Koh Shan Jun, 15

School: Raffles Girls’ School (Secondary)

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

Award: Merit, Senior Category, 2022

The Battle Between Our Morals and Singapore’s Conservative Nature

Organ donation falls nothing short of an act of radical compassion and empathy. The apprehension and uncertainty of organ donation is certainly understandable. Many times, this hesitation arises from the reluctance to accept the passing of a loved one. Instead, we clasp onto the flicker of hope, whisper prayers, and fall into a series of incessant praying, hoping for a miracle to arrive at our footsteps. As such, refusing to donate their organs is an instinctive coping mechanism, and undoubtedly an understandable one. However, this has subsequently led to a severe organ crisis due to the severe shortage of organs. Every year, more than 500 Singaporeans are added to the national waiting list, where they begin a harrowing and gruesome period of relentless waiting which lasts between 5 to 17 years¹. Many times, these patients are forced to give up in their agonizing battle against their various illnesses, despite putting on a commendable and admirable fight. This therefore illustrates the detrimental and malignant consequences patients are made to suffer as a result of this shortage. There are a number of reasons that explain the reluctance of Singaporeans to donate organs, all of which tie back to the conservative nature of our community, with our tendency to fall back onto our traditional religious beliefs and practices. In this context, a conservative nature takes place in the form of apprehension due to traditional values, and the reluctance to take unnecessary risks. Of which, has become significant driving factors as to why Singaporeans may have reserved views on organ donation.

Singaporeans’ reluctance to donate organs of their loved ones arises due to their religious beliefs. Singaporeans are certainly entitled to follow their own cultural and religious practices, but this has become a driving factor in their unwillingness to donate their organs. A retrospective study in a French organ procurement center showed that 16.4% of respondents were reluctant to participate in organ donation as a result of religion. Additionally, 46.3% respondents expressed their desire to keep the body’s wholeness, an ideology that is widely practiced by several religions. For example, Confucianism enforces the belief that dying intact is a way to show respect to ancestors, and is a belief widely practiced within those of a confucianist heritage². The notion of organ donation challenges the popular ideology of filial piety, whereby the deceased’s body is believed to be a gift and therefore deserves respectful treatment. Many also believed that dying intact was a crucial part of rebirth and essential in enabling their loved one to rest peacefully. With 33.9% of Singaporeans being Buddhists, the ideas introduced by confucianism that discourages organ donation therefore creates a significant impact on a large number of Singaporeans. Tibetan Buddhists believe that the spirit of the body remains for a week after death, and therefore should not be disturbed. Additionally, organ donation is also discouraged by South Asia Muslim ulemas³ and muftists⁴ due to their belief that a body acts as an amanant⁵ with god. Another example can be seen in Egypt, where organ donation remains a controversial topic. It can be inferred from muslims’ belief that the body belongs to god, and that god himself will save the patient, that they are therefore discouraged from donating organs. Muhammad Metwali Al Shaarawy, a prominent figure in Egypt, also proclaimed his negative perception of organ donation. His quote, ““How can you give a kidney that you yourself do not own?” perpetuated cynical views that quickly influenced Egyptian society, thereby discouraging the donation of organs. According to Islamic beliefs, the act of organ donation would also transfer the sins of one to another. In addition, consenting to organ donation is believed to be an interference with the business of God. In a survey conducted by Gallup Poll, it was revealed that 70% of Singaporeans found religion to be particularly important in their daily lives. It is thus concluded that religion is a significant part of every Singaporeans’ lives, and Singaporeans are therefore inclined to follow and uphold their traditional practices. Therefore, their tendency to follow such traditional practices significantly influence their views on organ donation, causing them to develop more hesitant and dismissive attitudes and thus, be more likely to resist the idea of organ donation.

There is an inevitable struggle for family members to accept the passing of a loved one. The denial and shock creates the pressing desire to hold on to their loved ones and pray for a miracle, instead of accepting their passing and donating their organs. Dr Lee Guan Huei, medical director of liver transportation at the National University Center for Organ Transplantation, mentioned that families ‘cannot come to terms with the death of the family member or doubt that their family member is really brain dead.’ Many times, families fall into an unrelenting cycle of dismissal, questioning doctors of whether ‘(they) are sure he is dead?’, upon seeing that ‘he is still breathing (supported by ventilator)’. Their refusal to accept the passing of their loved ones is evident in their pleas to ‘wait another day’ as they ‘hear there are miracles that happen sometimes’. However, this delay often results in deleterious consequences, with a mere 24-48 hour window before the organs become unviable. Often, those who are declared brain-dead create an even greater struggle for their family. A survey revealed that the main reason for the reluctance of organ donation was the denial and rejection of their loved ones being brain-dead, with 44.4% of respondents expressing this criteria as a driving factor⁶. Therefore, it is evident that Singaporeans are more likely to hold on to their hope for a miracle, or simply reluctance to accept the passing of a loved one, illustrating their denial of death, and therefore, unwillingness to donate their organs. Hence, they are reluctant to take such risks, a clear indicator of their conservative nature which consequently leads to their refusal of organ donation.

An opposing view would argue that Singaporeans are more inclined to act for the greater good and are thus willing to donate organs after the passing of family members. Their thoughts would be influenced by the knowledge that organ donation has the power to save the life of another, and with the comfort that their actions would benefit vulnerable patients, would therefore make the decision to agree to organ donation. It cannot be denied that some Singaporeans possess a heart of gold and are more than willing to engage in such a selfless act. With this rationale in mind, there will therefore be those who are likely to argue that Singaporeans are guided by their desire to do good, and are thus more than willing to donate their organs.

However, the most prominent flaw in the argument is their failure to account for the overwhelming feelings of grief and loss and the time of their loved one’s passing. In a research conducted by Frontier Public Health, 81% of respondents expressed their willingness to consent to the donation of their family member’s organs after being declared brain dead. However, when presented with a realistic scenario, only 65% were willing to continue with their decision on donating their loved one’s organs⁷. With a stark difference of 16%, this highlights how emotions of family members are likely to engulf their previous judgements, and with the inability to accept or process the passing of a relative, they become dismissive of organ donation. In the same research, it was found that the most commonly cited reasons for opposing organ donation was that they were “too upset and unprepared to make a decision”. Therefore, it can be concluded that emotions act as a driving factor for influencing their decisions, and any previous desire to do good is clouded by their deluge of grief and anguish. Hence, arguing that Singaporeans are likely to donate out of pure, good is not founded upon by rationale and concrete substantives.

Therefore, Singaporeans’ resistance to organ donation is driven by their devotion to their traditional beliefs and practices, in addition to their inability to accept the passing of a loved one, which are both reasons that stem from Singapore’s conservative nature. While Singaporean’s desire to do good should not be neglected and dismissed, their tendency to act out of emotions due to the overwhelming amount of grief influences their thoughts and restricts their willingness to consent to the organ donation of a family member. However, the importance of organ donation should not be swayed, as the donation of an organ, embodies a gift of life.

References

1. https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/educational-resources/moh-026-09_8pp-english.pdf

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867085/

3. Scholars

4. Jurists

5. Trusteeship

6. https://pubmed.ncbi.nlm.nih.gov/21440717/#:~:text=Conclusion%3A%20Our%20findings%20showed%20several,to%20meet%20the%20organ%20shortage.

7. https://www.frontiersin.org/articles/10.3389/fpubh.2021.712584/full#:~:text=Of%20the%20799%20participants%2C%2081,members’%20organs%20after%20brain%20death.

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