Kayla Utomo, 16

School: CHIJ St. Nicholas Girls’ School

Topic: Are youths apathetic towards organ donation?

Award: Merit, Senior Category, 2021

Organ donation is the process by which healthy organs from one person are surgically removed for transplantation into another person. Donatable organs include kidneys, heart, liver, pancreas, intestines, lungs, cornea and others. Most organ donations occur after death, but can also take place when alive. These organ donations can help save and transform patients’ lives, who are experiencing organ failures or have damaged organs due to diseases or injury. (Cleveland Clinic, 2021)

In the Singaporean context, organ donation rates remain low with the average wait for a kidney donation being 9 to 10 years and 1-2 years for a liver or heart. A spokesman from the Ministry of Health even stated that “The number of deceased organ transplants for kidney, heart and liver remained low for the past 10 years”. Moreover, Singapore also has the highest kidney failure rates globally. (Janice Tai, 2016) Despite the severity of the situation, I feel that a large number of youths continue to express their unwillingness towards organ donation.

Based on a cross-sectional study conducted by BioMed Central Ltd. aimed to assess the willingness of Singaporean youths towards corneal donation, out of the 500 youths aged 18 to 25 involved in the study, only 31 % were willing to donate their corneas while 22.2% expressed unwillingness and majority undecided at 46.8%. From these results, it can be observed that a larger number of youths indicate doubt and hesitance to the idea of organ donation. When asked why they were unwilling/ undecided, respondent’s main reasons were lack of knowledge of the transplant process (64.3%), concerns on how their body would be treated after death (19.7%), worries over ineligibility to donate (10.1%) and other reasons such as religion (5.8%) and fear of operation (2.4%). (Paraz, C.M.A., Truong, H.T.T., Sai, D.K. et al., 2016) Therefore, the above exhibit several of the reasons leading up to Youths’ apathy towards organ donation, which will now be further delved into.

Looking into the main cause of unwillingness, the lack of information regarding organ donation is the ultimate barrier. Misconceptions form in the midst of insufficient knowledge, misleading youths into groundless concerns and fears, affecting their decision to donate. Based on a research project done by a four-student team from Holy Innocents’ High School, young students were much more receptive and open to organ donation after learning about HOTA and organ donation. (Emilia Tan, 2014) This shows how the lack of social awareness in youths acts as a main cause for youths’ apathy towards organ donation, and expresses the concern of Singaporean youths’ lack of public conscience as a typical and common sight.

As for the medical aspect, living organ donors are exposed to several risks. Surgery-related risks include pain, infection, hernia, bleeding, blood clots and wound complications. Specifically, for kidney donations, long-term complications include high blood pressure, elevated protein levels in urine and reduced kidney function. As for liver donations, bile leakage, narrowing of bile duct and intra-abdominal bleeding may occur. (Mayo Clinic, 2020) Living donors are worried about these risks, especially death, hence prefer not to donate their organs as they prioritise their health over saving someone else’s life. However, these risks are very low. According to Dr Terence Kee, a senior consultant at SGH, advances in medicine have relatively lowered risks, with less than 1 % risk of complications and 1.5% risk of kidney failure in future for living kidney donors. (Varma, 2018)

Besides this, the misconception that blood compatibility is required for organ donations is widespread. Typically, blood types had to be matched in very specific ways. As such, people show no concern towards donating their organs because they believe that since their blood is incompatible with the patient, they are not potential donors. However, in recent years, incompatible blood organ donations have been made possible. Through sessions of plasmapheresis, which involves removing the blood plasma from the recipient and providing immune globulin treatment to replace antibodies, transplantation can take place. (Cedars Sinai, 2021) For example, SGH performed Singapore’s first blood group incompatible living donor liver transplant (LDLT) in 2017. The donor had blood group A+, while the recipient had blood group B+, but both recovered well. (Singhealth, 2018) According to data from the National Center for Biotechnology Information, the 5-year survival rates for ABO-incompatible LDLT were 71.0%, while that of ABO-compatible LDLT were 71.5%. (Lee et al., 2015) Hence, this shows that ABO-incompatibility transplantations are highly successful.

