Teh Keng Heng, Travis, 16

School: St. Joseph’s Institution

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

Award: High Distinction, Senior Category, 2022

Shackles No More, We Can Do More!

In Singapore, the need for organ transplants is projected to rise. With the advent of modern medicine, the life expectancy of individuals across the world has drastically increased, and Singapore is no exception. As our population ages, we will undoubtedly require more donors to cater to the inevitable increase in chronic diseases ever so present in old age. The importance of organ donation is undeniable, yet, why is it that Singapore has such a low organ donation rate? In my personal opinion, I believe that Singapore’s conservative culture, compounded by a lack of information and awareness in the Singaporean psyche on organ transplants are the reasons for the low organ donation rates.

The superstitious and religious beliefs of conservative Singaporeans can be attributed to the low organ donation rate. In Singapore, our populace is diverse and hail from a multitude of different backgrounds and cultures, practising unique customs and traditions. In some of these cultures, there is a stigma against organ transplants.

Take for example, the Chinese community. Among the Chinese community, one said stigma is known as “死无全尸”, translating to ‘dying without a whole body’. This stigma stems from the fact that it is believed that your physical body would be the one you possess in the afterlife. Thus, the removal of any body part entails the inevitable suffering from some form of handicaps. It could be blindness if one’s cornea has been donated or the dead might find itself without a heart or a kidney for that matter. Such superstitious beliefs evoke a crippling fear in people. Who is to blame relatives for feeling the haunting guilt should they decide to sign on the dots to agree to donate the organs to another? No doubt, it is easy to see why people can be apprehensive about organ transplants. While ironic, no one wants to cause more suffering to the dead.

Furthermore, Confucian philosophy, widely practised among the Chinese, Koreans and to an extent the Japanese and Vietnamese, strongly discourages altering your body. Confucian philosophy states “身体发肤，受之父母，不敢毁伤，孝之始也”, translating to ‘your hair and skin are endowed to one by one’s parents, and the beginning of filial piety is to dare not damage it’. This quote from the Book of Filial Piety [孝经], applies not just to the hair and skin, but rather is interpreted to refer to the entire body. Filial piety is one of the fundamental bedrocks of Confucian customs and being filially pious is one of the greatest virtues a person could ever possess. As such, to remove any body part, even for an organ transplant, can be seen as a major insult to your parents, for it is technically their property to begin with. Additionally, since to not damage or alter your body is given so much emphasis, so much so that it is considered the beginning of filial piety, it is no wonder conservative Confucians would refuse to donate their organs.

Another example would be the Muslim community of Singapore. The Quran, the Islamic Holy Book, explicitly states that to mutilate or burn a body is forbidden. Since organ transplant involves the removal of body parts from the body, organ transplants can be seen as violating the Quran. However, the Quran also states that to save a life, would be equivalent to that of saving the life of all of humanity, which organ transplants certainly do. This has led to discussions among the Muslim community on whether or not to allow organ transplant for followers of the faith. In 2014, a survey of Imams (Muslim religious leaders) was conducted in the city of Kahramanmaras, part of the Republic of Turkey, a majority Muslim country. The survey found that 78.6% of Imams agreed that organ donation was compatible with Islamic doctrine, while 1.6% said the contrary and 19.9% did not know. While the survey was not conducted in Singapore and should not be taken to reflect the overall sentiments of Singaporean Muslims towards organ donation, the survey is indicative of the generally positive opinions of Muslim towards organ donation,

However, this alone cannot truly be the entire cause of Singapore’s low organ donation rates. After all, as increasingly more western influences permeate among the younger generation, surely superstitions and beliefs held by the older generation would erode and make way for a more rationalist scientific mindset? This should in theory lead to higher organ donation rates, as an increasing number of people are no longer bonded to rigid traditions and customs. Yet, the opposite is true. The culprits are none other than the lack of information and interest in organ donation. This factor has exacerbated the shortages of organs available in Singapore for transplants. People in general are either still hesitant about it or are unsure about organ donation. Watching popular modern medical dramas such as “Grey’s Anatomy” or “The Good Doctor”, we often see the importance of organ donation, with bed-ridden patients desperately waiting for potential donors to give them a hopeful lifeline. Even so, in the public consciousness, donating organs is seemingly never spoken about.

My belief is that a lack of accessibility to the subject of organ donation prevents people from acting on this subject. If a person wanted to donate their organs to help others, he or she might not know how to do so. When one does an online research on the topic, they may be greeted by walls of text that seem intimidating to read, with jargon that is foreign and unfamiliar to them. They may also forget when visiting their doctor for checkups, or may be too timid to ask. In addition, they may not know the requirements for organ donation and if there are any associated costs. Some simply forget altogether about organ donation after turning off their televisions or smartphones and do not pay it any mind. The lack of widespread information and discussion on the topic of organ donation is hindering organ donations. Regrettably, the uncertainty, coupled with the chiding of more traditional family members, may discourage potential donors from taking the leap and reaching out. Donors might feel awkward asking about organ donation and would feel discouraged by the lack of support. Slowly but surely, their interest in organ donation would wither away, thereby contributing to Singapore’s low organ donation rates. With greater publicity and outreach efforts, the situation can be reversed.

In conclusion, while the importance of organ donation cannot be overstated, Singapore’s conservative culture, combined with the lack of knowledge and discourse over the topic, has contributed to a low organ donation rate. To combat this, the subject of organ donation must be given a priority and its narrative promoted at all levels. The subject can be made a way of life of the Singapore populace through education where relevant information is available to the public. In this way, individuals would finally start to gain the confidence to muster up the courage for the selfless act of donating an organ.

References

1. https://pubmed.ncbi.nlm.nih.gov/25402268/

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