Kher Hock Sheng, 17

School: Victoria Junior College

Topic: Importance of organ donation awareness and engagement efforts for every age group

Award: Fifth Place, Open Category, 2025

Tides of Life: How Generations Rolling Together Can Shore Up Hope 

Imagine yourself constantly battling a myriad of deteriorating medical conditions, but your only lifeline to lead a healthier life, an organ transplant, is months, even years away. This is but the bleak truth in Singapore, with a mere 3.56 donors per million population, 3.28 donors lower than the global average. Unfortunately, even with well-executed measures such as Live On Festival, Human Organ Transplant Act (HOTA), and the Medical (Therapy, Education and Research) Act (MTERA), patients’ shrill cries for help may not be heard or acted upon by all age groups in society. The immense importance of organ donation awareness and engagement efforts in reaching out to all ages equally simply cannot be highlighted more. 

Importance of Youths 

Firstly, youths are potential organ donors and recipients. Outreach to youths ensures continued and sustained engagement in the long run, allowing a more continuous and reliable supply of organs. To illustrate, both the HOTA and MTERA are voluntary. Such a system necessitates donors to play an active role. With sustained buy-in of youths to this cause, a new normal where organ donation is the societal norm may form with time as they transition into adulthood and silver years. 

Secondly, outreach efforts may inspire youths to take action to raise donation rates. Youths can be key drivers of change with their competence in technology and fresh, innovative ideas and perspectives. A global survey by Edelman revealed that 70% of Gen Z (13 to 28 years old) individuals are involved in social or political causes. With many of such activism being done online. In 2021, participants of the Lakota AI Code Camp in South Dakota developed AI tools to preserve endangered Native languages, combating cultural erosion. With Singapore's robust education system and highly educated youths, youths can leverage on the skills they learnt to spread awareness of organ donation, disseminating information and even inspire people to take action. Live on festival (LOF) encourages youths to express their thoughts on organ donation and transplantation through art and writing. Although an immediate change is unlikely given ingrained cultural and religious norms, it does shed light on the thorny issue of organ donation, reducing the burden on the government and organisations to be the sole informants. 

On the flip side, a lack of effort may widen the intention-action gap due to feelings of alienation. Consequently, youths may increasingly take up more passive roles in organ donation as their willingness to contribute decreases with time. As increasingly more youths become disinterested and disengaged, a snowball effect may occur as other youths will be “infected” by their peers’ beliefs like a contagious virus, forming an insidious cycle. As this generation of youth transition into adulthood, these concerning beliefs will be so widespread and engrained that it will become the new normal. Consequently, it will be too late for outreach efforts to push the needle. Hence, inordinate amounts of resources must be consumed to re-educate and re-engage them, or organ donation rates may plummet, causing unnecessary losses. 

Importance of the middle aged 

Firstly, middle aged individuals usually exert a huge influence in the decisions of family members due to mutual trust and structural empowerment. Being coined the “sandwich generation”, they generally take up vital responsibilities both at home and in the workplace as they may need to care for both their children and parents. An astonishing 47% of middle-aged adults support both aging parents and children, with 15% providing primary financial support to both generations. As such, both parties-old and young have a certain degree of trust and emotional dependence towards the middle aged. This is so as regular social interactions forges a close bond, establishing mutual trust. Consequently, the opinions of middle-aged individuals have more weight in the hearts of both parties. Therefore, outreach efforts to this group are crucial as they can act as a gateway into the hearts and minds of family members, allowing the notion of donation to slowly seep in and take root in family units. 

Moreover, they play crucial roles in the process of organ donation too as the structure of HOTA and MTERA. For example, while HOTA may possess legal consent, in practice, medical professionals often consult the deceased’s next-of-kin to confirm the absence of objection. For MTERA, if the deceased had not made a prior pledge, the next-of-kin can authorise organ donation. This shows that the decision to donate does not lie entirely on the donor. Alarmingly, a local study found that although 68.1% of participants were willing to donate their own organs, only 51.8% were willing to donate a relative’s organs. Notably, 78% had never discussed organ donation with their relatives. This highlights a substantial gap in understanding, which may be due to cultural and religious beliefs making the topic taboo. Thus, outreach efforts are vital in addressing these flaws as it reduces the information gap and can bridge the gap in understanding between the donor and relatives, ensuring a smooth organ donation process and a less distraught family on that grim occasion. 

