar Youths from Actively Supporting Organ Donation

While youths are generally more likely to be supportive of the notion of organ donation, there are still some challenges, such as the lack of knowledge about legislation and other matters relating to organ donation and the lack of support from parents or their cultural community, that likely inhibit them from being able to express and act upon their enthusiasm.

B1. Limitations of Current Education Efforts

Based on statistical data, most youths cited lack of extensive procedural knowledge as the main drawback in causing hesitation in donating organs themselves (Paraz et al., 2016) which is vastly different from reasons listed by disapproving adults. This could potentially lead to the prevalence of youths who are enthusiastic about organ donation but lack the knowledge to physically contribute. It is unlikely for anyone, including youths, to enter an organ donation procedure without proper understanding of the risks, methodology and possible side effects of an organ transplant, as well as the relevant legislation that pertains to organ donation. A local example to illustrate this discrepancy between the young and old is the ‘Understanding HOTA’ booklet which is supposedly issued to all Singaporeans and Permanent Residents when they turn 21 (National Organ Transplant Unit, 2009) and includes important information on the purpose and undertaking of HOTA and MTERA. Youths under 21 currently are not given this booklet. If they were to also be given basic information on HOTA and MTERA and given access to sites and platforms to pledge their future keenness to donate their organs, backed up by their belief in science and medicine, it is likely that more youths would actively support organ donation.

Knowledge on organ donation produces significant positive effects on willingness to donate their organs, studies have shown. In the younger age bracket, the negative stance toward cadaveric transplantation among Italian high school students were dramatically decreased by more than half through educational intervention (from 33.7% to 16%) (Piccoli et al., 2004), while Singaporean students showed increased willingness to donate their organs under MTERA (from 56.40% to 71.80%) following a lesson on organ donation and governing legislation. It is also worth noting that in the same study, the students showed poor knowledge on organ donation legislation prior to the intervention, where the majority of students had little to no knowledge about HOTA and MTERA (Truong et al, 2016). The efficacy of educational intervention among the youth is favourable in encouraging increased advocacy of organ donation and dispelling common doubts about transplantation by emphasising the need for organ donors.

B2. Cultural and Familial Concerns

The cultural concerns deep-seated among many still play a key role in dividing the stances of youth when it comes to organ donation, especially in a culturally rich and diverse society like Singapore. Some Buddhists, Muslims and Hindus express concern that the dissection of a body for the removal of organs violates the sanctity of the deceased (Woo, 1992). For instance, there is a traditional Chinese belief that a body needs to remain intact for a good afterlife (Heng et al., 2016) which naturally discourages subscribers from supporting organ donation. Another study found that Muslim youth were 3.65 times less willing to donate corneas compared to youths of other races (Paraz et al., 2016), due to religious concerns such as the discomfort with the cutting of the body and fears of offending God (Liu, 2018). This particular religious split is no surprise, given that only in 2008 were Muslims no longer exempted from HOTA (Ministry of Health, 2019). Other than religious youths who may subscribe to these beliefs, traditional parents who hold such religious concerns may discourage them from actively showing support for organ donation or avoiding the topic entirely.

Conclusion

Progression of thought, gradual cultural dilution, the media and shifting perspectives of the youth play significant roles in increasing youths’ enthusiasm toward organ donation. However, youths are restricted by lack of adequate knowledge on organ donation to commit to donating their organs, and hence appear to be apathetic towards it. Perhaps a more extensive and permanent education module for students is crucial in promoting active participation as organ donors. Furthermore, the inclusion of religious councils and cultural authorities in the dissemination of relevant information could dispel cultural and religious misconceptions, encouraging more to support organ donation. Therefore, with the right educational framework, there is a high probability that the push for increased rate of organ donation would be spearheaded by the youth.

