Thay Guan Yuan, 17

School: Dunman High School

Topic: Encouraging living donations is key to improve donation rates

Award: Special Mention, Open Category, 2024

Heartstrings of Hope: A Symphony of Compassion in the Organ Donation Dilemma

Picture yourself along the corridors of a hospital, witnessing the treacherous sight of emergency rescues and feeble cries hounding the thin line of death, for they must accept the reality. In the sterile waiting area of a hospital, a family huddled around, holding their collective breath in eager expectation and praying for their family's future. In an operating room, their beloved father and pillar of strength, their patriarch, lies unconscious, his life in limbo. For them, hope arrives in the form of a selfless act—a living donation that promises to restore vitality to their loved one's faltering existence. They were lucky. But not all were as lucky. In the backdrop of medical prosperity and scientific breakthroughs, a poignant narrative dividing the endeavor of expanding avenues of living donations have transcended moral boundaries, but a matter of personal dilemma over the implications to the alteration of one’s bodily structure, or to others, fearing death; to say the least. Organ shortages are not a mere statistic but a profound test of the boundaries of our moral fabric and societal structures. Millions of people are in desperate need of organ transplants, with only 10% of the world's need now being satisfied, according to the World Health Organisation ^[1]. The debate over living donations presents itself as a possible ray of hope as the need for organs grows worldwide. It sheds light on the complex relationship between encouraging individualistic charity and fostering group responsibility. In the cosmopolitan and highly advanced society of Singapore, encouraging living donations may very well be the keystone in bridging the chasm between the dire need for organs and the availability of life-saving transplants. As such, this writer believes that encouraging living donations will gradually elevate organ donation rates.

First and foremost, encouraging living donations overcomes the moral imperative beyond altruistic obligations, with emphasis on reconstructing societal norms, henceforth improving organ donations as a whole. Philosophically speaking, utilitarian and deontological viewpoints are both included in the concept of living contributions. Giving an organ while still living is regarded as the height of charity because it is a selfless gesture that profoundly improves the life of the recipient. This selfless deed is in line with the utilitarian maximisation of happiness and well-being in general. Living donations align with cultural standards of obligation and care in Singapore, where societal values are strongly ingrained in familial and community ties. As such, they could be utilised to enhance organ donation practices. It is imperative to maintain the autonomy of potential donors, guaranteeing that their permission is freely given and properly informed. Strict ethical standards and monitoring help to sensitively preserve the delicate global balance between autonomy and benevolence. The 2018 Istanbul Declaration promotes voluntary and informed consent while highlighting the need to shield donors against abuse and coercion. ^[2] Even though there is always a risk, it is usually done out of kindness and generosity rather than a desire for financial gain. Each significant milestone, such as the world's first successful kidney transplant performed by Dr. Joseph Murray in 1954 ^[3] or the ground-breaking developments in immunosuppressive medicine, symbolises a victory over mortality's constraints. Today, living donor transplants serve as a testament to the unyielding spirit of human resilience, offering hope where once there was despair and renewal in the face of affliction. Simultaneously, the populace's willingness to offer the gift of life to another lays the groundwork towards constructing a gracious society outlook, fostering a culture where living donations are motivated by genuine altruism. Here, the act of donating an organ while alive transcends mere altruism; it becomes an embodiment of familial duty and communal solidarity to alleviate another’s suffering, therefore being a key to improving organ donation rates.

