Chew Jia Xua, Gracia

School: CHIJ St. Nicholas Girls’ School

Topic: Are youths apathetic towards organ donation?

Award: Distinction, Senior Category, 2021

Organ donation is the legal removal of organ(s) for research into disease treatments or transplantation, with one’s consent while alive or the next-of-kin’s assent for the deceased (WKD, n.d.).

For decades, the global organ shortage crisis has shown little sign of abating. In Singapore, patients wait nine to 10 years for a kidney (Liu, 2021). In the United States (U.S.), 17 people die daily waiting for a transplant (HRSA, 2021). People worldwide watch helplessly as the clock ticks down and lives slip out of their grasp. The persistently donor shortfall has raised speculations on the possible stumbling blocks to transplants - apathetic young adults.

However, the world has seen a rise in youth advocates who strive to spotlight this grave issue. In 2018, after losing a relative to kidney failure, 18-year-old Radhika launched The Second Chance Project in India to raise awareness about organ donation (Ashoka Malaysia & Singapore, 2019). Through interventions like street plays and organ donation aprons, her team sensitized around 700 individuals and registered nearly 50 donors within 11 months. She is only one of the countless youth adherents of organ donation, spurred on by positive upbringing and open donation-related discussions. Therefore, I disagree largely that youths are apathetic towards organ donation.

Proponents of the statement postulate that religious taboos have driven devotees away from organ donation. Buddhism - closely associated with Confucianism - is one of Asia’s dominant religions. A rudimentary teaching, filial piety (Blake, 2015), dictates that children - out of respect for ancestors - should preserve all they have received from them by returning their bodies intact upon death (Cheng, 2009). Thus, organ removal, which opposes such principles, is unacceptable for staunch Buddhists. Moreover, some fear dying with incomplete bodies would prevent them from resting in peace and interfere with reincarnation (Lwin et al., 2002). This incites unwillingness in donating organs among pious youths, stifling transplant rates.

Furthermore, some - albeit medically suitable - are unwilling to donate, as the presumably invasive transplant surgeries have fuelled misgivings among healthy adolescents regarding the medical well-being of living donors. Though international studies have corroborated the general safety of kidney donation, an unfortunate few could face minor long-term repercussions, including back pain (MOH, 2009). According to the National University Hospital (2021), a kidney and liver transplant confer a 0.03% and 0.2 to 0.5% risk of mortality respectively. Donors also risk having postoperative infections, undiagnosed allergic reactions to anaesthetic or excessive bleeding (Lim, 2018). Despite evidence suggesting the slim likelihood of such manifestations, some have been deterred. Markedly, with heightened cognisance of donation-induced risks, some youths - worried for their health - have become apathetic towards donation.

Conversely, many youths - under positive family influence - have become ardent supporters of organ donation. A study by the National Centre for Biotechnology Information reported that families who uphold altruistic values desire to preserve the deceased ancestors’ legacy through organ donation, rejoicing at the functionality of their organs in benefiting another rather than “decay in the grave” (Yousefi, 2014). Having matured alongside philanthropic teachings, youths - imbued with charitable motivations - are more inclined to contribute their organs. In Georgia, a father donated his organs for transplant after brain death (HRSA, n.d.). Inspired by his gift of life, his juvenile daughter, Jillian, decided to volunteer for the Lifelink of Georgia, an organ and tissue recovery organization. Besides speaking about organ donation to college students, Jillian attended a fundraiser for the Georgia Transplant Foundation to reel in more donors, exemplifying that domestic environments - steeped in familial virtues - have nurtured adolescents with hearts of gold.

Often, low donor actualisation rates among young adults perpetuates the view that youths have taken a back seat on organ donation. In fact, the hands of compassionate - but underaged - youths are shackled by the law. Canadian laws (Campbell et al., 2013) and India’s Transplantation of Human Organs and Tissues Rules 2014 (Seth, 2020) underlined the prohibition of living organ donation by minors except on ‘exceptional grounds’, where ‘surgical’ and ‘psychological risks to donor are minimized’, ‘all other deceased- and living-donor options have been exhausted’, and the ‘minor freely assents to donate without coercion’. Nevertheless, the altruism of adolescents shines through in their fervour to donate against ruling decrees. In 2017, a 17-year-old Hongkonger was barred from donating her liver to her mother, an acute liver failure patient, despite pleading desperately to do so (Terry, 2017). The ban was based on the Human Organ Transplant Ordinance which defined the minimum age of living donors as 18 (FHB, 2017). Notably, edicts accord youths tenuous chances of fulfilling their selfless ambitions, unless approved as a last resort for transplant. Thus, it would be injudicious to presume youths are apathetic towards organ donation.

To augment donor supply, legislatures have refined donation policies. Singapore’s Human Organ Transplant Act (HOTA) - an opt-out scheme - was introduced in 1987 for deceased organ donation, undergoing amendments in 2004, 2008 and 2009 to cover heart, liver and cornea transplants, regulate living-donor transplants, and cover all mentally-sound Singapore Citizens and Permanent Residents above 20 who have not opted out (MOH, 2016). Additionally, Singapore’s Medical (Therapy, Education and Research) Act - an opt-in scheme - allows anyone above 17 to pledge to donate any body part for transplantation, education or research upon death (MOH, 2020).

