Dinesh Sanmugam, 16

Victoria School

9 January 2022

Conservative culture a root cause of low donation rates?

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School: Victoria School

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

Award: High Distinction, Senior Category, 2022

Eight. That’s the number of lives one can save apart from restoring sight of 2 others. While that number is inspiring, Donate Life America reports that through tissue donation, just one donor can bring joy to or enhance the lives of 75 others. However, although organ donations seem to have such an impact on so many others, why are donation rates still so low? Why haven’t Singaporeans embraced this culture of donating organs with a warm welcome? It is undeniable that there are a plethora of factors affecting this local and global issue. However, can one go as far as to say that Singapore’s conservative culture is the root cause for low donation rates? Or is socio-economic status and level of education a deciding factor for not only recipients but donors too? I wondered if Singapore’s conservative culture was the root cause of these low donation rates. Are people too deeply embedded in their strongly woven roots such that they are unable to change to save countless lives?

A collaborative study titled: ‘A Multiethnic Asian Perspective of Presumed Consent for Organ Donation: A Population-Based Perception Study done by professors in Singapore’s tertiary institutions such as National University of Singapore (NUS), Nanyang Technological University (NTU) and National University Hospital (NUH) aimed to understand public sentiments and different barriers toward organ donation from the perspective of Singapore, a highly diverse and multiethnic Asian society. The study concluded that despite implied consent regulations in Singapore, organ donation rates remain low due to patient-level impediments such as disparities, cultural norms, religious backgrounds, and emotional effects upon relatives’ deaths. They even included that it is critical for policymakers to engage in public education as well as strengthen transplant provisions and family protocols in order to successfully raise donor rates. Hence, I would posit that low organ donation rates is not mainly due to Singapore’s conservative culture but can be attributed to a multitude of reasons such as societal beliefs, emotional attachment by loved ones of the deceased, inadequate awareness, and knowledge regarding organ donation. If we, as a society, are able to change our mindsets and become more aware of the impending problem of low organ donation rates, I strongly believe that Singapore can become an example to the world of how to turn around organ donation rates.

Singapore’s conservative culture is tied to our religious beliefs and has resulted in a wide array of unique viewpoints from Singaporeans of all walks of life. Unfortunately, there is a substantial amount of grey area concerning organ transplantation for deceased individuals as donors due to conflicting ideologies and mindsets within religious groups. The sheer ambiguity of this issue can even result in members from the same religion having contradictory viewpoints. The Christian Science Board of Directors has explored the subject of organ donation, and organ donations and transplantation; acknowledge that it is an individual’s right to consider based on his/her own beliefs and understandings. Although, according to the U.S. Department of Health and Human Services (HHS), leaders of all major religions have determined that organ donation is one of the most altruistic gestures to mankind, Muslims have a custom of being buried within 24 hours. Therefore, a protracted organ removal operation may induce an unwillingness to donate organs in fear of not being able to follow usual practices. For example, the spiritual ‘mind,’ according to Tibetan Buddhism, can linger in the body for days after the breath has stopped. Only its departure is considered the genuine moment of death, and the corpse should be left alone until that period. Any interference to this process might be detrimental to the person’s future rebirth. These concerns are at conflict with Buddhism’s fundamental idea of generosity (dona), or selfless giving. Buddhist scholars arrive at diverse interpretations of this quandary. Some are adamantly opposed to posthumous donations, while others leave it up to the individual. Hence, even though donating organs is widely endorsed by most religions, practical considerations must be taken into account to eliminate any problems from arising and causing unnecessary mayhem.

On a societal level, Singapore’s many ethnoreligious groups share characteristics such as the belief in reincarnation and the necessity for the corpse to be entire when buried, resulting in an unconscious prejudice against organ donation, despite the fact that all major faiths in Singapore support it. Furthermore, in Asian countries, themes such as death are taboo, leading to a reluctance to communicate one’s dying wishes with one’s family. Family members are unclear about their loved ones’ final intentions, as well as whether organ donation is against religious or cultural views, due to a lack of communication and explanation of opinions. Given the ambiguity, most families prefer to be conservative and refuse to give their loved ones’ organs. While our conservative culture and societal beliefs tend to overlap regarding to why Singapore has such abysmal organ donation rates, I can conclude that Singapore’s societal beliefs indeed is a roadblock towards Singapore’s goal of having higher organ donation rates and is not only due to religious reasons (conservative culture)

Not only that, familial relations tend to be the most common source of resistance. They are undoubtedly too attached to deceased patients to accept their deaths or to doubt brain death. As a result, when doctors approach families who are distressed, questions regarding whether everything possible has been done to rescue loved ones are raised. These concerns provide families with the justification to seek alternative medical advice. As a result, valuable time in the window of opportunity for organ donation is lost. Furthermore, despite the fact that all of Singapore’s major religions favour organ donation, discussing it and afterlife planning in general remains taboo among Singaporeans. The inferred agreement of HOTA is sometimes not recognized by families if personal opinions on organ donation are not made clear before death.

Knowledge enhances willingness to donate and willingness to assent to organ donations of familial relations. With reference to research done by several renowned professors in Singapore (paragraph 2 above), one can conclude that a remarkable number of Singaporeans are unaware of several simple facts regarding organ donation. It is indeed human nature to not support something we are not fully familiar with. Out of the 14 knowledge questions, the most common misconception was that brain death certification was not a stringent process with only 11.5% of the respondents knowing this. Only 12.5% of the respondents knew what are the four organs covered under the HOTA namely the kidneys, liver, heart and corneas. Correct answers to questions concerning brain death testing had the highest association with being willing to assent to the donation of family members’ organs. Knowing that brain death is irreversible and knowing that organs could be procured from brain-dead patients were the strongest predictors of willingness to assent according to this study. However, being aware that HOTA was an opt-out system, based on presumed consent, was the strongest predictor of willingness to donate their organs. There was a significant positive association between the number of questions answered correctly and willingness to donate. This was also seen between the number of questions answered correctly and the willingness to assent in the clinical scenario.

Ultimately, it is evident that Singapore’s low organ donation rates are related to factors such as the country’s conservative culture, cultural views, emotional attachment by the deceased’s loved ones, and a lack of awareness and information about organ donation. Is it accurate to suggest that Singapore’s conservative culture is at the root of the problem? It’s logical to assume that a lack of information is the primary reason why Singaporeans are hesitant and do not feel obligated to donate their organs or those of their family members. If Singapore educates us, Singaporeans, from a young age about the necessity of organ donation and teaches us what it means, organ donation rates will undoubtedly increase in the near future, saving many precious lives that we humans cannot afford to lose.

References

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