Amelia Tay Juey Oon, 15

School: Raffles Girls’ School (Secondary)

Topic: Little interest in organ donation is due to its complexity

Award: Distinction, Senior Category, 2024

Disinterest in organ donation and transplantation: Simplicity in the complexity

An important question

This discussion may look like a simple true or false question, but it is in fact multi-dimensional. Before delving into this topic, we should understand why it is truly important for people to take an interest in organ donation and transplantation. Compared to Western nations where the rates of donation from presumed consent range from to 5.9 to 46.9 per million population, Singapore remains the sole Asian country adopting an opt-out system where the number of deceased organ donors remains low at 7–9 per million population per year despite the low national opt-out rate of 2.0–3.0%.^[1] Major contributors to this include knowledge gaps, religious or cultural beliefs or emotional responses when it comes to the crunch. To improve this, we need to interest everyone in this conversation.

2 premises and 1 assumption

Let us first examine the 2 premises in the view, firstly, that organ donation and transplantation is of little interest to people and secondly, that it is too complex. There is also the assumption that this complexity is the cause of the disinterest.

Uninteresting topic

Is it really true that organ donation does not interest people? From a study conducted by the Nanyang Technological University, which found that for the average Singaporean, “knowledge about the specifics of HOTA was poor, with 38.3% not even knowing it is opt-out and 92.5% being unclear of who the law applied to.” This would seem to support the first premise. In fact, another study by NUS found that among the major factors leading to rejection of organ donation, knowledge gap is a major contributor. 85% were willing to donate their own organs, while 81% were willing to donate their relatives’ organs, but that decreased to 65% when given a realistic scenario. Factors include lack of knowledge about certification of brain death and which organs were included in HOTA. Such lack of knowledge reflects a fundamental disinterest in this topic, because the resources are readily available in the MOH and Live On websites or just a simple google search.

The devil is in the detail

While seemingly complex, organ donation can actually be explained relatively simply. Medical procedures aside, it is accomplished largely in two different ways, through live donors and deceased donors.

In Singapore, live donors are only permitted to donate 5 organs, namely one kidney, one lung, a part of the liver, a part of the pancreas and a part of the intestine. People often donate these organs when their loved ones are in dire need of that organ, most commonly due to a disease or an accident, and they are the best fit to donate to them.

As a deceased donor, Singapore has 2 acts in place.

The first is the Human Organ Transplant Act (HOTA), which mandates that every Singaporean citizen and permanent resident 21 years old and above will donate their kidneys, heart, liver and corneas for the purpose of transplantation in the event of death. This is an opt-out system, and provides many of the organs that are being transplanted to people in need of organs today.

The second act is an opt-in scheme, the Medical (Therapy, Education and Research) Act (MTERA), where people living in Singapore of any nationality, aged 18 and above, can pledge their organs and any body part for transplantation, education or research when they pass away. Their next-of-kin could also decide to donate the organs on their behalf, if they are deemed unable to make the decision themselves.

So the laws themselves are not complex and fit in 2 paragraphs. However, the decision for organ donation and transplantation is not so straightforward, as can be seen in the 16% drop in people who agreed to the idea of donating a relative’s organ when faced with a realistic scenario. That is because in real life, there are many other details and complexities, like is the patient really brain dead? Will he or she recover? Do they really want to give up trying to save the patient’s life? These may cause delays that make organ donation impossible. A seemingly simple yes or no decision takes on layers of complexities in this situation, made worse by the emotional impacts of facing a dying relative, their own religious or cultural beliefs or family dynamics.

Complexity = Disinterest?

Is it complexity that leads to disinterest? I would say yes and no. Few like crunching through complicated and dry issues, and until it affects them personally or affects their family members, who would bother to find out or read and meditate on such an esoteric subject? The lack of immediate relevance to their current life is probably the biggest reason! But that need not be so, as demonstrated by the media frenzy and sudden explosion of interest and awareness during the saga of celebrity Pierre Png donating his liver to equally famous Andrea DeCruz. I was not born yet, but take it on good authority that it was the news of the day. Therefore, disinterest is probably not primarily due to the complexity of the topic but rather the dryness and lack of relevance, easily overcome by star power!

Is disinterest surmountable?

Again, as demonstrated previously, clearly not. Even more so in the day and age of social media with the reach of TikTok challenges and influencers. Perhaps a simple challenge like filming you convincing your “ah gong” or “ah mah” to agree to organ donation on World Organ Donation Day, the 13th of August, could go viral and inspire a social trend. They can be great avenues to celebrate the selflessness of the donors and the new lease on life of the recipients.

Of course, there is the tried and tested route of education from young. Everyone knows the story of “Kong Rong” letting his brother have the larger pear. Generations of Singaporean children having learnt this story in school. Teaching children about the noble aspirations of the HOTA and showing them that anyone, even themselves or their family might one day need to tap on it may prove to be an enduring lesson, which brings about a shift in attitudes. Isn’t that what the Character and Citizenship Education classes are for?

Students across Singapore could be encouraged to take up Values-In-Action projects to raise awareness for those in need of organ donations, through sharing their stories on social media, which has since become ubiquitous in today’s society, or through interacting with living organ donors or the families of deceased ones, to share their stories and empower others to follow suit. Helmed by Singapore’s youth, these simple actions can inspire others to take action too, whether by choosing to donate their organs, or by supporting those going through organ transplantations.

That being said, there is value to simplify the process of organ donation and transplantation for the public, so it is less complex and more digestible. Knowledge will demystify the process and take away fears and misconceptions on the process of brain death certification, the risk of making a mistake and denying themselves or a relative the chance to live on and instead allow the healthy organ to go to someone else so they may live on. It may inspire more to come forward as living donors and others to refrain from objecting to HOTA, allowing it to fulfill its purpose.

Conclusion

Disinterest in the topic of organ transplantation and donation is real. There are various factors, not just complexity of the topic alone which contributes to this disinterest. However, with our ingenuity and the all-penetrating reach of social media, schools and other socialisation tools, this problem is not one that is insurmountable. The HOTA, MTERA and living donor transplantation are schemes born out of goodwill and kindness to our fellow citizens, so the dying may live on. We owe it to ourselves to make it blossom.

^[1] Mark D Muthiah et al. A Multiethnic Asian Perspective of Presumed Consent for Organ Donation: A Population-Based Perception Study. Front Public Health. 2021; 9: 712584.

References

1. https://dr.ntu.edu.sg/handle/10356/72620

2. https://www.straitstimes.com/life/entertainment/ andrea-decruz-thanks-pierre-png-for-extra-21-years-as-they-celebrate-21st-transplant-anniversary

3. https://www.moh.gov.sg/policies-and-legislation/the-medical-(therapy-education-and-research)-act-(mtera)#:~:text=What%20is%20MTERA%3F,research%20after%20they%20pass%20away.

4. https://pubmed.ncbi.nlm.nih.gov/%2019434338/#:~:text=Despite%20this%20legislation%2C%20the%20number,%20to%20many%20other%20developed%20countries.

5. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC8525798/#:~:text=Compared%20to%20Western%20nations%20 where,national%20opt%2Dout%20rate%20of

Disclaimer: Please note that the views and opinions expressed in the essays for the Live On Festival 2024 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