Cheow Jun Wei, 22

Topic: Will donor’s altruism be negated by advancement in transplantation in 2050?

Award: Third Place, Open Category, 2023

Political Leader Tenzin Gyatso once said, "The future of humanity will depend on our ability to cultivate empathy, compassion, and kindness in the face of technological and social change." In the context of organ transplantation, Gyatso emphasised that it is imperative to keep a check on our humanity as we embrace advancements in transplantation. For decades, whenever scientists discuss ethics relating to transplantation, they always question whether medical technology and stem cell advancements violate the sanctity of human lives. However, qualities like altruism that make us human were never really in question. In 2050, transplant experts predict that we can expect to see sophisticated preservation techniques, regenerative medicine and a decrease in the likelihood of organ rejection. Most prominently, advancements such as xenotransplantation and organ cloning threaten donors’ spirit of giving. If humans could use animal organs as alternatives to human organs or even mass-produce the most intricate organs through bioengineering, will human organ donation lose its meaning? Will there be any significance left in donors’ altruism? Reluctantly, many would agree that donors’ altruism will eventually be negated by advancement in transplantation on the basis that the panacea would far outweigh human sentiments. But I strongly believe that such feelings hold a value that is unlikely to be negated.

It doesn’t matter whether it is the year 1950 or 2050, organs are incredibly personal objects that cannot be regenerated once lost. As such, the immense gratitude by the donee and donors feeling that they have done something meaningful are intangible feelings which cannot be compared to tangible indicators like advancement in organ transplantation. Altruism is, after all, associated with human emotions and cannot be quantified against transplantation advancements. As such, altruism and transplantation advancements are independent of each other. There has been increasing support for organ donation globally as seen when the 2021 Gallup Poll showed an overwhelming 80% of Americans expressed support for organ donation, while the Global Observatory on Donation and Transplantation saw a 35% increase in deceased organ donors worldwide between 2010 and 2019, and when anonymous organ donation comprises half of the organ donations in countries like Spain, Belgium and the Netherlands. Most prominently, according to the Organ Procurement and Transplantation Network, over 60% of deceased organ transplants in 2020 came from individuals who were not genetically related to the recipients. These show the immense altruistic support for organ donation in the past years, where people consent to the donation of their organs to strangers or even donate after death so that it can be beneficial to others. The point is that the increasing number of people extending their help to people whom they do not even know, despite all the medical alternatives available today, is a basis to argue that such altruism will not be negated by advancement in transplantation in 2050.

However, the layman may be convinced that if advancements in transplantation reach levels where organs can be cultivated and widely produced like lab-grown meats, our perception of organs will radically shift from a sacred object to a commodity instead. Indeed, this is a reasonable concern since increasing the availability of such a scarce resource can increase competition, which could result in the commodification of organs. While this phenomenon does not exist today, there are, unfortunately, some indicators to show that the commodification of organs can materialise. For instance, organ transplant tourism, where individuals travel to countries with less stringent transplantation regulation, suggests that people can travel to countries with higher availability of organs, indicating a willingness to pay for organs and thus suggesting a potential commodification of organs. Other salient examples include countries like China providing organ donors with generous financial incentives and compensation to encourage organ donation. Astonishingly, this initiative was successful in many provinces in China, with the Zhejiang Province observing a two-fold increase in organ donation rate from 23 to 43 within a short span of four months. These case studies show that people can be coerced easily when organs can be accessed using money. Being able to utilise xenotransplantation or regenerate organs using advanced technology one day means that people might exploit organ transplantation. Surely, this could lead to a slippery slope scenario where the high availability of organs reduces the value and appreciation for the act of donation. Sceptics also worry that the commodification of organs could also discourage individuals from engaging in altruistic acts and undermine the spirit of giving. Therefore, it is likely that the advancement in transplantation may ultimately negate the altruism in donors.

