Koh Sy Chyi, 18

School: Tampines Meridian Junior College

Topic: Encouraging living donations is key to improve donation rates

Award: Third Place, Open Category, 2024

Together

Organ donations offer a life-enhancing and live-saving opportunity for those who are at the end of the line for hope. Plagued by organ failure, for most of these patients, organ transplant is usually the only solution for them to live on. As such, organ donors have become a beacon of hope for them. However, there is a widening gap between the number of organs donated and the number of people who are in dire need of it. There are 103,223 men, women and children on the national waiting list, yet there were only 46,000+ transplant recipients in 2023 (Health Resources & Service Administration, 2024). As general life expectancy increases, this creates a larger pool of people who are in need of an organ at some point in their lives (J Law Biosci, 2018). Furthermore, more and more individuals suffer from modern civilization diseases. The unhealthy diets, physical inactivity and excessive alcohol consumption exacerbated by modern lifestyle has led to a growing prevalence of diseases like obesity and type 2 diabetes, conditions which may eventually result in organ failure (J Law Biosci, 2018). These two facts coupled together have led to a growing vacuum for organ transplantation. With 17 people dying each day while waiting for an organ transplant (Health Resources & Service Administration, 2024), more should be done to address this issue. One such way would be through encouraging living donations in order to reduce waiting times for organ donors and preventable deaths.

Currently, most organ donations occur after the donor has died. Deceased donors are more than 90% of the time people who are brain dead and through their prior consent or family’s decisions have become an organ donor (Center, n.d.). However, not all deceased individuals can become organ donors. Only individuals who are certified brain dead are typically eligible for organ donation. In fact, only 3 in 1,000 people die in a way that allows for deceased organ donation (Health Resources & Service Administration, 2024). This significantly reduces the pool of viable donors, as such merely having deceased organ donors is inadequate in comparison to the demand of organ donations. According to data collected in March 2024, 106,441 patients were on the waiting list for organ donations whereas there were only 9,462 deceased donors (organdonor.gov, 2024). Apart from deceased donors, there are also living donors that can contribute. Unlike deceased organ donors, living donors are limited to and reserved mainly for liver and kidney transplants, and require one to undergo surgical procedure (Byzak, 2018). However, that is not to say that living donors do not play a major role in saving lives. The kidney is one of the most common and most needed transplanted organs, with 85% of people on the organ transplant waiting list needing one (Health Resources & Service Administration, 2024). As such, living donors can help to close the increasing gap between organ donations and those who need it by increasing organ supply. Living donors also tend to offer the best long-term outcome for the recipient as they experience a higher quality of life. Research has shown that on average, a kidney from a living donor lasts about 15-20 years compared to 7-10 years from a deceased donor (American Kidney Fund, 2023). This results in significant cost savings and resource optimisation within healthcare systems as the need for repeat transplants and re-initiation of dialysis is significantly reduced. With studies showing that the average patient survival at 10 years is 90% with a living donor transplant compared to 75% after a deceased donor transplant (NHS Organ Donation., n.d.), living donors maximise the utilisation of scarce organ resources and ensure that each transplant has a lasting impact.

Yet even though living donors offer a second chance to life to recipients, there are many who hold reservations about living donations. The most common reasons cited for not wanting to donate organs are health concerns and financial limitations. Firstly, people are concerned about the possible health risks and impact on their quality of life. Donors can experience surgery-related risks such as pain, infection, hernia, bleeding, blood clots, wound complications and, in rare cases, death (Mayo Clinic, 2024). Donors may even experience long-term side effects like hypertension for kidney donors, or intestinal problems for liver donors (National Kidney Foundation, 2023). However, statistics have shown that surgical procedures for organ donations are relatively safe. The chances of surgery-related risks are rather low (0.07% for death directly related to organ donation and 2.5% for surgically complications requiring surgery) (Weill Cornell Medicine, n.d.).

While there is a lack of data on the long-term effects on organ donations, across the board data has shown that living donors’ lives are largely unaffected and their bodies are able to return to pre-donation physics. Additionally, there are careful health screenings in place to ensure that the living donors are healthy and their health will not be compromised from the donation (Living Donor Evaluation, 2023). Secondly, people are worried about financial losses due to potential wage loss as they recover from surgery. They may be worried about how the surgery may impact their ability to work and maintain their employment as they have to take time off to recover and may face workplace discrimination for doing so. In addition to direct costs such as travel expenses for medical appointments, hospital stays, accommodation, and medication fees, individuals may also incur indirect costs (Klarenbach et al., 2006). These indirect (productivity) costs encompass the economic consequences of reduced ability to work or participate in leisure activities, including lost income and expenses related to household upkeep, as well as caretaking responsibilities for dependents (Klarenbach et al., 2006). Although these costs may not seem significant to some, it is still important to take into account. Biological relatives and spouses make up the majority of living donors, and thus may already be financially burdened by the family member’s chronic medical illness (Klarenbach et al., 2006). A study involving 133 potential donors to a family member, 24% did not donate because of the anticipated financial hardship (Klarenbach et al., 2006). However, in Singapore, there is financial assistance available to living donors to lessen the financial burden. For example, The National Kidney Foundation (NKF) has set up a Kidney Live Donor Support Fund, a $10 million fund, to encourage more live donors to donate their kidneys via financial support to low-income patients (The National Kidney Foundation (NKF) Singapore, 2022). Covering the cost of health screening, medical follow-ups as well as reimbursement of loss of two months’ income (The National Kidney Foundation (NKF) Singapore, 2022), this will significantly encourage people to donate by removing any financial worry.