Following legislative efforts, Singapore’s youths have shown strong support for organ donation. A 2014 survey of 281 Singaporeans by students from Hwa Chong Institution found that youths below 30 are most receptive to postmortal donation, with 81.9% being willing to do so (Today, 2014). Moreover, youths have provided valuable discourse on Singapore’s donation system. In 2016, Primary 5 student Raphael Niu broached the inefficacy of HOTA’s presumed consent on The Straits Times’ Voices of Youth, propounding a switch to ‘mandated choice’, where Singaporeans would need to decide, upon reaching a certain age, if they consent to deceased donation. He felt this would “allow Singaporeans to seriously reflect on their stance upon reaching adulthood”, and remove “present dilemmas” faced by families in postmortal donor authorisation. During the Covid-19 pandemic, local university undergraduate Yap Hsin Chen spearheaded a campaign - Don’t Hold Back - to drive more open familial discussions on cadaver organ donation (Chua, 2021).

This sweeping positivity and concern regarding the donation landscape is also emulated globally. Stadlbauer et al. (2020) surveyed 354 11 to 20-year-old students in two secondary schools in Austria and Switzerland, of which 84.6% would authorize their donation after brain death. Amogh Gowda and Srishti Gowda, a college freshman and senior high student in Troy, Michigan, were inspired to ‘make a change’ after discovering the ‘struggles’ and ‘long waiting time’ their former teacher-cum-organ recipient had to experience (Gowda, n.d.). To educate youths their age on organ donation and eradicate the present ‘(ignorance)’ regarding the donor shortfall, they co-founded the Gift8Lives club at Troy High. Srishti also volunteers at Gift of Life Michigans events, exhorting community members to register as donors. She even developed an improved education toolkit with Gift of Life Michigan’s for Driver’s Education classes. Unquestionably, youths worldwide have demonstrated compassion towards donation and taken the lead as advocates to address donor deficiencies.

Since parental authorisation governs decision processes for deceased paediatric organ donation, the refusal thereof largely stems from parental disregard for the help their child’s organs could offer to others - not the child’s apathy thereof. In most countries, if one dies before age 18, parents or legal guardians possess the right to authorise the donation (Yang, 2020). Even if adolescents understand the value of organ donation, they are legally restrained from exercising self-consent on accounts of physical and mental immaturity (Seth, 2020). Therefore, dissent towards paediatric organ removal mainly arises from the burden of decision-making and donation-related concerns borne by bereaved parents. In 2018, 2,005 parents were surveyed across the U.S. in the C.S. Mott Children’s Hospital National Poll on Children Health (Freed et al., 2018). 54% of parents of children aged 0-14 were concerned whether their child would receive all treatments in life­ threatening situations, 53% felt keeping him/her alive for donation would increase his/her sufferings, 30% were concerned about financial costs, while 6% were unwilling to consider donation. These worries suppressed transplant rates, causing 115 children in the U.S. to die on the waiting list in 2019 (Pembleton, 2019). Thus, with youths lacking the autonomy and ability to actualise their donations, it would be ill-considered to hold their ‘apathy’ accountable for paediatric organ scarcities.

Essentially, though religious and surgical-related concerns have produced naysayers, burgeoning numbers of compassionate youths have elucidated the general empathy borne by youths towards organ donation. Positive upbringing has nurtured benevolence that is unfortunately restrained by legal restrictions. Nonetheless, the rise of youth activists has amplified their aspirations to galvanise more support for donation. On this note, donation-related attitudes held by adults may also come into play in pediatric cadaver donation, hence attitudes of other generations should be equally scrutinised against donor scarcity. Amidst rising life expectancy and chronic diseases, policymakers should bolster efforts in dispelling the ‘not-my-problem’ syndrome and fostering greater concern towards donation.

References

1. Ashoka Malaysia & Singapore. (2019, December 30). Radhika: Desensitizing India to organ donations. Retrieved May 23, 2021, from https://www.ashoka.org/en-sg/story/radhika-desensitizing-india-organ-donations

2. Blake, J., & Jones, I. (2015). Religious beliefs and attitudes to organ donation. Retrieved February 24, 2021, from http://lorca.cf.ac.uk/115471/1/150730-religious-beliefs-attitudes-organ-donation-en.pdf

3. Campbell, M., Wright, L., Greenberg, R. A., & Grant, D. (2013). How young is too young to be a living donor? American Journal of Transplantation, 13(7), 1643- 1649. Retrieved May 23, 2021, from https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.12307

4. Chua, N. (2021, February 19). Sharp fall in organ donation numbers amid pandemic. The New Paper. Retrieved May 17, 2021, from https://www.tnp.sg/news/singapore/sharp-fall-organ-donation-numbers-amid-pandemic

5. Food and Health Bureau, Hong Kong (FHB). (2017, June 14). Background Information on Organ Donation and Transplant. Retrieved May 26, 2021, from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/170600_organ_donation_transplant/e_background_paper_organ_donation_transplant.pdf