While both sides have their merits, we should seriously consider complexities in reality that can influence the mitigation of donors’ altruism. One school of thought that we can certainly examine is that advancement in organ transplantation may not be ubiquitous. In reality, wealthier countries like Singapore, Japan and the United States have greater ability and capacity to carry out research that can contribute to advancements in organ transplantation. If organ cloning meant that individuals will no longer need to sacrifice their organs, but rather donate their cells to cultivate a new organ, then such advancements can indeed have implications on donors’ altruism. However, nations like Afghanistan, Madagascar and South Sudan that lack technological capabilities cannot hope to gain access to such advancements. Furthermore, the limited resources and funding available in these nations make it extremely unlikely for them to keep pace with the advancements made in wealthier countries. Without access to cutting-edge technology, specialised medical professionals, and adequate infrastructure, these nations will inevitably fall behind in the field of transplantation. As such, unless transplantation advancements can reach poorer nations, individuals from these nations will have to continue relying on traditional forms of organ transplantation. Fortunately, these have their perks too as these individuals will be less reliant on advanced medical technology and hence are unlikely to be desensitised to feelings of altruism associated with organ donation. As it was previously established that transplantation is correlated with the desensitisation of altruistic feelings, perhaps traditional modes of organ donation in poorer nations can be an anchor for altruism to still exist in 2050.

But ultimately, understanding that transplantation advancements negating donors' altruism oversimplifies the intricacies of human principles, is imperative for retaining their sense of altruism. Believing in such logic would only trap people in the false cause fallacy where people think that the mere existence of advanced transplantation techniques will be the cause of this decline in altruism. Altruism is a complex human trait that is influenced by personal values, societal norms, and cultural attitudes. While advancements in transplantation may alter the landscape of organ donation, it would be an oversimplification to attribute any decline in donors' altruism solely to the advancements themselves. Instead, recent developments in transplantation have shown that advancements have encouraged even more donors to donate their organs. For instance, in countries like Australia, Canada and Germany, the number of living organ donors has continued to rise as minimally invasive techniques and improved post-operative care in countries like Australia, Canada and Germany have made it safer and more feasible for individuals to donate organs while they are still alive. Despite these advancements, the willingness of individuals to selflessly donate their organs has not diminished. Moreover, countries like Spain, the Netherlands and the United Kingdom have seen an upsurge in living organ donors coming forward to voluntarily save the lives of their loved ones or even strangers. They undergo surgeries and bear certain risks to their own health, indicating their genuine desire to help others in need. The point is that the sustained altruism of living organ donors contradicts the false cause fallacy, which would incorrectly attribute the advancements in organ transplant procedures as the cause of negated donor altruism. Instead, it highlights the enduring human capacity for empathy and compassion, regardless of technological advancements.

While the year 2050 holds immense promise for advancements in transplantation, the impact on donors' altruism remains uncertain. While we can only speculate for now, there is much optimism that donors’ altruism will not be negated by transplantation advancements in 2050 as altruistic feelings associated with organ donation are extremely complex and can’t be simply undone. Furthermore, we can expect poorer countries with slower progress in transplantation to retain traditional organ transplantation methods, which invokes altruistic feelings in donors. However, some insist that transplantation advancements can lead to the high availability of organs which consequently diminishes the value of organ transplantation or, in severe cases, lead to the commodification of organs. Regardless, while scientific and technological progress may enable groundbreaking solutions such as 3D-printed organs, organ cloning and xenotransplantation, the core values of compassion and selflessness that drive organ donation are deeply ingrained in human nature. As we navigate the future, it is crucial to foster a balance between medical innovation and preserving the spirit of altruism. By upholding ethical standards, ensuring informed consent and addressing potential disparities in access, we can strive for a future where advancements in transplantation enhance and complement the selfless act of organ donation, ultimately saving and improving countless lives.

Disclaimer: Please note that the views and opinions expressed in the essays for the Live On Festival 2023 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