Furthermore, being young adolescents, I think that they may not truly understand the importance of organ donations. At their teenage age, it is unlikely that they have contracted severe diseases or experienced organ failures, hence they would not realise the pain one goes through of having such a life-threatening medical condition or a family member diagnosed with one. On top of that, they could be unaware of how significant just one organ donation can be when in fact, one organ donation can save up to 8 lives. (Live On, 2020)

Therefore, in my opinion, I think that youths’ inadequate understanding towards organ donations heavily limits their willingness to want to donate their organs. From this one root cause, stems into many more issues as misconceptions surface and the inability to recognise the crucial need for organ donations. Hence, the youths begin to dwell in unnecessary distress and concerns, all due to this wrong mind-set that they hold, thus hindering their willingness to donate and causing the apathy present in the youths today.

Being a multiracial and multi-religious country, many cultural issues arise pertaining to Singaporean’s willingness towards organ donation. The various races and religions have different spiritual beliefs that negatively influence people’s openness towards organ donation, especially with most youths following their parent’s religious footsteps and practices. Firstly, the Chinese and the Buddhists, believe that deeds in this life impact their chances of reincarnation (Wee, 1976b). Hence, they prefer to keep their body and organs intact in anticipation of human reincarnation, otherwise, they may be reborn with physical disabilities due to the donated organs. (Comber, 1969) For example, they are influenced by Confucian values, and by Buddhist beliefs that “associate an intact body with respect for ancestors or nature” (p. 449) (Childress, 2006). Secondly, the Malays and the Muslims, believe that their bodies are given to them by Allah in a pure condition and their bodies should be maintained, as such when they pass away (Nagata, 197 4). This belief comes from the Islamic understanding of the ‘primordial natural state’ enshrined in the verse of the Qur’an ‘This is the natural disposition God instilled in mankind-there is no altering Gods creation,’ (Q. 30:30). Hence, organ transplantation in both iterations, reception and donation are not allowed. (Ali, 2020)

In 2018, Professor Jean Liu from Yale-NUS college conducted a cross-sectional survey assessing 567 Singaporeans’ reasons for their uneasiness towards organ donation as a function of ethnicity. Results showed that Malays participants expressed stronger discomfort towards organ donation with higher concerns on 14 out of the 18, with fears ranging from funeral arrangements to blasphemy. Chinese participants were most anxious about the possible incompatibility of their organs, and Malay participants were most concerned about their body being dissected for organ donation (l.Ju, 2018). As seen, local taboos and beliefs from our diverse cultural background hold back Singaporean youths from organ donation.

In the legislative field, the Medical (Therapy, Education and Research) Act (MTERA) and Human Organ Transplant Act (HOTA) were enacted to encourage organ donation in Singapore (Tong et al., 2009). However, the terms of these legislations often result in apathy instead. A cross-sectional survey of the Singapore public on HOTA revealed that 79.3% of respondents were aware of the act (Kee et al., 2010) Despite Singaporeans being well-informed about both acts, the donation pool for HOTA is at 3 million in 2009 while that of MTERA’s is only at 45,202, 66 times lower (Tong et al., 2009). Since HOTA is a reciprocal system, people who opt-out have lower priority if they need a transplant, but this does not apply to MTERA. The great disparity in registered donors suggests that the majority of Singaporeans, including local youths, are only donating their organs to protect their self-interests and it is not truly out of empathy towards the scheme. This clearly highlights that most Singaporean youths are apathetic towards organ donation as if they willingly donate under HOTA, they should be willing to opt-in for MTERA.

In conclusion, I believe that Singaporean youths are apathetic towards organ donation, caused by many factors, ranging from medical risks, religious issues, commonly caused by the lack of information on organ donation, and thus actions such as public education can be taken so as to strengthen their willingness and empathy towards organ donation.

References

1. Cleveland Clinic. (2021 ). Organ Donation and Transplantation. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/11750-organ-donation-and-transplantation#resources ↗ (opens in new tab)

2. Tai, J. (2016, May 22). Organ donations remain low despite changes to law. The Straits Times. https://www.straitstimes.com/singapore/organ-donations-remain-low-despite-changes-to-law ↗ (opens in new tab)

3. Paraz, C.M.A., Truong, H.T.T., Sai, D.K. et al. Knowledge and attitudes toward corneal donation among Singaporean youth: a cross-sectional study. Eye and Vis 3, 17 (2016). https://doi.org/10.1186/s40662-016-0049-3 ↗ (opens in new tab)