However, improving organ donations requires much more than singular activism, but that of the government. Take Singapore, where the proactive stance of the government, as exemplified by the Human Organ Transplant Act (HOTA), has significantly boosted deceased donor rates. However, despite this progress, there remains a crucial gap that living donations could help bridge. Incentivising living donations requires a delicate balance between ethical considerations and practical benefits. While controversial, financial compensation, as seen in Iran's regulated kidney market, has led to remarkable success in eliminating kidney transplant waiting lists. Singapore could consider similar approaches, offering financial support, tax incentives, and comprehensive health coverage to donors, thereby easing the economic burden and encouraging donations. The economic advantages of increasing living donations extend far beyond immediate medical outcomes. Dialysis, the alternative to kidney transplantation, is not only a long-term but also a costly treatment, exceeding $70,000 annually ^[4]; thus the economic case for transplantation becomes compelling. In Singapore, the hefty average cost of dialysis per patient adds significantly to the financial strain on the healthcare system. Conversely, successful kidney transplants from living donors could substantially reduce these costs, saving approximately $150,000 per patient over their lifetime, based on global estimates ^[5]. Therefore, promoting living donations not only improves patient outcomes but also enhances the sustainability of the healthcare system. In the realm of policymaking, the organ donation crisis presents a formidable challenge that necessitates innovative solutions and visionary leadership.

Policymakers in Singapore's parliamentary chambers struggle to strike a delicate balance between moral leadership and practical economics. How can we encourage live contributions without reducing human life to commodities? How do we navigate the fine line between fiscal responsibility and moral duty? These are the pivotal questions driving the political-economic discourse surrounding organ transplantation.

Through rigorous economic analysis, the cost-benefit calculus of organ donation unveils its significance with precision. By promoting living donations, policymakers have the opportunity not only to save lives but also to alleviate the long-term financial strain on the healthcare system—a mutually beneficial proposition for patients and taxpayers alike. Thus, only with the government’s active participation in enveloping legislative guidelines and encompassing a surge in living donations, could organ donation rates increase sustainably. Advocating for living donations is undoubtedly crucial in confronting the organ shortage crisis. While government intervention can offer incentives for living donations, relying solely on this strategy risks oversimplifying the intricate web of challenges surrounding organ scarcity. Merely urging living donations without tackling systemic barriers and ethical complexities risks perpetuating inequalities and vulnerabilities within the organ donation system. However, what must be noted is that there must be boundaries set between encouraging, enforcing and pressurising. Families of the victims should not be pressured to cede to living donations, regardless of circumstances, in turn to reduce financial burden, nor should they be obliged to participate in surgical transplants.

Finally, encouraging living donations emerges as a paramount strategy in addressing the persistent challenge of organ scarcity. From the advent of laparoscopic nephrectomy to the refinement of immunosuppressive protocols, each advancement represents a triumph of intellect over affliction—a testament to the boundless potential of human endeavor, significantly reducing the risks associated with living kidney donations, making the procedure less invasive and recovery more swift. In the realm of medical science, the quest for perfection is a perpetual journey—a ceaseless pursuit of innovation and discovery. In the operating theatres of Singapore's leading transplant centers, surgical teams orchestrate intricate ballets of precision and skill, guided by the singular goal of saving lives. These medical advancements are pivotal in promoting living donations, reassuring potential donors of the relative safety and manageability of the process. Internationally, the National Organ Transplant Unit (NOTU) of the United States reveals a substantial difference in survival rates, with recipients of kidneys from living donors boasting a remarkable 5-year survival rate of approximately 90, surpassing those from deceased donors by 10 percentage points, reinforce the feasibility and effectiveness of robust living donor programs on a global scale. Beyond the numbers lies a deeper truth: that behind every statistic is a life reclaimed, a family restored, and a future rewritten. Thus, healthcare systems can strategically advocate for living donations, fostering greater awareness and participation, and ultimately alleviating the organ shortage crisis, offering recipients a second chance at life.

The organ donation dilemma is a compassionate crescendo in the vast symphony of human endeavor, demonstrating the limitless capacity of the human soul. The horizon sparkles with promise and possibilities in Singapore, where compassion, integrity, and innovation beat at the center of growth. While encouraging living donations holds promise, it's not a panacea. Careful consideration should be given to ethical issues, possible coercion, and logistical difficulties. A more comprehensive strategy is provided by diversifying tactics like deceased donations, public education, and regulatory reform. While valuable, living donations are but one facet of a multifaceted solution to the organ donation crisis, with a myriad of other solutions needed. Alas, this would not be possible without legislative support, medical procurement and active citizenry. As leaders of tomorrow, let us walk hand in hand with the vulnerable, let us seize the opportunity, and establish a future where every individual’s life is cherished, every voice is heard, and every heart beats in unison.