Although financial schemes are available to living donors, these schemes are primarily designed for individuals who already intend to donate to their loved ones. They do not effectively encourage more people to become living donors to strangers. Therefore, additional aid and support should be provided to motivate and assist individuals in becoming living donors for those they do not personally know. One such way could be state incentives. Just like Singapore which made the buying and selling of organs illegal, The Nuffield Council also has the same stance. However, going beyond the gift versus market dichotomy, The Nuffield Council considers the concept of state rewarding donors and offering incentives as a favorable and ethical way of encouraging donation (J Law Biosci, 2018). As such, Singapore could consider this too. Incentives enable the state to express gratitude for the donor's altruistic act toward the recipient and society. Public surveys in developing countries show high public support for organ donations, with most people having a positive attitude towards donating (J Law Biosci, 2018). However, the medical reality paints a different picture, marked by high rates of abstention and refusal (J Law Biosci, 2018). This discrepancy between attitudes and actions, known as the attitude/action gap, is addressed by state incentives. Incentives provide the necessary motivation needed to overcome an individual’s laziness, apathy, and inertia that prevents them from wanting to donate (J Law Biosci, 2018). Consequently, incentives serve as a catalyst for many who are willing to donate but have not yet taken steps to do so (J Law Biosci, 2018). Additionally, a public policy centered on incentives also reinforces the ban on commercial transactions involving organs. Another way to encourage living donors would be through public awareness campaigns. The government can spread awareness of living donors and debunk some misconceptions about the health risks of organ donations through these campaigns. Public awareness campaigns are effective. A study shows that after an awareness campaign, 52% of the population were ‘unaware’ of living kidney donation but having been ‘made aware’, 62% of people considered donating to a family member or friend and 22% to someone they did not know (Burnapp, L. et. al., 2019). Thus, public awareness campaigns are also vital to encourage living donations.

In conclusion, encouraging living donation can significantly boost organ donation rates. By expanding the pool of available organs beyond those from deceased donors, living donations offer the chance to address this critical shortage of organs for transplantation. Living donors are able to shorten waiting time for recipients, alleviate their suffering, and improve their overall transplant outcomes. However, it is crucial to address the reservations and concerns individuals may have about living donations such as health risks, financial implications, and ethical considerations. Through comprehensive support and education, we can encourage more living donors. Therefore, promoting and facilitating living donations should be a key component of efforts to increase organ donation rates and improve access to transplantation for individuals in need.

References

1. Organ donation Statistics | Health Resources & Service Administration (2024, March 1). https://www.organdonor.gov/learn/organ-donation-statistics

2. State incentives to promote organ donation: honoring the principles of reciprocity and solidarity inherent in the gift relationship | J Law Biosci, (2018, May 19) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121056/

3. Center, U. D. T. (n.d.). Nonliving Donors | Transplant Center | UC Davis Health. https://health.ucdavis.edu/transplant/nonlivingdonors/nonlivingdonors.html

4. Byzak, A. (2018, December 29). Living donation versus organ donation: What’s the difference? - Tri-City Medical Center. Tri-City Medical Center. https://www.tricitymed.org/2018/04/living-donation-versus-organ-donation-whats-the-difference/

5. American Kidney Fund. (2023, April 18). Deceased donor kidney transplants. https://www.kidneyfund.org/kidney-donation-and-transplant/deceased-donor-kidney-transplants#:~:text=The%20kidney%20has%20less%20chance,average%20for%20deceased%20donor%20transplants

6. What is living kidney donation? (n.d.). NHS Organ Donation. https://www.organdonation.nhs.uk/become-a-living-donor/donating-your-kidney/what-is-living-kidney-donation/

7. Becoming a living donor. (2024, April 24). National Kidney Foundation. https://www.kidney.org/atoz/content/becoming-a-living-donor

8. Perceptions and Attitudes Towards Organ Donation Among People Seeking Healthcare in Tertiary Care Centers of Coastal South India | Prasanna, et al. (2018, August) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775029/

9. Living-donor transplant - Mayo Clinic. (2024, March 28).
   https://www.mayoclinic.org/tests-procedures/living-donor-transplant/about/pac-20384787#:~:text=But%20for%20the%20donor%2C%20organ,%2C%20in%20rare%20cases%2C%20death

10. Long-term risks. (2023, November 16). National Kidney Foundation.https://www.kidney.org/transplantation/livingdonors/long-term-risks

11. Risks and Benefits of living kidney donation | Patient care. (n.d.). Weill Cornell Medicine. https://weillcornell.org/services/kidney-and-pancreas-transplantation/living-donor-kidney-center/about-the-program/risks-and-benefits-of-living-donation

12. Living Donor Evaluation. (2023, November 16). National Kidney Foundation. https://www.kidney.org/transplantation/livingdonors/evaluation

13. Klarenbach, S., X. Garg, A., & Vlaicu, S. (2006). Living organ donors face financial barriers: A national reimbursement policy is needed. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402383/

14. Detailed description of data | organdonor.gov. (2024, March 1). https://www.organdonor.gov/learn/organ-donation-statistics/detailed-description

15. Becoming a donor. (n.d.). MEH. https://www.mountelizabeth.com.sg/conditions-treatments/transplant/becoming-a-donor?gclid=EAIaIQobChMI3s7Zyc2hhgMVnKNmAh0KhQSQEAAYASAAEgL75PD_BwE

16. The National Kidney Foundation (NKF) Singapore. (2022, February 18). Kidney Live Donor Support Fund.
    https://nkfs.org/treatment-options/kidney-live-donor-support-fund/

17. Burnapp, L., Van Assche, K., Lennerling, A., Slaats, D., Van Dellen, D., Mamode, N., Citterio, F., Zuidema, W., Weimar, W., & Dor, F. J. M. F. (2019). Raising awareness of unspecified living kidney donation: an ELPAT view. Clinical kidney journal, 13(2), 159–165. https://doi.org/10.1093/ckj/sfz067

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