Ma Weiyi, 15

School: Dunman High School

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

Award: Distinction, Senior Category, 2022

Stronger Within

An orchestra of machinery emits a staccato of whirs and beeps, awkward yet recognisable in its polyrhythmic nature. Professionals stroll in tailored laboratory coats, comforting the frantic eyes that shoot glances around the whitewashed walls of spiralling hallways, illuminated by a myriad of fluorescent lights.

In one austere room, family members huddle around an emaciated man lying in a hospital bed, their spirits clinging onto the last bits of hope they have. Uncontrollable tears moisten their grief-stricken faces, accursed with the knowledge that all good things eventually come to an end.

The man shuts his eyes and exhales for the last time.

His place in the world fades away, leaving an empty husk behind. As digital lines fall flat and emit a continuous stream of ringing, the tears flow faster than ever before, cries of anguish and agony brought into existence by the fact that not a single organ donor was available.

Singapore may be a first-world country that has shocked the world with its groundbreaking socioeconomic developments and rapid progressions since its independence merely 57 years ago, yet the nation still grapples with its dismally low transplant rates. There are only 5 organ donors for every 1 million Singaporeans, a statistic that hopelessly pales in comparison to other countries that receive up to 7 times our amount.

Although drifting into the direction of a more liberal society, surveys have shown that a large portion of Singaporeans share buttoned-down and conventional opinions on many topics. Singapore is still mostly governed by the People’s Action Party (PAP), a major conservative centre-right political party currently occupying 83 out of 104 seats in parliament. Paired with an increasingly ageing population, this gives way to the majority of Singapore’s citizens possessing traditional mindsets and expressing conservative views, thus resulting in public ignorance and a sense of general illiteracy towards modern issues such as LGBTQ+ rights, advanced technology, environmental justice, discrimination, and others. Unfortunately, this long list also includes healthcare, a fact that can be seen through a multitude of exemplary demonstrations, such as the anti-vaccination movement in Singapore in response to the ongoing coronavirus pandemic. Furthermore, there is a great disparity between the ethical values of those who are right-leaning and those who are left-leaning, as liberal individuals are focused more on equality and protection from harm. Therefore, many believe that the main reason for Singapore’s drastic organ donation conditions is due to its conservative culture accompanied by religious and ancient beliefs, with regards to Singapore’s reputation as a conservative society.

Are citizens in Singapore, a nation considered to be scintillating and progressive, still riddled with antiquated ideas? Is it true that old-fashioned approaches can do such severe harm, resulting in the death of hundreds of patients? Even with the implementation of the Human Organ Transplant Act (HOTA), are traditionalist views still hindering our advanced medical field, holding up Singapore’s queue for those who require organ donors? In my opinion, the answer to all of these questions is yes.

First and foremost, Singapore’s ageing population and conservative attitude towards organ donation practices acts as a massive contribution to the lowering of organ donation rates. Growing up in the past, older citizens may have more trouble understanding the mystifying mechanisms of modernity; experiencing childhood without the fancy technological advancements that society witnesses today can prove to be an disadvantageous aspect of one’s life when one peers into the perplexing world of modern healthcare. History states that the first organ donation occurred in 1954, indicating that those aged 70 and above today were born into a world where the mere thought of organ donation was considered to be a fantasy. In one interview conducted by Channel News Asia (CNA), Dr Will Loh, Consultant at National University Hospital, has observed “a culture change as traditional attachments to the physical body gets eroded”, discussing how “the younger generation of Singaporeans are more willing to donate their organs after death”, thereby indicating that older Singaporeans do not share the same eager attitude towards organ donation as the younger generation. Thus, it is likely that most senior citizens have doubts and concerns over the concept of organ donation, for they may not understand the intricacies of such an operation.

However, it seems that not only senior citizens have trouble acknowledging organ donation; anecdotal evidence from doctors suggests that entire families struggle to understand organ donation policies and practices with Singapore. According to another interview conducted by CNA, Dr Wong Yu Lin, senior consultant at Tan Tock Seng Hospital shares that even when families have come to terms with the death of their loved ones, “they do not want organ donation and cannot accept the presumed consent provided under HOTA”. Furthermore, in a survey conducted with over 60 intensive care physicians in Singapore who are involved in referring intensive care unit patients for brain death certification, more than 8 in 10 doctors highlighted a lack of awareness and acceptance of organ donation policies among family members. Therefore, it is without a doubt that ignorance within older Singaporeans over medical procedures has greatly caused struggles and misunderstandings between doctors and patients alike over the matter of organ donation.

By the same token, religious beliefs can also play a significant role in Singapore’s disastrous organ donor proportions. According to a 2020 census, Buddhism is the most popular religion in Singapore, with 31.1 percent of participants stating that they believe in Buddhism. In this religion, the preservation of a dead body is not seen as crucial, but the problem arises from problematic perspectives on the concept of brain death. Many believe that brain death does not count as “actual death”, refusing to give up patients due to the regard that a disturbance of spiritual consciousness may adversely affect the person’s next rebirth. The stance on organ donation between Buddhist scholars remains a controversial topic consisting of mixed feelings, with some vehemently opposing deceased donation.

Another instance is Confucianism, a quasi-religious belief system from ancient China, is a common philosophy developed from the teachings of ancient Chinese philosopher Confucius. This philosophy is a common sight in many regions of Asia, and dictates that an intact body is needed in the afterlife. One Confucian teaching states that “body, hair and skin are gifts from parents, let no one damage them”, implying that organ donation is disrespectful towards one’s parents and is considered to be unfilial. Contemporary studies and interviews have shown that these ancient beliefs are still prevalent in countries like mainland China, Hong Kong, and Korea, with medical workers constantly facing protracted battles with extended families over the issue of organ donation. For example, there are only 1.2 organ donors per 1 million citizens in mainland China, with the comparable number in the United States of America amounting to over 20 donors per million citizens. Given that approximately 76% of Singaporeans are of Chinese descent according to official government data, it is no wonder as to why Confucian values and conservative Chinese perspectives are still rampant in Singapore. A plethora of other religions, such as Judaism and Shintoism, also oppose the concept of organ donation. Therefore, it is highly likely that general feelings of organ donation among the Singaporean population has been greatly influenced by religious beliefs and understandings of spiritual and physical forms in the afterlife.

In essence, the relationship between conservatism within Singapore and Singapore’s low organ donation rates is greatly noticeable with striking clarity, providing many explanations as to why Singapore has such a low proportion of the amount of organ donors to the amount of citizens. Some factors include religious and spiritual beliefs, as an allocation of certain religions dictate that the physical body of a human being should not be disturbed even upon death. Others may also struggle to understand the logistics and intricate details surrounding brain death, organ donation, and presumed consent. In order to increase Singapore’s organ donation rates, it may be important for the government to take active steps in publicly educating citizens about practices and policies such as HOTA, thereby clearing up confusion about medical operations surrounding organ donation and transplantation and reducing ignorance among the general population. It is also important for family members to have a discussion about such a sensitive yet important topic, for a simple conversation may do wonders in helping others understand the concept of organ donation. To end off, I believe that one day, organ donation will be normalised and understood by virtually everyone, allowing Singapore to progress with significance and dignity, thereby allowing our nation to be, both figuratively and literally, stronger within.

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