^[1] Jour Ward, Alyssa Klassen, David Franz, Kate Giwa, SebastianLewis, Jedediah, Published 2018/04/01, Social, Economic, and Policy Implications of Organ Preservation Advances,Volume 23, 10.1097/MOT.0000000000000532, Current Opinion in Organ Transplantation https://www.researchgate.net/publication/324701937_Social_economic_and_policy_implications_of_organ_preservation_advances/citation/download

^[2] THE DECLARATION OF ISTANBUL ON ORGAN TRAFFICKING AND TRANSPLANT TOURISM (2018 Edition) Preamble. (2018). https://www.declarationofistanbul.org/images/Policy_Documents/2018_Ed_Do/2018_Edition_of_the_Declaration_of_Istanbul_Final.pdf

^[3] Komaroff, A. (2012, November 28). Remembering Dr. Joseph Murray, a surgeon who changed the world of medicine - Harvard Health Blog. Harvard Health Blog. https://www.health.harvard.edu/blog/remembering-dr-joseph-murray-a-surgeon-who-changed-the-world-of-medicine-201211285590

^[4] Bruce, M. A., Beech, B. M., Sims, M., Brown, T. N., Wyatt, S. B., Taylor, H. A., Williams, D. R., & Crook, E. (2009). Social Environmental Stressors, Psychological Factors, and Kidney Disease. Journal of Investigative Medicine, 57(4), 583–589. https://doi.org/10.2310/jim.0b013e31819dbb91

^[5] STEPHEN J. CHOI, MITU GULATI, & ERIC A. POSNER. (2018). ALTRUISM EXCHANGES AND THE KIDNEY SHORTAGE . Vol. 77:289 . https://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=4701&context=lcp

References

1. Jour Ward, Alyssa Klassen, David Franz, Kate Giwa, SebastianLewis, Jedediah, Published (2018, April 1), Social, Economic, and Policy Implications of Organ Preservation Advances,Volume 23, 10.1097/MOT.0000000000000532, Current Opinion in Organ Transplantation https://www.researchgate.net/publication/324701937_Social_economic_and_policy_implications_of_organ_preservation_advances/citation/download

2. THE DECLARATION OF ISTANBUL ON ORGAN TRAFFICKING AND TRANSPLANT TOURISM (2018 Edition) Preamble. (2018). https://www.declarationofistanbul.org/images/Policy_Documents/2018_Ed_Do/2018_Edition_of_the_Declaration_of_Istanbul_Final.pdf

3. Komaroff, A. (2012, November 28). Remembering Dr. Joseph Murray, a surgeon who changed the world of medicine - Harvard Health Blog. Harvard Health Blog.
   https://www.health.harvard.edu/blog/remembering-dr-joseph-murray-a-surgeon-who-changed-the-world-of-medicine-201211285590

4. Human Organ Transplant Act - Singapore Statutes Online. (2021, December 31). Agc.gov.sg.
   https://sso.agc.gov.sg/Act/HOTA1987

5. Bruce, M. A., Beech, B. M., Sims, M., Brown, T. N., Wyatt, S. B., Taylor, H. A., Williams, D. R., & Crook, E. (2009). Social Environmental Stressors, Psychological Factors, and Kidney Disease. Journal of Investigative Medicine, 57(4), 583–589.
   https://doi.org/10.2310/jim.0b013e31819dbb91

6. STEPHEN J. CHOI, MITU GULATI, & ERIC A. POSNER. (2018). ALTRUISM EXCHANGES AND THE KIDNEY SHORTAGE . Vol. 77:289 . https://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=4701&context=lcp

7. Cecka, J. M. (2005). The OPTN/UNOS Renal Transplant Registry. Clinical Transplants, 2005:1-16.(17424721), 1–16. https://pubmed.ncbi.nlm.nih.gov/17424721/

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