Chay Li Teng Marianne, 16

School: CHIJ St. Joseph’s Convent

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

Award: High Distinction, Senior Category, 2022

Understanding Our Organ Donation Rates

Introduction

Singapore is home to more than 5.6 million people. For such a substantial number of people living in this country, it is rather disheartening that our organ donation rates remain low at 6.6 organ donors for every one million people (Baker, 2019). The reason why Singapore’s organ donation rates stand this alarmingly low may be attributed to certain sociocultural practices within our society, but may also be possibly attributed to other factors such as worries over health, and coping with difficult emotions while having to make a tough decision. Such reasons do have a significant impact on our low organ donation rates.

1. What is Singapore’s conservative mindset?

The word ‘conservative’, as defined by the Cambridge Dictionary, is the “tend[ency] to emphasise the importance of preserving traditional cultural and religious values, and to oppose change” (Cambridge Dictionary, 2022, Definition 4). By this definition, Singapore appears to be the epitome of ‘conservative’.

1.1 How culture and religion play a part

Singapore prides itself on being a multi-cultural, multi-religious nation, and much of our diversity stems from our strong belief in practising the various cultures and religions in order to maintain social cohesion. Given our diversity, our socio-cultural practices are deep-seated among many, and in this manner, Singapore holds a relatively conservative mindset. According to a study carried out by the Lee Kuan Yew School of Public Policy (LKYPSS), a total of 70 percent of male respondents and 69.6 percent of female respondents indicated that they felt religion was either of great importance or slight importance to them. The minority indicated that religion held no or little importance in their lives (Mathews et al., 2021). In the Singaporean context, the importance of religion, and in turn, upholding the principle values and beliefs of religions, takes precedence over organ donation‒an act deemed impermissible or discouraged by some religions due to varied understandings of death and bodily autonomy.

According to the National Kidney Foundation (NKF), the majority of largely practised religions, worldwide, do indeed support the donation of organs. However, some religions do not have explicit rules that support or oppose organ donations and remain relatively neutral on the subject (National Kidney Foundation, n.d.). Under such religions, it is entirely up to the individual to decide whether to donate their organs after death. Conversely, some religions do have explicit rules in place that strictly oppose or discourage the donation of organs. To name an example, the need to keep a body intact during a funeral is of greater importance than organ donation to the Confucians. (Muthia et al., 2021). As presented in the 2020 Census report, 80 percent of Singaporeans are affiliated with a religion (Singapore Department of Statistics, 2020). This far outnumbers the percentage of secular Singaporeans, who are not likely to possess the same mindset towards preserving tradition. Our heterogeneous culture – where upholding traditional beliefs is prime – lies at the heart of this nation, and as a result, low organ donation rates are simply inevitable.

1.2 Population distribution and its effect on the majority

One point of view is that the distribution of our population sways our organ donation rates. At first glance, the distribution of our population may seem rather irrelevant to the argument that Singapore’s conservative mindset is the root cause of our low organ donation rates. However, according to an article by The Straits Times, a study conducted by the LKYPSS found that millennials displayed greater liberalism than their older counterparts (Tham, 2019).

A large proportion of the Singaporean population is those of the older generation, with 65.1 percent of the population between the ages of twenty and sixty-five years, and 10.4 percent of the population above the age of sixty-five. This far outnumbers the younger population, which stands at 24.5 percent for those aged nineteen and below (National Population and Talent Division, 2021). Given the numbers, the percentage of Singaporeans who are more likely conservative significantly outnumber the percentage of Singaporeans–namely youths–who are more liberal. The mere uneven distribution of the various age groups in Singapore is sufficient to sway our organ donation rates, and it hence can be justified that Singapore’s conservative mindset is one of the sole causes for our low rates.

2. What About Other Factors?

While Singapore’s socio-cultural environment and its conservative mindset play a significant role in swaying our organ donation rates, the notion that it is the core factor instigating our scant rates is rather one-dimensional.

2.1 Uncertainty and Reluctance Surrounding organ donation

The concern of health is also a reason low organ donorship in Singapore can be attributed to. Based on a survey conducted by students from Hwa Chong Institution, the percentage of Singaporeans willing to donate their organs (by age groups) falls as their age increases and older Singaporeans were found to be less comfortable with donating their organs. This stems from the concern that their organs are unsuitable for donation as a result of old age and generally poorer health (Tan, 2014). From this survey alone, it is seen and worthy to note that having a traditional mindset is not the sole reason for the lack of organ donation. Singaporeans are held back by unallayed worries over the risks of organ donation imposed on the recipient, especially so if the donor is of old age.

On the other hand, though, the fear of possibly dying on the operating table if the operation goes awry also holds them back. Mrs Lau, an organ donor hailed as a ‘superhero’ by the recipient’s family, had donated a part of her liver to save baby Jayden Chong’s life. In an article written by Channel News Asia, Ms Lau recounted how she had cried silently to herself as she headed to the hospital for the operation, fully aware of the possibility of never seeing her three-year-old son again if the operation went wrong. At the hospital, she was informed of the possibility of death during the operation, yet she readily accepted it and went ahead with the operation. (Baker & Tang, 2018). Singaporeans actually have good intentions, and there have been notable cases where Singaporeans choose to donate their organs while alive to another, out of good will. But like Ms Lau, fear of the possibility of not coming out of the surgery alive makes one ponder it’s worth. It is understandable to fear death, and never be able to see the people one loves anymore in an attempt to save another’s life. Especially given the misinterpretation that only family members can donate their organs, many people are held back by these concerns. After all, why should one risk their life for a complete stranger? But this only goes to show that there are other reasons why our organ donation rates may be low.

