Chou Tsz Lam, 16

School: CHIJ St. Nicholas Girls' School

Topic: An email to a classmate on your thoughts on pledging under MTERA and how to respectfully discuss organ donation with his parents.

Dear Ben,

How are you? It has been a while since the start of the school holiday. Thank you for confiding in me about your thoughts on organ donation and your intention to discuss this important matter with your parents. I am glad that you are taking this seriously and thinking it through carefully. It is truly admirable that you are approaching such a complex topic with maturity, especially since organ donation involves both personal values and family beliefs. I agree that it is worth discussing with your parents and I am more than willing to share my thoughts on how you might approach them.

First, it is important to clearly understand the difference between remaining under HOTA and pledging under MTERA. The Human Organ Transplant Act (HOTA) is an opt-out scheme that ensures a reliable supply of life-saving organs like kidneys, liver, heart and corneas. All Singapore citizens and permanent residents, 21 years old and above, who are not mentally disordered are included under this act, unless they formally withdraw. The intention here is to encourage organ donation as a social responsibility, forming the backbone of Singapore's transplant system.

In contrast, the Medical (Therapy, Education and Research) Act (MTERA), is based on voluntary and explicit consent. It reflects a deliberate and personal commitment to donate organs or tissues or even one’s whole body, driven by individual values such as altruism and compassion. Individuals aged 18 years old and above, regardless of nationality, can pledge to donate specific organs, tissue or whole body for purposes such as transplantation, therapy or education and research upon death. Organs and tissues like lungs, trachea, pancreas, heart valves, iliac vessels and skin can be donated under MTERA. Beyond saving lives, MTERA also contributes to long term advancement of medical knowledge and training of future healthcare professionals. Therefore, choosing MTERA demonstrates a more intentional and holistic commitment to helping others. In other words, HOTA assumes consent unless you object while MTERA expresses a deliberate choice to give.

That being said, it is completely natural for your parents to have reservations. Discussions about death and the body can be emotionally challenging, especially for parents who instinctively want to protect their child. Losing their loved ones is already heartbreaking and having to accept the organs donation from the deceased one for transplant and educational purposes is even more heart wrenching. They may feel uncomfortable thinking about such matters or worry about the impact on funeral arrangements and cultural practices. Moreover, concerns about body integrity and whether funeral rites may be affected are common, particularly if these matters are closely tied to cultural or personal values. Also, since you are still young, your parents may feel that your decision is impulsive and not fully thought through. Whatever considerations and concerns they have, they all come from care, not resistance, so approaching them with patience will make a meaningful difference. Acknowledging their concerns is crucial because it shows that you recognise their care and are not attempting to override their feelings.

There are also several potential myths about organ donation that need to be clarified. Some may fear that doctors will not try their best to save the donors’ life if they have pledged under MTERA. However, this is untrue. Organ donation is only considered after brain death has been confirmed by two doctors, so patient care is never compromised by the potential for organ retrieval. Also, others may worry about the disfiguration of the body which hinder the open-casket funeral. In reality, donations are carried out respectfully. For example, the donated skin is a very thin layer recovered from areas that can be covered by clothing, so an open-casket funeral is still possible. If this is one of your worries, you need not fret. After all, it is indeed a heroic decision for one to commit to MTERA and the medical team will definitely pay their respects to whoever the donor is.

When speaking to your parents, the tone you adopt may be just as important as the content. Rather than trying to persuade them immediately, it may be helpful to frame the discussion as a way of sharing your thoughts and seeking their understanding and support. Remember to present your views calmly and the reasons why you would like to pledge under MTERA. It is natural for them to feel shocked at first but do listen sincerely to their concerns as well. After all, you are still their son and asking them to think of what will happen after your death is heart wrenching. Besides that, avoid being insistent or dismissive and it is important to give your parents the time and space to process what you have to share. Respect works both ways, if you want your parents to listen to you, first of all, you have to let them voice out their concerns.

I hope these points help you better understand the differences between HOTA and MTERA and to ease your worries as you convey your thoughts to your parents later on. Ben, your intention really makes me realise the culture of voice and the culture of expressed willingness for organ donation to make it clear to all families that our choice and our body have not been sacrificed in becoming a gift of life to others. Remember, no matter the outcome, I will always be here to support you. Do take care and feel free to reach out if you would like to talk further.

Love,
Nicole Chou

Disclaimer: Please note that the views and opinions expressed in the essays for the Live On Festival 2026 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 ↗ (opens in new tab)