Krish Bhatia, 15

School: Raffles Institution (Secondary)

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

Award: Distinction, Senior Category, 2024

Organ Donation: Will Reward Trump Risk?

In 2022, a tenth of prospective beneficiaries of organ donation in America passed away while waiting, or were delisted. Some doctors were forced to tell parents that their beloved children would have to die slow, painful deaths in the beds of hospital wards because by the time they would likely have received an organ donation, their condition would not be salvageable. Other doctors were also given the privilege of telling devastated families that their loved ones, having successfully received organ donations, would be staying with them. The stark polarity of these emotions are two sides of the same coin. Ultimately, what matters is which side the coin lands on.

There is more to organ donation than pure benevolence and goodwill. Circumstantial intricacies severely complicate the decision-making process. In many instances, such complexities discourage potential donors from taking the big step. Can they be blamed? I hardly think so.

A chief issue that impedes any chance of an informed decision being made is a lack of literacy and understanding of organ donation. The majority of potential organ donors are victims of brain stem death. This means to say that so long as they are supplemented with artificial life support, their heart will still beat and they can still breathe. However, the moment such support is removed, they will die. Regardless of whether they are given life support or not, they will never regain consciousness again - thus, they are legally considered dead. Problems arise when many family members are unable to distinguish brain death from the vegetative state of mind, in which regaining consciousness, even if highly unlikely, is certainly possible. Parents, brothers and sisters are told that their children or siblings have slipped into the crevice of eternal unconsciousness, but when they see, with their own eyes, their loved one’s still breathing, it becomes very difficult to accept this fact. The truth is, they do not want to accept it, and very understandably. An amalgamation of unquantifiable love coupled with the unwavering hope that their loved one is still alive pushes them to cling desperately on to the illusion that there is a chance that they may still be conscious, even though the cold, harsh reality is that no such possibility exists. In such cases, the further the acceptance of the demise is delayed, the likelihood of them even considering an organ donation drastically drops.

Even if the family of a potential donor is able to comprehensively conceptualise such complexities, ethical dilemmas throw a spanner in the works. In cases where the deceased had consented to organ donation, the grieving process is significantly exacerbated by the unfortunately tight timeline that Organ Procurement Organisations (OPOs) must follow - a confirmatory request for organ donation is literally sent along with news of their loved one’s passing. Additionally, for many families, the process of organ donation is symbolic of them genuinely letting go. To let go of the inundating grief and sorrow that stems from death is virtually impossible within such a strict time frame. Furthermore, grieving is a process - to hurry it would be to strip it of its efficacy and purpose, in which case, you risk never truly being able to experience the emancipation that you rightfully deserve to feel. Things get even tougher if the deceased never passed a decision on whether they would be agreeable to donating their organs after their demise. In such cases, their family members are forced to make a decision for them. The pressure of failing to fulfil their loved ones’ final wish is overwhelming, and even debilitating. Though the ultimate decision should principally be based on the wish of the deceased, lacking any concrete evidence forces family members to estimate and reason to understand what the deceased would have likely wanted. Such a game of probability is fraught with holes and margins for error, in which personal biases and views could easily soil the decision-making process. For example, some family members would be concerned about preserving the dignity of the deceased, motivating them to refuse to donate any organs. Others may believe that donating organs would be in accordance with what the deceased would have always wanted, motivating them to agree with organ donation. The high likelihood of differing views in a decision-making process characterised by intrinsic subjectivity breeds conflict - the last thing you need in such an already tricky situation.

Given all that I have said, there are definitely things that can be done by various stakeholders to ease the process. First off, effective and sensitive communication between healthcare officials and the families of potential donors is of paramount importance. Many may underestimate the extent of impact that communication has on the decision-making process. However, empathetic and respectful listening to the woes of donors and cogent reasoning with them could save lives - the same way that a lack of diligence and fidelity to detail could kill. Additionally, given the overwhelming demand for organs which far exceeds the meagre supply, widely encouraging organ donation where feasible is certainly possible. More specifically, it is definitely true that religious institutions have the authority and principal incentive to encourage organ donations, as such acts of charity align with their tenets of goodwill and benevolence. For example, organ donation is morally permissible and even encouraged in the Islamic and Catholic religions.

Ultimately, it is true to some extent that possible complications and complexities of the process of organ donation discourage the act. However, it is also true that within each and every one of us resides an existential urge to help others. The real question is - how resilient are we? Are we able to stay true to such goals even after emotionally traumatic experiences? I have strong reason to believe that we are. Many of us are grateful for the lives that we have. Now, organ donation has allowed us to give life to others as well. The moment we witness beneficiaries breathing and smiling, when they could easily have been dead, is the moment we will know for a fact that we have made the right choice.

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