Benjamin Tan Hong Yu, 16

School: Chung Cheng High School (Yishun)

Topic: Conservative culture a root cause of low donation rates?

Award: First Place, Senior Category, 2022

“At times our light goes out and is rekindled by a spark from another person.” This is certainly true for donating organs. Life is often unpredictable, anything can happen. Accidents, diseases and misfortunes can strike anyone anytime, bringing them to death’s doorsteps. In times like this, a donation of organs from someone can become the spark to the burning embers of another’s life, relighting the flames of their lives and providing a brighter future for them. Organ donation saves lives and brings hope to millions. Unfortunately, organ donation rates remain low, especially in countries like Singapore. Despite having one of the world’s most distinguished health care systems and the presence of legislation that presumes all citizens as organ donors unless they choose to opt-out, the number of organ donors per million population annually in Singapore remains comparatively lower than other developed countries such as the United States. Some people have pointed fingers at Singapore’s conservative culture as the main culprit, claiming that it has caused people to be reluctant to donate due to their desire to uphold tradition and religious beliefs that are in conflict with organ donation. However, I strongly disagree that Singapore’s conservative culture is the root cause for its low organ donation rate because it is a smaller factor given that most people in Singapore are increasingly accepting towards organ donation and also the fact that larger factors such as a lack of knowledge on organ donation and a flawed donation system are in play.

Firstly, one key cause of the low donation rates in Singapore is the inadequate knowledge of the general public on organ donation. While the government has taken steps to raise awareness by updating and informing the public about the Human Organ Transplant Act (HOTA) and organ donation, it remains that the general public in Singapore continues to lack adequate knowledge about them. This is a crucial problem because it affects the willingness of people to donate their organs after death as well as the acceptance towards the donation of organs of their deceased family members. For example, a study conducted in Singapore which involved the interviewing of 799 participants living in Singapore, found that only 38.3% of participants had known that HOTA was an opt-out system. The same study also established that this knowledge was a strong determining factor in a person’s willingness to donate their organs after they die. Moreover, it was also found that more than 80% of the participants did not know that the certification of brain death is a stringent process and around 50% of the participants did not know that brain death was irreversible. Understanding brain death is highly important because an organ transplant will take place once a patient is considered brain dead to obtain organs that are the most viable for organ transplants. Patients who are deemed brain dead lose all cognitive function with no chance of recovery. However, processes such as breathing and the beating of the heart may still continue even after the patient is deemed brain dead. Consequently, the lack of knowledge thereof can be hugely problematic. Lacking the knowledge that brain death is irreversible, family members are given the false hope that there is still a chance for the patient to recover. Believing that it is too soon to give up on saving the patient or doubting that the process to determine whether the patient is brain dead is stringent, they may become reluctant to allow their deceased relative’s organs to be donated and attempt to delay the organ donation process. Given that organs lose viability for transplant within one to two days, such delays can eventually result in potential organs becoming unsuitable for an organ transplant. Hence it can be seen that it is the lack of knowledge that is the root cause and not the conservative culture in Singapore that is responsible for the low organ donation rates in Singapore.

Additionally, the low organ donation rates in Singapore may also be attributed to the flaws within the organ donation system itself rather than conservatism. Singapore utilises a presumed consent system in order to address the rising demand for organ transplantation within Singapore. This means that anyone of age and are healthy is obligated to donate their organs such as the liver, heart and corneas when they die unless they choose to withdraw from it. Consequently, due to the lack of an explicit statement from the deceased to prove that they had agreed to donate their organs, family members are often left in the dark about the decision made by the deceased. Hence, when it becomes time for the organs to be taken from the deceased family member, it comes as a shock to family members for their deceased relatives to have their organs donated. Family members refuse to believe the validity of the consent and argue that it is against the will of the patient. This spurs them to resist greatly against having their family member’s organ harvested for organ donation, resulting in delays and complications that can potentially cause the organs to become unsuitable for an organ transplant. Moreover, family members can also request that their family members be withdrawn from cardiopulmonary support prior to the certification of brain death. In doing so, it prevents the criteria of brain death certification from being met, causing the consent to donate the organs to not be obtained. This has resulted in the loss of many potential donors and was responsible for causing around 56.7% of potential donors in Singapore from actualising in 2007 alone. By creating reluctance within families to cooperate and also having loopholes for all people to circumvent organ donation, it is evidently clear that it is the result of the flaws within the organ donation system and not the conservative culture that is causing the low organ donation rate.

On the other side of the spectrum, proponents may argue that Singapore’s conservative culture is indeed the root cause of the low organ donation problem, citing that people in Singapore prefer to stick to their beliefs and traditions and thus refuse to donate their organs. Some religions and beliefs embrace the idea of the wholeness of the body which is in direct conflict with the idea of donating one’s organs. Moreover, organ harvesting is taboo in some religions and beliefs. These religions and beliefs preach the idea that the deceased must have all their body parts intact to ensure a smooth transition into the afterlife. This is especially so in Asian societies such as Singapore where beliefs such as Confucianism are more prevalent. Confucianism preaches the idea that the bodies of individuals must remain fully intact even in death to uphold the moral of filial piety. As such, for a country typically considered conservative, it would be expected that many Singaporeans retain such conservative views and refuse to donate their organs in order to stay true to their beliefs. As a result, there would be a lower number of willing donors, causing organ donation rates to remain low.

While it is certainly true that there are people in Singapore who have conservative views towards organ donation, it must be noted that Singapore is becoming increasingly open towards organ donation. With the help of education and awareness provided by the government, people in Singapore are starting to understand the importance of organ donation and are becoming more willing to donate their organs after death. Based on a survey conducted by Hwa Chong Institution on 281 Singaporeans, it was found that those below thirty were very receptive to the idea of organ donation. Almost 80% of them stated that they would be willing to donate their organs after they die. Those who were between the ages of 30 and 60 were also relatively supportive of organ donation, with 60% of them stating they would donate their organs. The elderly were the least supportive with only 20% stating they would do so. Contrary to popular beliefs, the reason behind the low willingness to donate organs of the elderly was not because they were likely to be more conservative but because they felt that their organs were unsuitable for donation. This further disproves the notion that the conservative culture within Singapore is the main source of the low organ donation problem.

In conclusion, I strongly disagree that conservative culture is the root cause of its low organ donation rates because while there are people who continue to stick to their beliefs and superstitions, the majority of the people in Singapore remain supportive of organ donation. Moreover, inadequate knowledge, as well as flaws within the existing organ donation system, are the greater sources of the problem at hand as opposed to conservatism. Ultimately, what is more important is that the government, medical sector and people take progressive steps towards organ donation by refining existing policies and cooperating with one another. In this way, more flames can be rekindled and be given another chance to obtain a brighter future.

Disclaimer: Please note that the views and opinions expressed in the essays for the Live On Festival 2022 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