Neo Yu Hui, 15

School: Dunman High School

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

Award: Distinction, Senior Category, 2022

Our Society: Organ Donation

A single organ donor has the potential to save as many as seven lives. According to Donate Life America, an alliance of non-profit organisations across the United States committed to increasing organ donations, there were close to 20,400 organ donors in 2021. These donors were able to enhance the quality of life of not only the recipients of organ donation, but also their families. In the United States, the number of patients on the waiting list for an organ transplant rose to over 95,000 in 2006, with the number of patient deaths exceeding 6,300, says a report done by the National Institutes of Health (NIH) in 2007. Since then, these figures have grown at an exponential rate, creating an even greater need for organ donations. Such a trend is not limited to the United States. In fact, in Singapore, there are more than 500 patients waiting to receive a life-saving transplant every year, and a majority of patients need to wait 5 to 17 years before receiving an organ donation. The demand for organ donations thus far outstrips the availability of supply. In 2017, Spain had the highest deceased organ donation rate in the world, with 46.9 organ donors per million population (pmp). That same year, Singapore had an organ donation rate of 6.6 organ donors pmp. Why exactly, is there such a stark difference in donation rates between the two countries? Or, for that matter, why are Singapore’s organ donation rates so low? Could this be due to Singapore’s conservative culture, where citizens are change-averse, and are not willing to welcome organ donation- something that does not conform to the social norm?

To start off, due to Singapore’s conservative culture, the idea of organ donation is treated as a ‘taboo’ topic. The social stigma revolving around organ donation causes people to be reluctant to discuss such matters, and hence knowledge of organ donations is not very widespread, with little to no Singaporeans having a comprehensive understanding behind the concept of organ donation. On top of that, frequently on social media platforms, campaigns advocating organ donation do not gain enough momentum, and as a result do not receive favourable publicity. This could be attributed to the hesitance and apathy of Singaporeans to better involve themselves in organ donation. In 1987, the Human Organ Transplant Act (HOTA) was enacted, in an attempt to improve organ donation rates. The HOTA allows for the kidneys, heart, liver and corneas of all Singaporean Citizens and Permanent Residents 21 years old and above, who are not mentally disordered, to be used for organ transplantation in the event of death, unless they have opted out. Based on a study on the knowledge, attitudes and challenges of deceased organ donation in Singapore that was done by Nanyang Technological University, the results of the survey expressed strong support from the public, with 90.5% of respondents being willing to donate their organs. However, though opt-out rates have been low, a vast majority of Singaporeans lacked knowledge about the specifics of HOTA. In fact, 38.3% did not know it was opt-out, and 92.5% was unclear of who the law applied to. From such statistics, one can form a postulation that Singapore’s low organ donation rates are due to the ignorance of our citizens. In addition, with an immense number of Singaporeans being uninformed on organ donation, this could lead to misinformation, and in turn lead to misconceptions, especially seeing how quickly fake news travels with the ubiquity of the internet. For example, people may have the false conception that donating organs may pose as a health risk towards the organ donor post-donation. Subsequently, they would steer clear of organ donations.

Next, resulting from Singapore’s conservative culture, people would tend to follow traditional religious beliefs. For instance, in the present day, numerous Muslims believe that organ donation is haram, and is thus forbidden. With reference to Prophet Muhammad, founder of Islam and proclaimer of Quran, the sacred scripture of Islam, he said that ‘breaking the bones of the deceased is like breaking his bones when he is alive’, implying that the human body remains sacred even after death and should not be harmed. This led Muslims to maintain a passive approach towards organ donation. Yet, organ donation being prohibited in their religion is in fact a myth. In the Quran, it states that ‘If anyone saves a life, it is as if he saves the lives of all humankind’, and in 1995, the Muslim Law (Sharia) Council UK (United Kingdom) issued a fatwa, a religious edict, declaring that organ donation is permitted. Some Muslims therefore continue to blindly follow such traditional religious beliefs, and this could also be chalked up to the lack of knowledge with regards to the topic of organ donation. In January of 2019, an Australian study by Eugene Chan of Monash University noted that conservatism was strongly associated with religious beliefs, and hence directly linked to greater adherence to sacred things, such as ‘not violating taboos’, ‘taboos’ referring to organ donation. In the study, supporters of conservative political parties were less likely to report that they intended to donate their organs. The main driving force behind their decision was their concern over preserving ‘bodily integrity’. Their belief was that a person who has to endure eternity, or be reincarnated without organs, would be precluded from the afterlife. Conservative culture in Singapore has led people to continue to act in accordance with their religious beliefs, and thus they are not willing to donate their organs, contributing to lower organ donation rates.

However, the people have also taken to a mindset shift with the predominance of campaigns to spread awareness of organ donation. This also serves to convey the message that they are unafraid to break out of society’s boundaries and make a change. The impact of raising awareness is not to be undermined. Raising awareness is an essential tool for advocacy. It is able to educate people on unfamiliar topics and inspire them to incite changes. One such example is the ‘Don’t Hold Back’ digital communications campaign by students from Nanyang Technological University. The campaign started with the aim of creating more conversations within families on organ donation. In the event of a death, family members would naturally fall into the role of proxy-decision makers, so this is relevant as more conversations within the family allows for more clarity and certainty over the deceased’s wishes with regards to organ donation, consequently reducing family ambiguity and ambivalence when a decision is to be made. Family members would also be better able to respect the wishes of their deceased family member. Hence, this could create a ripple effect and therefore expand Singapore’s pool of organ donors. The campaign was also met with positive responses. From December 2020 to March 2021, it managed to increase the number of conversations on deceased organ donation by 4.8%, intention to partake in such a conversation by 33.9%, and perceived relevance of the issue of organ donation by 10.2%. This is merely one example among the myriad of initiatives being implemented in Singapore. With greater availability and certainty of information on organ donation, Singaporeans have been able to break out of conformity and communicate that Singapore is no longer just of conservative culture.

The stigma that stems from society’s standards restricts the discussion of unconventional topics, leading to knowledge deficit, which may encourage the spread of false information. Religious affiliations of Singaporeans also play a role in discouraging organ donations. Although, information channels to promote organ donation have been widespread, and enables Singaporeans to better approach the matter of organ donation. Low organ donation rates in Singapore can be credited to a multitude of factors. It is critical for the country to cooperate well with the government and advocacy programmes in order to combat this issue.

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