4. Mayo Clinic. (2020). Living-donor transplant. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/Iivingdonortransplant/about/pac20384787#:-:text=lmmediate%2C%20sugery%2Drelated%20risks%20of,limited%2C%20and%20studies%20are%20ongoing ↗ (opens in new tab)

5. Varma, A., (2018). SGH working to raise awareness of living donor transplants. Singapore General Hospital. https://www.sgh.com.sg/news/patient-care/sgh-working-to-raise-awareness-of-livingdonortransplants#:-:text=%22Advances%20in%20medicine%20have%20meant.monitored%20closely%20with%20yearly%20checks ↗ (opens in new tab)

6. Cedars Sinai. (2021 ). ABO Incompatibility in Transplants. Cedars Sinai. https://www.cedars-sinai.org/programs/transplant-center/programs/kidney-pancreas/abo-incompatibility.html ↗ (opens in new tab)

7. Singhealth Duke-NUS Academic Medical Centre. (2018, September 20). SGH performs Singapore’s first blood group incompatible living donor liver transplant. Singapore General Hospital https://www.sgh.eom.sg/sites/shcommonassets/Documents/News/sgh-performs-singaporee28099s-first-blood-group-incompatible-living-donor-liver-transplant-/sgh-performs-singaoore-first-blood-group-incompatible-living-donor-liver-transplant.pdf ↗ (opens in new tab)

8. Lee, Chen-Fang. (2015, October). Adult Living Donor Liver Transplantation Across ABO-Incompatibility. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/26496313/#affiliation-1 ↗ (opens in new tab)

9. Wong, LP. (2010). Information needs, preferred educational messages and channel of delivery, and opinion on strategies to promote organ donation: A multicultural perspective. http://smj.sma.org.sg/5110/5110a4.odf ↗ (opens in new tab)

10. D, J. (2013). Social Marketing Initiatives: National Kidney Foundation’s Organ Donation Programs in Singapore. Retrieved from Social Marketing Initiatives: National Kidney Foundation’s Organ Donation Programs in Singapore. https://dr.ntu.edu.sg/bitstream/10356/80844/1/jppm%252E21%252E1%252E66%252E17613.pdf ↗ (opens in new tab)

11. Ali, M., & Maravia, U. (2020, February 21 ). Seven faces of A fatwa: Organ transplantation and Islam. https://www.mdpi.com/2077-1444/11/2/99/html ↗ (opens in new tab)

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13. Liu, J. (2018, April 2). Evaluating attitudes Towards organ donation in Singapore. https://lost.io/73x9j/wiki/home/ ↗ (opens in new tab).

14. 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 ↗ (opens in new tab)

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16. Bey, M.L. (2007, February 28). Youths turning 21 told about organ-transplant Act. The Straits Times, p.37.

17. Sua, T. (2007, February 8). Brain-dead man’s kin in scuffle over op to remove organs. The Straits Times, p.36.

18. Tong, K.K. (2009, April). The Transplantable Organ Shortage in Singapore - Has Implementation of Presumed Consent to Organ Donation Made a Difference? Annals Academy of Medicine, pp 346-353. https://www.annals.edu.sg/pdf/38Vo1No4Apr2009N38N4p346.pdf ↗ (opens in new tab)

19. Liu, W.Y. (2017, October). ls the Human Organ Transplant Act (HOTA) to Blame? Addressing Our Organ Shortage from a Public Policy Perspective. Annals Academy of Medicine, pp 392-394. https://www.annals.edu. ↗ (opens in new tab)

20. Low, D. (2016, May 24 ). Organ donation: Consider mandated consent. The Straits Times. https://www.straitstimes.com/opinion/organ-donation-consider-mandated-consent ↗ (opens in new tab)

21. Chong, J.L. (2016). Policy options for increasing the supply of transplantable kidneys in Singapore. Singapore Med J. 2016; 57(9):530-532. https://doi.org/10.11622/smedj.2016163 ↗ (opens in new tab)

22. Voo T.C (2021, February 4). Dealing with the difficult issue of organ donation when a loved one passes on. Channel News Asia. https://Uwww.channelnewsasia.com/news/commentary/death-organ-donatjon-how-to-deal-with-difficulty-hota-mtera-11554440 ↗ (opens in new tab)

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 ↗ (opens in new tab)