Isaac Ong Bin Hui, 21

Topic: Generating positive mindset change on organ donation

Award: Fifth Place, Open Category, 2023

Changing Hearts and Minds: Cultivating a Positive Attitude Towards Organ Donation

‘You are turning 21 soon, what a milestone!’

Seeing the words ORGAN DONATION in big, bold letters at the top of the envelope as I waited to turn 21 this year was bewildering. What organ donation act? HOTA? MTERA? My eyes widened as I imagined the grotesque and gruesome things that would be done to my cold, lifeless body when it was the end of the road.

The cold, clinical cut of a scalpel, the gorging out of my organs, and surgeons clad in faceless outfits ripping out well, me. Literally, me.

Despite strong legal mandate through the Human Organ Transplant Act (HOTA) and the Medical (Therapy, Education and Research) Act (MTERA), the organ donation rate of Singapore is amongst the lowest in the world at 4.48 deceased donors per million population, which translates to a lengthy waiting time for patients that require new organs, with the average waiting time for a kidney transplant being 9 years.

This is time that many do not have, and when their need for organs to the highest imperative is not met, they too will pass away.

Consequently, it seems that the fundamental issue with organ donation in Singapore is not the lack of legal backing, nor is it the lack of critical infrastructure or medical personnel. At its core, it is ultimately the unwilling mindset of potential organ donors that poses the issue. Generating positive mindset change on organ donation seems to be a daunting task, and in this essay, I will discuss why it is as such and how it can be overcome.

I will now stratify the reasons for why generating positive mindset change on organ donation seems to be a daunting task on three levels: Individual, Familial, and Societal.On the first degree, individually, I would argue that parallel to my above anecdote, many individuals would feel mortified that even after their demise, a team of surgeons will remove their organs as per HOTA.

The act of having one’s organs removed could feel like the ultimate act of indignity, as even after death their body is cut open and objectified.

It feels like it would almost be reasonable to state in the most gruesome terms that this is “medical mutilation”, almost akin to dehumanisation. Ultimately, it seems that on an individual basis, it may be difficult to generate a positive mindset towards organ donation as it is arduous to dissuade fear and the innate want to preserve some degree of dignity, even in death.

How can this be overcome? I would presuppose that a fundamental mindset shift may be achieved by the notion that most people would want to leave a positive legacy and be remembered. This want-to-do-good may supersede their fear of losing their dignity, especially when the latter is not only for the greater good, but also in an absolutely painless manner. Moreover, their organ donation will almost certainly be remembered by the recipient of said organ, or their loved ones.

Consequently, a pragmatic solution on generating a positive mindset change on organ donation can be done through raising awareness and hosting pledge campaigns to remind individuals on the goodness of organ donation and the very tangible benefits that arise out of it: The chance for others to live, which is encapsulated in supporting the idea of hope for a better life.

On to the next tier: Familial. While in its explicit definition, this term only refers to that of one’s family, I would like to expand its definition in the context of this essay to also cover that of one’s friends.

It is difficult to cultivate a positive mindset towards organ donation because when a loved one is lying on the deathbed or even has passed from a familial perspective, there will intrinsically be a fundamental human-want to cling onto the chance that they may recover. In the throes of worry, anxiety, pain, and grief, it is perhaps understandable that the family or friends of the patient will fight tooth and nail to protest organ donation of the deceased. An example in which this may play out is when the deceased is still “breathing” through the help of a ventilator, which gives the shattering illusion that there is still life - despite the patient being brain dead. In another devastating scenario, even the heart can remain beating insofar as it has oxygen through a ventilator. The cruel beeping of the heart monitor could give the illusion that the patient is still “alive”, despite being brain dead - which is, irreversible. Such scenarios are not hypothetical, and play out daily in hospitals all across Singapore. Consequently, wrestling against this ubiquitous emotion of desperate, or even unfounded hope is extremely challenging: Which leads to the difficulty in generating a positive mindset towards organ donation.

Overcoming this hurdle is especially challenging when it comes from a place of great emotional grief and essentiality, irrationality.

