Joy Loke Jia Huan, 18

Topic: Ways to improve organ donation rates

Award: Second Place, Open Category, 2021

Lumen: Giving organ recipients the light of life

In Singapore’s ageing society, the prevalence of chronic diseases is mounting, and the need for organ donors will only increase. Currently, the local average waiting time for a kidney transplant is almost a decade long, which can in itself prove fatal. As a 17 year old deeply invested in our nation’s health, I humbly propose the following solutions under the acronym L.U.M.E.N, Latin for “light of life”, to improve local organ donation rates and counteract the short supply.

Leverage Current Opportunities

Before the COVID-19 pandemic struck, events such as the Donor Appreciation Ceremony (DAC) and the Wellness Carnival were held to honour deceased organ donors and increase awareness of the benefits of organ donation respectively. Though such large-scale physical events may not be currently feasible, the pandemic has also opened up opportunities. Singaporeans are now more in touch with the value of good health and the fragility of life, which may help them become more willing to engage with sensitive issues like deceased organ donation. Hence, it is crucial that we shift DAC and the Wellness Carnival online, to provide valuable avenues for learning and meaningful public discourse.

Activities like the myriad of games and simulations at the carnival can be transformed into an interactive, permanent online experience. Heartfelt discussions and sharings via applications like Clubhouse will also dismantle one’s reservations regarding organ donation, and provide a platform for donor recipients to share their stories. To add a personal touch to these online initiatives, certain facets of past physical events can be retained. Appreciation gifts to families of organ donors and the Wellness Carnival’s lucky draw prizes can be delivered straight to intended recipients’ doorsteps. Maximising inclusivity is also paramount - online resources should be made available in the 4 official languages, and brochures should continue to be provided for people without access to the Internet.

Hosting these two events online will remind Singaporeans that the need for organ donations and our gratitude towards organ donors have certainly not diminished, even in the backdrop of a pandemic.

Understand other perspectives (and alleviate concerns)

Rather than assume the reasons behind Singaporeans’ aversion towards post-mortem organ donation, we should strive to understand their perspectives instead. For starters, the Human Organ Transplant Act (HOTA) opt-out form can include a section for people to share their concerns, worries, and other reasons for not donating. This will allow us to better plug the gaps in public awareness and clarify commonly held misconceptions. At the same time, organ donation is ultimately a very personal and voluntary decision, and we must refrain from demonising those who do not wish to enrol.

To alleviate the fears and concerns potential living donors may have, the Ministry of Health (MOH) can also provide more financial safety nets. Financially covering living organ donation-related procedures could be a good first step to aid potential organ recipients and donors who are unable to foot the costs- such is already the case for post-mortem organ donation. Furthermore, though the risks associated with organ donation are not high, it may be difficult for Singaporeans to risk putting their health in jeopardy, especially if they are their family’s main breadwinner. Monetary support for living organ donors can be explored, in the form of medical insurance for complications which may arise, as well as paid hospitalisation leave. Potential donors, especially those self-employed or working part-time, may not otherwise be able to miss work to recuperate from the surgical procedures. These safety nets will financially enable altruistic organ donations, encouraging more Singaporeans to rise to the occasion.

Mandatory opt-out procedures

Presently, Singaporeans can opt out of HOTA by filling out a form, and there lacks a follow up attempt to understand and allay their fears. MOH can consider kickstarting a mandatory course for those who choose to opt out, with the aim of clarifying certain misconceptions about organ donation, and exemplifying its importance. Such a course can take place in the form of a workshop featuring roundtable discussions and sharings by organ recipients. While the course should not coerce or force Singaporeans to change their minds, there is great potential for misunderstandings like “Organ donation makes having an open-casket funeral impossible” to be quickly clarified. Even if it ultimately does not change Singaporeans’ decision to opt out, the course may allow them to become more understanding and supportive of organ donation.

