Astin Yeo, 16

School: Nan Chiau High School

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

Award: Second Place, Senior Category, 2022

With the ever-dismal number of organ donors in Singapore, the future of organ transplant cases here is looking bleak. According to Channel News Asia, there were a risibly meagre 6.6 donors per million people in Singapore in 2017. We may ask ourselves: how did our healthcare system reach this state? Amid this predicament, we may find an answer from the prevalent conservative culture in Singapore. That said, not all passivity towards organ donation should be associated with a conservative disposition - there are other burgeoning issues that continually waned the will of people to donate their organs.

First and foremost, we may like to expound on the concept of conservatism based on cultural beliefs and deviation from tradition. In this respect, a main form of conservatism in Singaporean culture can be attributed to religious beliefs. According to a research study by Frontiers in 2021 on organ donation in Singapore, 19.9% of the individuals cited religion or superstition as the main reason for not assenting to donate their kins’ organs. Evidently, religious perspectives are a significant factor affecting organ donation. However, there is actually no formal religious consensus that prohibits organ donation as a whole. Some religious communities do oppose it due to a perceived desecration of the body, but this is a highly debatable sentiment, considering the lifesaving help organ donation provides. Understandably, organ donation has been a controversial issue, as this is a relatively novel breakthrough in medicine that would have been beyond the wildest dreams of the founders of these beliefs. Nonetheless, in the context of Singapore, her most followed religions stipulate it as a permissible action, with some even encouraging their believers to do so to some extent. Since the central motive of organ donation is to help others and preserve life, it is rendered a noble sacrificial act, which is in line with many religious teachings. With all that being said, why do many people still turn to religion to justify their aversion to organ donation?

The issue of using religious justification may be explained by two separate camps of these non-participants: one camp being those possessing this knowledge yet remaining passive, and the other still obstinately clinging to their misconceptions of religious beliefs. We can suppose the former may be opting to play safe and conform to a larger religious demographic. As seen in the survey, we know that many religious communities seem to display an aversion to organ donation. Some believers may want to avoid stirring up a heated religious discourse concerning organ donation with their fellow believers, so a passive approach would be most anodyne. Another reason could be to avoid the slim chance that organ donation would nevertheless still be an infringement on religious doctrine, and consequently steer clear of committing any sins in this aspect. In this context, it is pertinent to stress that the latter may have been misinformed about the position of religion on organ donation, and thus resort to using religion as a justification for opting out of organ donation.

Another lens from which we can view the widespread inertia of Singaporeans towards organ donation is in terms of the common man’s general aversion. Due to the relatively novel nature of a social responsibility such as organ donation, the people’s lack of familiarity with the subject matter may perhaps be commensurate with a lack of understanding. Education, or its lack of emphasis thereof, plays a major role in determining the people’s attitude, or specifically, willingness to become donors, as they cling to more traditionalist mindsets that favour inaction. This issue of incomprehension can be explored from a few perspectives: a lack of urgency, general misconceptions, as well as the diffusion of responsibility.

First and foremost, the lack of urgency stems from the extent of one’s internalisation of the idea that organs are scarce, rather than their complete ignorance about it. They may be knowledgeable about the subject of organ donation, but this acknowledgement does not go beyond that level of shallow awareness. This situation may be accounted for by the gap between a rudimentary level of acknowledgement versus genuinely implementing action; drawing upon an analogy, though one may know the detrimental effects of smoking offhand, this would not mean one would take deliberate action to curb excessive smoking - a person may recognise the implications of smoking, but be simply indolent. This paucity of urgency stems from an alienation of personal responsibility from this societal issue, better known as apathy. As the moral imperative to donate and one’s aversion are irreconcilable forms of cognition, the cognitive dissonance may cause the non-donor to feel guilty for his or her passiveness. To offset this frustration, the mind is more inclined to remain in the relatively more comfortable, customary mental state of dispassionate non-participation. However, this state of indifference also encourages and sustains a perpetual cycle of refusal of organ donation.

Secondly, it is also possible that people have misconceived the myriad aspects of organ donation, or rather do not possess sufficient knowledge of the situation. There is a positive correlation between the inclination to donate and one’s level of cognisance regarding organ donation. According to a survey of residents from Frontiers, those who scored more knowledge questions correctly were more willing to donate their organs. Conversely, those who fared worse, indicative of a lack of understanding, were more opposed to donation. There is also a possibility that many Singaporeans have misconstrued moral doctrines, which was briefly reflected in the second paragraph. In this case of religious conservatism, numerous interviewees cited religion as a reason, even though all the representative organisations of primary religions in Singapore declared donating organs to be permissible. This sheds light on not only a pervasive spate of medical misunderstandings, but also ideological ones that have embedded themselves in a ‘culture’ of aversion towards organ donation.

Last but certainly not least, the diffusion of responsibility contributes greatly to the issue of a lack of participation. Simply stated, responsibility diffusion is where a person is less likely to hold themselves accountable for an action or inaction owing to the presence of bystanders, who are similarly perceived to be culpable. This theory of individuals morally disengaging themselves from action explains rather impeccably the context of Singapore’s abysmal organ donation rates - with the constant self-assurance that someone else will donate their organs, those who are unwilling would consequently be idle towards contributing to this sector. Similar to the aforementioned issue of the lack of urgency, this biased psychological disposition could function as an ostensible facade to the real reason that they are too conservative, in the process resulting in the unwillingness to donate their or their next-of-kin’s organs.

However, one cannot simply pin the blame for aversion towards organ donation on factors that contribute to and sustain a country’s conservative culture - there are other factors at play that may diminish her people’s willingness to donate.

One such factor is borne out of the emotional need of individuals, which can be reviewed in the context of both living and deceased donations. From the perspective of living donors, these potential donors may have reservations about donating their organs. As an entity of one’s body, one would certainly feel a sense of hesitation and reluctance in giving it away. Besides, this stems from an individual’s sense of control. The latter case of deceased donations eponymously implies death, and certainly, the enervating vacuum of helpless shock and despondent grief would imminently displace the mental faculties of reasonable thought. In a survey from Frontiers, 40.3% of interviewees cited being too emotionally involved to make a decision on whether or not to give the green light for their dead next-of-kin’s organs to be donated, under the Medical (Therapy, Education and Research) Act (MTERA). Grief is an essential part of the human psyche that cannot be neglected - in fact, the last thing family members think about is organ donation whilst in the mournful period of their loved one’s untimely departure. Understandably, in the fits and throes of rampant emotion, all rhyme and reason would be carelessly thrown out the window, much less a favourable reply to a proposed organ donation.

To summarise, I agree that the paucity of organ donors has been largely due to Singaporeans’ conservative take on organ donation. Compounded by the community’s egregious lack of comprehension on this subject, the volition to donate organs for many remains a velleity at best. Despite the plausibility that people evade organ donation out of a sense of self-concern, it is my belief that ultimately a close-minded, conservative community culture has impeded our medical community’s arduous journey in aiding many a patient on the waiting list.

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