I would postulate that the approach for this should come from a place of compassion and empathy. Accordingly, it would be appropriate to provide effective counselling training for all medical staff, as well as counselling staff for the deceased’s family and friends. I would argue that strong emotional support is paramount, as any objections to organ donation would quintessentially stem from familial inability to “let go”, and therefore shouldn’t be primarily addressed with logic, but instead with emotion.

Furthermore, a two-pronged solution could be coupling the above with a mandatory educational brief about organ donation when a patient enters palliative care, or when a medical staff judges that his/her condition is seriously deteriorating. Such conversation allows medical staff, family, and the patient to iron out any discrepancies, questions, or doubts about organ donation. More often than not, the patient may be in a better state, which allows such important conversations to happen with their loved ones so that they can all be in agreement: Hence addressing the lack of understanding towards organ donation that many families have.

This is based on the notion that prevention is better than cure, as this will prevent delays of potentially life-saving organ transplantations that could occur when the patient passes. After all, it is indispensable to remember the caveat that organ donation only occurs when brain death happens and that every reasonable chance at survival has been exhausted medically. In sum, I suggest that both a preemptive educational brief about organ donation, as well as supplementary counselling could be impactful in tangibly nurturing a positive mindset about organ donation on a familial level.

Lastly, on why generating positive mindset change on organ donation seems to be a daunting task, I will attempt to address why so on a societal level. In the Singaporean context, death and dying are generally taboo topics that most people will shy away from, and even mentioning such things will lead to dirty looks and loud exclamations of “CHOY!!”, an exclamation spoken to ward off evil or bad luck.

Culturally, this is the norm and this could be due to the fact that most people are superstitious talking about death. Even if one could grasp the concept of death - to which many can - it still brings about harsh connotations of sadness, fear, and regret.

Therefore, encouraging such a huge paradigm shift about death and dying is a complicated and challenging task. The shift will almost certainly not be fast, as the government has to address deep-rooted beliefs and attitudes: A sustainable solution is needed to slowly ebb away our unwillingness to engage with the great beyond.

In short, a whole-of-government approach is needed in the form of raising public awareness through education. Tying in the different ministries of not just health and legal, but also culture, media, and family to say the least, will be absolutely imperative to encourage discourse and an eventual positive mindset change in Singapore.

Delegating such responsibility to religious groups will also be crucial, given that religion and dying are often an intertwined sphere, and that all major religions in Singapore support organ donation due to it being considered a gift.

Dispelling myths about organ donation is also needed. For instance, some people would detract from HOTA due to them perceiving it as additional cost beyond other medical fees, but public education campaigns will rightfully assure them that for deceased organ donation, neither them nor their family will have to pay the hospitalisation bill for any organ removal-related procedure and test. Summative, a whole-of-government approach is needed to galvanise positive change in societal mindset pertaining to organ donation, and while it may not be immediate, public education and awareness are one of the greatest tools to do as such due to its sustainability.

At the heart of it all, the act of organ donation is altruistic, and I for one will be in support, not just because up to 7 lives can be saved by 1 donor, but so that perhaps another person can wake up and hear: “You are turning 21 soon, what a milestone!”

References

1. 'Are you sure he is dead?': Doctors struggle with families’ lack of understanding of HOTA https://www.channelnewsasia.com/singapore/human-organ-transplant-act-doctors-families-understanding-887136

2. Facts About Organ Donation https://www.liveon.gov.sg/facts.html

3. The Gift of Life, The Gift of Hope https://www.singhealth.com.sg/news/giving-philanthropy/The-Gift-of-Life,-The-Gift-of-Hope#:~:text=Despite%20the%20opt%2Dout%20Human,donors%20per%20million%20population1.

4. In Singapore, Talking About Death Is Taboo. But That’s Exactly Why We Should Do It https://www.ricemedia.co/current-affairs-features-talking-about-death-taboo/

5. HUMAN ORGAN TRANSPLANT ACT https://www.moh.gov.sg/policies-and-legislation/human-organ-transplant-act

6. Organ Donation | Singapore Hospice Council https://singaporehospice.org.sg/organ-donation/

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