Kayden Ang Kai Jian, 17

School: Victoria Junior College

Topic: Encouraging living donations is key to improve donation rates

Award: Special Mention, Open Category, 2024

The Key - Living Organ Donations

The very prospect of living organ donations scares many. From individual perspectives, living organ donations entail the removal of one's organs in a noble, albeit risky procedure, one they may not desire to undertake. From a governmental perspective, living donations may result in unfavorable complications. Many hesitate to even consent to deceased organ donation, let alone put themselves under the knife. However, many of the views and assumptions that cause some to have an aversion to the procedure tend to be hyperbolic, especially for living organ donations. In actuality, living organ donation is not as perilous and unrewarding a procedure as many perceive it to be. It may be quite the opposite. Ultimately, I believe encouraging living donations may be the key to improving organ donation rates.

Firstly, and perhaps most saliently, encouraging living donations would undoubtedly translate to an increase in the number of organs available for transplantation in the national reserves. It is not surprising that patients on the transplant waiting lists for various organs are often left waiting for an agonisingly long time for their turn to arrive, if at all. Some examples of this can be seen, according to the National University Centre for Organ Transplantation (NUCOT), with the average waiting time in Singapore for a deceased kidney transplant being estimated at 9.3 years, as of 2020. The deceased organ donation rate of Singapore is also amongst the lowest in the world at only 4.48 deceased donors per million population. These current rates of organ donations leave much to be desired. With more than 500 patients on the waiting list for all organs each year, it is clear that relying on deceased organ donation alone will not suffice to match the burgeoning demand for organs. This is where living organ donations enter the fray. Organs from living donors serve the purpose of alleviating the glaring insufficiency of deceased organ donations alone in meeting the organ donation needs of the country, and would thus bolster the chances of patients receiving their much-needed organ transplants, giving them that much more hope, and ultimately successfully increase organ donation rates.

From an emotional standpoint, encouraging living donations would give rise to more personal accounts of living organ donors about their donation experience, helping the public to grasp better the processes involved as well as the emotional fulfillment such experiences can confer on the donors themselves, motivating others who may not have considered living donation, to, in turn, volunteer themselves. Present on both social media and websites of organisations, these stories and accounts, often in the form of short videos, show the genuine relationships and bonds forged between donors and recipients, and how the lives of both parties are improved. For instance, such stories are shared on the websites of organisations such as the National Kidney Foundation, to spur organ donation efforts by appealing to people's emotions. They also help to allay concerns that people might have on living donation. In another instance, Mr Sakthibalan Balathandautham was named The Straits Times Singaporean of the Year 2021 for his selfless act of donating part of his liver to a one-year-old girl whose plight was made known to him through a plea by her parents on social media, with his own donation story being published in the form of an article on the Straits Times in 2022. It is precisely these stories that inspire others to take the first step towards donating. By encouraging living donations, more of such stories and accounts would be brought to light, offering a glimpse of the myriad of benefits on the human mind and psyche to prospective donors and hesitant skeptics alike. The result is a population that is more willing to volunteer themselves, in hopes of experiencing the same catharsis through an act whose meaningfulness they can greatly appreciate, ultimately causing organ donation rates to rise.

Finally, living organ donations can be targeted at specific cases on the national waitlist, with tests being conducted on both the donor and recipient to ensure a genetic match, which lessens the risk of rejection and an unsuccessful donation. Rejection can occur for a manifold of reasons, whether it be due to incompatibility of organs, differing blood types, or the presence of antibodies in the recipient’s immune system. The often stringent and comprehensive tests conducted before living donors are cleared for donation procedures play an integral role in preventing organ rejections and other possible complications that may arise. For example, blood and urine tests are often administered to ascertain medical fitness and psychosocial evaluations are run to evaluate donor motivations. Prospective donors are also required to be in the pink of health to ensure a healthy and functional organ for donation. This rigorous medical examination, coupled with the various pre-transplant precautions that are taken, helps to minimise the risk of complications that may arise during the donation process. This degree of specificity and scrupulosity may not be found in the case of deceased organ donations, as compared to living donations, less of such tests can be run, and the quality of the organ may inevitably deteriorate as a result of time and inability to perfectly preserve the organ until transplantation. This is supported by a study published in the National Library of Medicine in the USA, which states that, in the case of kidney transplantation, live donor transplants have superior graft and patient survival rates and lower acute rejection rates as opposed to deceased donations. Living donations can thus be expected to produce higher rates of successful organ donations, and offer a greater peace of mind to individuals in need of organ donations.

However, despite encouragement, mistrust and fears may still be present among the general public and prospective donors that may hinder them from acting on their desire to donate. Beyond individuals, governments also adopt a rather conservative stance to encouraging living donations because of these potential complications. One source of such mistrust and uncertainty would be the pervasive risk of illegal organ trafficking in organ donations. The World Health Organisation in 2004 believed organ trafficking rates to be steadily on the increase, and it was also estimated by the United Nations in 2018 that 10% of organ transplants done globally are completed using black market organs. This risk has its largest impact on the poor who, already plagued with expenses, have to contend with soaring organ prices. Some may even be forced to sell their organs, against their will, for sustenance due to a lack of income sources. However, I believe that whilst such concerns are not unfounded, they are more than adequately addressed by government legislation, especially in Singapore. One example of this is the enactment of the Prevention of Human Trafficking Act (PHTA) in 2015, where human trafficking and Trafficking in Persons, which includes the removal of an organ, is an offense that is criminalised. The efficacy of this policy has also been demonstrated evidently, with 10 cases having been convicted with a maximum sentence of 80 months imprisonment and a maximum fine of $30,000 since its inception. Internationally, this problem has been tackled by the United Nations, with the General Assembly encouraging "Member States to exchange experience in and information on preventing, combating and punishing the illicit removal of and trafficking in human organs." Therefore, I believe that while the risk of perpetuating organ trafficking by encouraging living donations is not wholly eliminated, it is severely limited. At the end of the day, prevention of such acts from occurring, which is incumbent on the relevant authorities, should not dissuade willing donors from passing up the chance to save lives.

In conclusion, I believe that encouraging living organ donations may be the key to improving organ donation rates, as it bolsters the national organ reserves, appeals to the public on an emotional wavelength, and provides greater assurances of successful donations. Nevertheless, there is still the need for complementary measures and an increase in the altruism of the people, for an improvement in organ donation rates. Ultimately, I feel that to effect a significant increase in organ donation rates, both living and deceased organ donations should be leveraged and work in harmony, and allow people, from all walks of life, to appreciate the fact that they may have all they need to enable others to truly live on.

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