Importance of elderly 

Firstly, outreach efforts to the elderly are important because there is much untapped potential in improving donation rates. Contrary to popular belief, organs from elderly donors are evaluated based on function, not chronological age. A case in point is the donation of a liver from a 98-year-old United States (US) veteran which saved a 72-year-old woman. In fact, organs from the elderly are more effective for elderly organ receivers. For example, studies confirm organs from donors above 50 years old show comparable complication rates to younger donors when medically screened. For instance, elderly living liver donors have no higher mortality or severe complications. For this to happen, outreach is needed to dispel common myths plaguing organ donation, encouraging them to contribute too. A high enough support rate can even allow specialised donations to only elderly from elderly, such as the “Old-for-Old” Programs in the US or the U.S. Kidney Donor Profile Index. 

Addressing of limitations 

However, critics may argue that reaching out to all ages equally without prioritising age groups is an inefficient and wasteful use of limited resources that result in minimal gains. This is because some postulate that certain age groups act as the cornerstones to improving organ donation rates, and that targeting them will cause a cascade of change, opening the floodgates to organ donation. 

Detractors argue that outreach efforts should be concentrated on youths. Youths are usually the most receptive to mindset change because they are still in their formative years where their worldview is still taking shape. Thus, they are more receptive to outreach efforts. Youths are also more willing to act as shown by 81.9% of Singaporeans under 30 expressing willingness to donate organs, sharply higher than the 60.3% among those aged 30-60. This causes widespread blossoming of intention into action with minimal resource spent and continued support across time, forming a virtuous cycle It is no wonder that critics hold on to such a dreamy vision. 

However, this view does not paint the full picture as it ignores the fact that other age groups can affect youths too. A study utilising data from the 2005 National Youth Survey found that family support and challenges significantly influenced youths’ involvement and leadership in various social activities (including organ donation). For example, in a family, youths’ grandparents may instill myths and beliefs to youths’ parents, such beliefs will then be passed down to youths themselves, and may become too ingrained due to long term exposure. Thus, holding on to the pipe dream of outreach efforts being able to dispel deep rooted beliefs engrained via upbringing is too idealistic. 

Moreover, outreach to all ages equally is most effectively done with tailored strategies that meet different age groups’ unique needs that can be implemented in equal magnitudes for all ages. For example, outreach efforts for youths can focus on online engagement and long-term education to appeal to digitally savvy youths. Outreach to the middle aged can be bite-sized and online to suit their fast-paced lifestyle. Outreach to the elderly should involve more physical interaction, such as with ambassadors or with the use of traditional media, focusing on dispelling myths and false ingrained beliefs. 

All in all, it is of utmost importance to harmonise all age groups equally in our intent to contribute to this noble cause. Doing so allows all ages to be champions of organ donation and ensures existing flaws limiting organ donation rates can be addressed in the long run, ensuring sustainable support for those in need of organs. When everyone, regardless of age, is mobilised, individual ripples of change can accumulate to form a huge tide, shoring up donation rates to “live on” together! 

References

1. Comparing organ donation decisions for next-of-kin versus the self: results of a national survey, https://pubmed.ncbi.nlm.nih.gov/34785552/, Christopher Weiyang Liu 1 2 3, Lynn N Chen 4, Amalina Anwar 5, Boyu Lu Zhao 5, Clin K Y Lai 5, Wei Heng Ng 5, Thangavelautham Suhitharan 2 3 6, Vui Kian Ho 2 3 6, Jean C J Liu 7 8

2. Organ Donation - NUS Medicine. 24 Jul 2024, https://medicine.nus.edu.sg/cbme/wp-content/uploads/sites/14/2024/08/2024-Jul_Julian-Sumy_Organ-Donation-1.pdf

3. The Sandwich Generation. By: Kim Parker and Eileen Patten, https://www.pewresearch.org/social-trends/2013/01/30/the-sandwich-generation/

4. Youth most open to organ donation after death: Poll. By Emilia Tan. Published October 18, 2014. Updated October 18, 2014, https://www.todayonline.com/singapore/youth-most-open-organ-donation-after-death-poll

Disclaimer: Please note that the views and opinions expressed in the essays for the Live On Festival 2025 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