Educate

Indeed, donating one’s organs is a fully altruistic act. To convince Singaporeans to donate their organs, perhaps they must first understand the innate value and significance of doing so. Hence, I propose that learning about organ donation be embedded in our education system. Starting from primary school, students learn about the intricate inner workings of organs in Biology class, from the liver’s multitude of functions to the corneas’ role in allowing us to read these very words. However, most lessons revolve around normal organ function, making concepts like brain death and organ failure relatively foreign to students. The addition of a module addressing organ failure and donation will greatly enrich their learning, and simultaneously remind them to care for their physical health. Through listening to stories of how organ transplants have transformed their recipients’ lives, a deeper appreciation and understanding of what our organs are capable of can be cultivated. As younger Singaporeans already tend to be more willing to donate their organs, the module may even encourage them to take their spirit of giving a step further by opting in for the Medical (Therapy, Education and Research) Act (MTERA), the voluntary scheme that greatly benefits local medical research and education.

A sample lesson structure could look like this:

1. Building on students’ existing knowledge of biology, for example the visual system, describe how the cornea can damage upon infection or chronic conditions, and the debilitating blindness that may result. [20 minutes].

2. Simulate life without eyesight: blindfold students and let them attempt a mini obstacle course, or navigate daily tasks. [10 minutes]

3. Explain corneal donation procedures, and screen a video sharing by a cornea recipient. [10 minutes]

4. Introduce HOTA and MTERA, emphasising the fact that everyone can enrol in the two. [10 minutes]

5. Kahoot quiz on the information learnt! [10 minutes]

New HOTA consent system

At present, Singapore automatically includes its citizens and permanent residents under HOTA when they turn 21 years of age, though opting out is possible. However, according to a 2019 Channel NewsAsia article, some families of eligible donors (who have been declared brain-dead) doubt their loved one’s understanding of, or consent to HOTA, and consequently object to the organ donation. Given the highly emotive circumstances these families are placed in, and the fact that their loved one can no longer make their wishes known, this outcome is understandable but unfortunate. To prevent such instances from occurring, I propose that Singaporeans be asked to reaffirm their opt-in status to HOTA, via a physical form or national online platforms like Singpass. This is not to replace the current opt-out system, but rather act as a safeguard in the event that the donor’s consent comes under doubt. The benefits are multifarious: Families of eligible donors may cope better knowing definitively that they have followed their loved one’s wishes. Simultaneously, this will help dispel apathy towards organ donation, as Singaporeans can mull over the issue and do their research before reaffirming their opt-in status, and thereby become more convinced. While some may believe that asking Singaporeans to do so will only increase opt-out rates, it is not sustainable to have an opt-out system reliant on potential donors’ ignorance. After all, consent based on a lack of understanding may breed misconceptions regarding organ donation, and resistance from eligible donors’ family members. If implemented alongside the other proposed measures, I believe that this policy tweak can prevent ambiguity, and help society become more receptive to organ donation especially in the long-term.

Organ donation is not only life-saving, it also has immense restorative power. It can liberate organ recipients from painful and lengthy treatments like dialysis, and grant their families the immense comfort that the health of their loved one has been restored. We as humans hold so much potential to not only live, but to give others “lumen” via organ donations. Through L.U.M.E.N, I sincerely hope that there will be more organ recipients able to experience the light of life.

References

1. Baker, J. (2019, May 5). There were a total of 504 deceased donor organ transplants last year, 88 per cent of which were cornea transplants. Retrieved April 29, 2021, from CNA website: https://www.channelnewsasia.com/news/singapore/human-organ-transplant-act-doctors-families-understanding-11459284

2. Organ Donation in Singapore (under HOTA, or For Science). (2018, October 26). Retrieved April 29, 2021, from SingaporeLegalAdvice.com website: https://singaporelegaladvice.com/law-articles/organ-donation-in-singapore/

3. What is HOTA all about? (2013, August 21). Retrieved April 29, 2021, from Www.gov.sg website: https://www.gov.sg/article/what-is-hota-all-about

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