Kaelyn Hong Yan Ning, 17

School: Hwa Chong Institution

Topic: Encouraging living donations is key to improve donation rates

Award: Second Place, Open Category, 2024

Life is inherently ephemeral; everyone will pass on someday. However, there are means to which we can efficiently enable some lives to be prolonged. “Every year, more than 500 persons are on a waitlist for a life-saving organ transplant in Singapore. Despite the opt-out Human Organ Transplant Act (HOTA) and opt-in 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.” ^[1] Organ donation is a huge factor in saving the lives of many, and getting to be a recipient is akin to a lifeline for patients all over the world. Hence, the critical shortage of organ donations in the world as a whole poses a significant problem. Singapore especially, faces this issue on a significantly greater scale. This is evident from a study published in the National Library of Medicine states “Compared to Western nations where the rates of donation from presumed consent range from to 5.9 to 46.9 per million population (pmp), Singapore remains the sole Asian country adopting an opt-out system where the number of deceased organ donors remains low at 7–9 pmp per year despite the low national opt-out rate of 2.0–3.0%.” ^[2] But how can this be fixed? A viable strategy is encouraging living donations, and I believe that this may be the key to improving organ donation rates.

Firstly, organ donations from deceased donors are simply not enough to fulfill the need for organs, causing living donations to be ever so vital. Not all the deceased slated to become organ donors end up having their organs donated. Due to organ donations being limited to patients who underwent brain death or circulatory death, there is a severely reduced pool of deceased organ donors. “In 2007, there were a total of 86 potential donors referred to the transplant coordinators of the National Organ Transplant Unit, of which 26 were eventually actualised as organ donors, yielding an overall actualisation rate of 30.2%.” ^[3] As a result, living donations are crucial in filling this gap. The rate of living organ donations is comparatively, much more in our control. Organs that living donors can donate include part of the liver and the kidney. ^[4] The conscious step taken towards donating these organs compensates for the limited number of deceased donors, and has an insurmountable impact on the lives of their recipients. For instance, when the kidneys are unable to perform their due diligence, dialysis is used to filter the blood on behalf of the failed kidneys. “Hemodialysis treatments last about 4 hours each, up to 3 times per week.” ^[5]Thus, a kidney transplant would save a great extent of time and effort of the recipients, immensely increasing the quality of their lives. By encouraging the general public to donate their organs as living donors, it will have an immediate impact in increasing organ donation rates, enabling many, who desperately need these organs to sustain their lives, to get them as quickly as possible.

Secondly, I hold the notion that encouraging living donations through education has the potential to ameliorate the organ donation scene in Singapore. In Singapore, there is generally a negative connotation associated with living organ donations. This arises from the masses not being well educated about the complexities of organ donations, and being quick to dismiss it as something too dangerous for them to even consider; especially if the recipient is a complete stranger. The reluctance towards altruistic donation of our organs to strangers often arises naturally from the innate attachment to those that we have a sense of familiarity to. It is comparatively much easier to take this leap for a family member or a friend, thanks to the already strongly entrenched emotional bond we share with them. Even so, to many, regardless of circumstance, the perceived risks that come hand in hand with organ donations are simply not worth the potential benefits. “Multi-cultural and racial factors, religious beliefs, and diverse traditions of many centuries have resulted in reluctance to organ donation.” ^[6]Additionally, “besides the fear of the risks of surgery, risks to health and other individual factors, family pressures weigh on the organ donation decision for both potential donor and potential recipient.” ^[7] Therefore, I believe that with proper education, more people will have a better grasp on the risks and complications that come about when being an organ donor. Education can come in the form of lessons in schools across the nation, holding public seminars and broadcasts on major television networks. This will have a directly proportional influence on organ donation rates as many of the now hesitant individuals will step up as living organ donors.

Consequently, encouraging living organ donation by educating the general public will have a favorable impact on increasing organ donation rates.

Opponents of my stand may argue that encouraging living organ donation leads to ethical considerations, especially when we enter the domain of monetarily motivated organ donations. Hence, it is not the appropriate way to increase organ donation rates. As a paper by Connie L Davis states, “the World Health Organization (WHO) earlier this year reaffirmed their commitment “to the principles of human dignity and solidarity which condemn the buying of human body parts for transplantation and the exploitation of the poorest and most vulnerable populations and the human trafficking that result from such practices”” ^[8] Such forms of organ donation brings into question moral and legal concerns. Organs are a scarce resource, and the demand for it, as previously mentioned, surpasses the supply by leaps and bounds. This results in the willingness of many people in giving up preposterous large sums of money in exchange for their desired organs. That being the case, many facing financial difficulties will be enticed to ‘donate’ their organs for the promise of financial gains, which brings in a multitude of multi-faceted ethical dilemmas. Is it ethical for us to support others in “selling” parts of their body for materialistic gains? Will this result in forceful manipulation of people into unwilling organ donation? Does this simply open the floodgates to a thriving illegal black market? While I understand the logic behind these considerations, it is my conviction that we should nevertheless encourage living donations as it is inevitably the most effective and thus vital way to increase organ donation rates. This can be done alongside addressing these concerns and preventing them from actualising. For instance, strict legislation can be passed to ensure that all potential donors are partaking in organ donation out of their own accord, and the field of organ donation remains free and fair.

Organ donation is an immensely meaningful thing for everyone to do. Be it for a loved one or a stranger, partaking in organ donation can greatly increase the quality of life, or even save the life of the recipient. With the perilously meager rates of organ donation in Singapore, encouraging living organ donation is quintessential and undoubtedly the way to go.

References

^[1] SingHealth. The Gift of Life, The Gift of Hope. SingHealth, https://www.singhealth.com.sg/news/giving-philanthropy/The-Gift-of-Life,-The-Gift-of-Hope, Published 25 November 2020, Accessed 12 April 2024.

^[2] Muthiah MD, Chua MSH, Griva K, et al. A Multiethnic Asian Perspective of Presumed Consent for Organ Donation: A Population-Based Perception Study. Front Public Health. 2021;9:712584. Published 2021 Oct 5. doi:10.3389/fpubh.2021.712584

^[3] Kwek TK, Lew TW, Tan HL, Kong S. The transplantable organ shortage in Singapore: has implementation of presumed consent to organ donation made a difference?. Ann Acad Med Singap. 2009;38(4):346-348.

^[4] Live On. FAQ, Living Donor Organ Transplant. Live On, https://www.liveon.gov.sg/faq.html#:~:text=Donation%20of%20organs%20is%20usually,not%20be%20suitable%20for%20transplantation, Accessed on 13 April 2024

^[5] Brian Krans, Medically reviewed by Cynthia Taylor Chavoustie, MPAS, PA-C. What to Know About Dialysis: Procedure Types, Benefits, and Risks. Healthline, https://www.healthline.com/health/kidney-health/kidney-failure-treatment, Published on April 2 2024, Accessed on 15 May 2024.

^[6] Sivathasan C, Lim CP, Kerk KL, Sim DK, Mehra MR. Mechanical circulatory support and heart transplantation in the Asia Pacific region. J Heart Lung Transplant. 2017;36(1):13-18. doi:10.1016/j.healun.2016.09.006

^[7] Chin JJ, Kwok TH. After presumed consent: a review of organ donation in Singapore. Indian J Med Ethics. 2014;11(3):139-143. doi:10.20529/IJME.2014.038

^[8] Davis CL. How to increase living donation. Transpl Int. 2011;24(4):344-349. doi:10.1111/j.1432-2277.2010.01212.x

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