2.2 Bereavement and its impact on a family’s choice

Finding oneself facing the pain and grief from the loss of a loved one is not something that can be easily accepted. But when the next-of-kin of a loved one finds themself in such a situation, a tough decision must be made: to donate or not to donate. Under the Medical (Therapy, Education and Research) Act (MTERA), if a person who has been certified brain dead did not previously pledge their organs to be donated under MTERA, it is then entirely up to the deceased’s next-of-kin to choose if they wish for the deceased’s organs to be donated. Unlike the Human Organ Transplant Act (HOTA), which requires all Singaporeans aged twenty-one and above to donate their organs after death (unless they have opted out), MTERA is not mandatory and applies to people of any nationality in Singapore (Ministry Of Health (MOH) of Singapore, 2020). However, bereavement is an emotionally-heavy challenge for the deceased’s next-of-kin to grapple with. The decision of whether the deceased’s organs should be donated on top of coping with bereavement may be highly upsetting, and many next-of-kin refuse to donate the deceased’s organs as they grieve (Channel News Asia (CNA), 2017). It is certainly difficult to think about organ donation during bereavement, and many would naturally be focused on wishing their loved ones well. This is why it is unfair to claim that Singapore’s conservative mindset is the sole reason for low organ donation rates.

Conclusion

In conclusion, many reasons may contribute to Singapore’s low rates. No one reason is more justified than another, and no one reason can be singled out as the core factor. However, shirking the blame on others in society should not be the way to go if we want to raise our organ donation rates. The focus should not be on who or what is to blame for low donation rates, but rather, on what can be done to raise these rates for the common good of our society. With a little more empathy, understanding and awareness surrounding organ donation, our rates are sure to rise. Slowly, but surely.

References

1. References are Baker, J. A. (2019, May 5). ‘Are you sure he is dead?’: Doctors struggle with families’ lack of understanding of HOTA. Channel News Asia. https://www.channelnewsasia.com/singapore/human-organ-transplant-act-doctors-families-understanding-887136 ↗ (opens in new tab)

2. Baker, J. A., & Tang, S. K. (2018, June 30). ‘When I saw this innocent baby facing death, I knew I had to do something’: Stranger who donated liver to 6-month-old baby. CNA. Retrieved March 5, 2022, from https://www.channelnewsasia.com/singapore/stranger-donated-liver-to-6-month-old-baby-820556 ↗ (opens in new tab)

3. Cambridge Dictionary. (2022, February 23). CONSERVATIVE | meaning in the Cambridge English Dictionary. Cambridge Dictionary. Retrieved February 28, 2022, from https://dictionary.cambridge.org/dictionary/english/conservative ↗ (opens in new tab)

4. Channel News Asia (CNA). (2017, October 21). Commentary: Promote expressed consent, even with presumed consent in organ donation. CNA. Retrieved March 4, 2022, from https://www.channelnewsasia.com/commentary/commentary-promote-expressed-consent-even-presumed-consent-organ-donation-994946 ↗ (opens in new tab)

5. Mathews, M., Teo, K. K., Tey, M., & Wang, A. (2021, February). IPS Exchange series - Our Singaporean Values: Key Findings From The World Values Survey. Lee Kuan Yew School of Public Policy. https://lkyspp.nus.edu.sg/docs/default-source/ips/ips-exchange-series-16.pdf ↗ (opens in new tab)

6. Ministry Of Health (MOH) of Singapore. (2020, June 30). MOH | The Medical (Therapy, Education and Research) Act (MTERA). Ministry of Health. Retrieved March 4, 2022, from https://www.moh.gov.sg/policies-and-legislation/the-medical-(therapy-education-and-research)-act-(mtera) ↗ (opens in new tab)

7. Muthia, M. D., Chua, M. S. H., Griva, K., Low, I., Lim, W. H., Ng, C. H., Hwang, J. Y. F., Yap, J. C. H., Lyer, S. G., Bonney, G. K., Anantharaman, V., Huang, D. Q., Tan, E. X.-X., Lee, G.-H., Kow, A. W. C., & Tai, B. C. (2021, October 5). A Multiethnic Asian Perspective of Presumed Consent for Organ Donation: A Population-Based Perception Study. Frontiers. Retrieved February 28, 2022, from https://www.frontiersin.org/articles/10.3389/fpubh.2021.712584/full ↗ (opens in new tab)

8. National Kidney Foundation. (n.d.). Religion and Organ Donation. National Kidney Foundation. https://www.kidney.org/atoz/content/religion-organ-donation ↗ (opens in new tab)

9. National Population and Talent Division. (2021). Overview. National Population and Talent Division. Retrieved February 21, 2022, from https://www.population.gov.sg/our-population/population-trends/overview ↗ (opens in new tab)

10. Singapore Department of Statistics. (2020). Infographic - Census of Population 2020 - Religion. Singapore Department of Statistics. https://www.singstat.gov.sg/-/media/files/visualising_data/infographics/c2020/c2020-religion.pdf ↗ (opens in new tab)

11. Tan, E. (2014, October 18). Youth most open to organ donation after death: Poll. Today Online. Retrieved March 4, 2022, from https://www.todayonline.com/singapore/youth-most-open-organ-donation-after-death-poll ↗ (opens in new tab)

12. Tham, Y.-C. (2019, May 2). Singapore society still largely conservative but becoming more liberal on gay rights: IPS survey. The Straits Times. Retrieved February 28, 2022, from https://www.straitstimes.com/politics/singapore-society-still-largely-conservative-but-becoming-more-liberal-on-gay-rights-ips ↗ (opens in new tab)

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 ↗ (opens in new tab)