6. Freed, G. L., Singer, D. C., Schultz, S. L., Gebremariam, A., Clark, S.J. (2018, January 22). Parent views on registering children to be organ donors. C.S. Mott Children’s Hospital National Poll on Children’s Health, University of Michigan. Vol 31, Issue 1, January 2018. Retrieved May 23, 2021, from http://mottpoll.org/reports/parent-views-registering-children-be-organ-donors

7. Gowda, A. (n.d.). About. Gift8Lives. Retrieved May 26, 2021, from https://www.gift81ives.org/about

8. Health Resources & Services Administration (HRSA). (n.d.). Father’s Donation Sets Example that Daughter Still Follows. organdonor.gov. Retrieved May 26, 2021, from https://www.organdonor.gov/statistics-stories/donation-stories/jillian­ advocate.html

9. Health Resources & Services Administration (HRSA). (2021, April 1). Organ Donation Statistics. organdonor.gov. Retrieved June 6, 2021, from https://www.organdonor.gov/statistics-stories/statistics.html

10. Lim, M. (2018, December 5). Living Organ Donation in Singapore. Asia Law Network. Retrieved March 01, 2021, from https://www.google.com/amp/s/learn.asialawnetwork.com/2018/12/05/living­ organ-donation-in-singapore/amp/

11. Liu, J. (2021, February 10). Commentary: Timely to review our opt-out organ donation policy. Channel News Asia. Retrieved March 03, 2021, from https://www.channelnewsasia.com/news/singapore/commentary-timely-to­ review-our-opt-out-organ-donation-policy-9317580

12. Lwin, M. 0., Williams, J. D., & Lan, L. L. (2002). Social Marketing Initiatives : National Kidney Foundation’s Organ Donation Programs in Singapore. Journal of Public Policy & Marketing, 21(1), 66-77. Retrieved March 01, 2021, from https://dr.ntu.edu.sg/bitstream/10356/80844/1/jppm%252E21%252E1%252E66% 252E17613.pdf

13. Ministry of Health, Singapore (MOH). (2009, June 26). Understanding HOTA (Human Organ Transplant Act). Retrieved March 02, 2021, from https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/educational­-resources/moh-026-09 8pp-english.pdf

14. Ministry of Health, Singapore (MOH). (2016, August 18). Increasing Singapore’s Organ Transplant Rate. Ministry of Health Singapore. Retrieved March 01, 2021, from https://www.moh.gov.sg/news-highlights/details/increasing-singapore’s­-organ-transplant-rate

15. Ministry of Health, Singapore (MOH). (2020, June 30). The Medical {Therapy, Education and Research) Act (MTERA). Ministry of Health Singapore. Retrieved March 01, 2021, from https://www.moh.gov.sg/policies-and-legislation/the­ medical-(therapy-education-and-research)-act-(mtera)

16. Pembleton, M. (2019, August 19). There is a shortage of pediatric organ donors. Here’s what parents need to know. The Washington Post. Retrieved May 23, 2021, from https://www.washingtonpost.com/lifestyle/2019/08/19/there-is­-shortage-pediatric-organ-donors-heres-what-parents-need-know/

17. Seth, A. (2020, April, 15). Living organ donation in minors: An ethical conundrum. ETHealthworld.com. Retrieved May 23, 2021, from https://health.economictimes.indiatimes.com/news/policy/living-organ-donation­-in-minors-an-ethical-conundrum/75159230

18. Stadlbauer, V., Zink, C., Likar, P., & Zink, M. (2020, July 9). Family discussions and demographic factors influence adolescent’s knowledge and attitude towards organ donation after brain death: a questionnaire study. BMC Medical Ethics, 21(1), 1-11. Retrieved May 26, 2021, from https://doi.org/10.1186/s12910-020-00499-x

19. Terry, E. (2017, May 22). A Dying Mother, her Filial Daughter, and the Good Samaritan. Retrieved May 23, 2021, from http://bioethics.med.cuhk.edu.hk/assets/files/userupload/Dying%20Mother%20Fil ial%20Daughter%20and%20Good%20Samaritan%20v.4.pdf

20. Today. (2014, October 18). Youths most open to organ donation after death: Poll. today. Retrieved May 20, 2021, from https://www.todayonline.com/singapore/youth-most-open-organ-donation-after­-death-poll

21. World Kidney Day (WKD). (n.d.). Organ Donation. World Kidney Day. Retrieved March 01, 2021, from https://www.worldkidneyday.org/facts/topics/organ­-donation/

22. Yang, X. (2020, August 10). An earth angel: 7-year-old boy’s donated organs help six children. China Global Television Network (CGTN). Retrieved May 23, 2021, from https://news.cgtn.com/news/2020-08-10/7-year-old-boy-s-donated­-organs-help-six-children-SQ1WXfo3BK/index.html

23. Yousefi, H., Roshani, A., & Nazari, F. (2014, May). Experiences of the families concerning organ donation of a family member with brain death. Iranian journal of nursing and midwifery research, 19(3), 323. Retrieved March 04, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061636/
    

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