References

1. Armstrong-Carter, E., and Telzer, E. H. (2021). Advancing Measurement and Research on Youths’ Prosocial Behavior in the Digital Age. Child Development Perspectives, 15(1), pp. 31-36. https://doi.org/1O. l1 l l/cdep.12396

2. Baker, J. A. (2021, February 4). ‘Are you sure he is dead?’: Doctors struggle with families’ lack of understanding of HOTA. Channel News Asia. https://www.channelnewsasia.com/news/singapore/human-organ-transplant-act-doctors-families­ understanding-l1459284#:-:text=Singapore%20had%20a%20deceased%20organ,the%20highest%20in%20the% 20world

3. Borenstein, S. (2015, July 2). Opinions on science vary by age group - The Boston Globe. BostonGlobe.com. https://www.bostonglobe.com/news/nation/2015/07/01/survey-political-and-gen eration-gaps-science-issues/hki8357khXwGmHbcbL1zPN/story.html

4. Cleveland Clinic. (2016). Organ donation facts & Info: Organ transplants. Retrieved February 21, 2021, from https://my.clevelandclinic.org/health/articles/11750-organ-donation-and-transplantation

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6. Heng, W., Truong, T., Tham, I., Yick, J., Chiang, I., and Seek, T. (2016). Psychosocial Factors, Knowledge and Attitudes Influencing Skin and Heart Valve Donation among Healthcare Professionals in Singapore. Annals Academy of Medicine Singapore, 45(8), 8. https://www.annals.edu.sg/pdf/45Vo1No8Aug2016/MemberOnlyN45N8p338.pdf

7. Liu, J. (2018, April 2). Evaluating attitudes Towards organ donation in Singapore. https://osf.io/73x9j/wiki/home/

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9. National Organ Transplant Unit, Understanding HOTA: Human Organ Transplant Act (HOTA) (2009). Singapore, Singapore; Ministry of Health. https://www.liveon.gov.sg/docs/info_booklets/S020870_Hota_english2013.pdf

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11. NUS Yong Loo Lin School of Medicine. (2017, February 28). Support for Organ Donation. https://medicine.nus.edu.sg/support-for-organ-donation/

12. National Youth Council. (2020). Youth Statistics in Brief Youth Statistics in Brief. https://www.nyc.gov.sg/en/initiatives/resources/youth-statistics-in-brief/

13. Paraz, C. M., Truong, H. T., Sai, D. K., Cajucom-Uy, H. Y., Chan, C. L., and Kassim, S. M. (2016). Knowledge and attitudes TOWARD CORNEAL donation Among Singaporean Youth: A cross-sectional study. Eye and Vision, 3(1). https://doi.org/10.1186/s40662-016-0049-3

14. Piccoli, G. 8., Soragna, G., Putaggio, S., Burdese, M., Longo, P., Rinaldi, D., Bergamo, D., Mezza, E., Consiglio, V., Novaresio, C., Giacchino, F., Jeantet, A., and Segoloni, G. P. (2004). Efficacy of an educational program on dialysis, renal transplantation, and organ donation on the opinions of high school students: a randomized controlled trial. Transplantation Proceedings, 36(3), pp. 431-432. https://doi.org/10.1016/j.transproceed.2004.02.058

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16. Tan, E. (2014, October 18). Youth most open to organ donation after death: Poll. TODAYonline. https://www.todayonline.com/singapore/youth-most-open-organ-donation-after-death-poll.

17. Truong, H., Yoo, K. R., and Tan, C. K. (2016). Educating Secondary School Students about Organ and Tissue Donation Legislation: A Pilot Study. https://www.hsj.gr/medicine/educating-secondary­school-students-about-organ-and-tissue-donation-legislation-a-pilot-study.php?aid=9499

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19. Xu, K. (2019, July 2). Youth dominate organ donors. Global Times. https://www.globaltimes.en/content/I 156555.shtml

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Disclaimer: Please note that the views and opinions expressed in the essays for the Live On Festival 2021 are those of the participants and are not endorsed by the National Organ Transplant Unit (Ministry of Health).

To learn more about organ donation and organ transplantation in Singapore, please visit www.liveon.gov.sg