Lee Ze Xun Izac, 16

School: St. Joseph's Institution

Topic: Are conversations about death necessary to encourage organ donation?

Dialogue and the Limits of Organ Donation Advocacy

It's a truism that organ donation is lifesaving, life-changing and also viewed as a moral grey area. The issue of the shortage of organs for transplantation is becoming more prevalent in this current day and age as demand continues to outgrow supply. In Singapore alone, more than 500 patients are currently on the waiting list for vital organs, with the average wait time stretching to 9 years and more. For many facing end-stage organ failure, an organ transplant is a desideratum.

However, there is a substantial chasm between willingness to donate and actual donor registration, with the main reasons being family refusals that can override registered intent to donate and organ donation carrying the societal patina of taboo. In fact, family refusal is the leading cause of missed organ donation opportunities. Therefore, it is of utmost importance that conversations about death be made to families of organ donors and beyond in order to encourage organ donation

To espouse organ donation is easier said than done. Even with Singapore implementing the Human Organ Transplant Act (HOTA) to facilitate donations, shortage of organ donations is still prominent. Interpersonal dynamics mould family discussions about organ donation. Family refusals persist as regret, cultural beliefs and insufficient awareness can significantly affect consent and cloud judgement of family members. Organ donation is especially sensitive for family members involved, as psychological and societal factors can further complicate the process. After all, processing the enormity of information about neurological death and the limit of one’s morality at an emotional time accounts for one of the reasons why families demur organ donation, even under presumed consent provided under HOTA.

This puts every possible organ transplant at risk; healthcare professionals are racing against the clock to ensure viable organs for transplant while dealing with grieving families. Above all, lack of awareness, misconceptions, and socio-cultural influences majorly hinder widespread adoption and consent of organ donation. This accentuates the importance of end-of-life discussions with family members of donors and relatives involved. These discussions aid in dispelling misconceptions and breaking stigmas surrounding taboo topics such as mortality and death. In this way, families can be more empowered and certain in decision-making and consent.

However, it is to an extent how much families are willing to honour the wishes of the donor. Strong cultural and religious beliefs on the preservation of the physical integrity of the body after death can stymie communication even after prior discussion. This is especially ubiquitous in a multi-cultural and multiracial society like Singapore. The issue of following one’s religious doctrine can clash with organ donation and engage in a tug-of-war with utilitarianism, where the slightest misstep by a healthcare professional can augment the despair of losing a loved one. Coercion into donation of organs, a slippery slope of human rights violations that should not be tolerated, is also futile.

Ultimately, a more judicious and beneficent approach has to be taken to pursue bodily autonomy and respect the volition of family members involved. Communication must also be specific and clear in order to further concretise the topic of organ donation and dissuade avoidance behaviour of family members surrounding the topic of mortality. Poor communication and insensitive language will only impinge upon the decision-making of family members. In order to espouse organ donation, healthcare professionals approaching family members in an empathetic manner and being open to honest and transparent discussion are discriminating factors in the decision-making process.

Beyond the family members of donors, society also has a proclivity to tend towards misconceptions and insouciance towards organ donation. In spite of efforts and public campaigns to promulgate and spread awareness on organ donation, scepticism, misconceptions, and preconceived notions still persist, especially around deceased organ donation. With common media playing a major role in indoctrination of the youth, alongside technological strides made in organ donation negating donors’ altruism, the mindset of the population towards organ donation can be negatively morphed, contributing to the paltry modicum of organs required to satiate the insatiable. At the helm, the eschewment of society from the macabre topic of death except in niche circumstances such as insurance plans has inadvertently led to the reluctance of considering organ donation for many, whether voluntary or mandatory.

In order to break down the parochial attitude towards the murky topics of death and organ donation, open conversation is a necessity. Enhanced engagement through talks, podcasts and fireside chats between healthcare professionals can help abolish doubts and public scepticism on deceased organ donation and open a platform for open discussion on further topics surrounding this issue, such as presumed consent under acts such as HOTA. Implementing more public educational initiatives through collaborations between organisations like “Live On” and institutions of higher learning can impugn and debunk preconceived notions and further educate on the legal, ethical, and medical aspects of organ donation. Targeted media campaigns in collaboration with influencers on various social media platforms leverage the wide diverse reach of social media for open communal dialogues about death and mortality to be made. These allow for many to broach the topic out of understanding, conducing increase in donor registrations and public trust. Further exposure to media featuring organ donation and impact of organ donation in the community can further facilitate this change. By normalising and starting these conversations in today’s social milieu, interventions can be further tailored to aid in enhancing visibility of organ donation to many. On the other hand, how these changes would impact the next generation is yet to be seen considering technological advancements made in organ donation and transplantation in a short amount of time.

In short, maximising organ donation rates requires conversations about death to be made. While registering as a donor or not, opting out of a presumed consent model such as HOTA may not seem conflicting, the willingness of the donor’s loved ones to uphold that decision is a whole other can of worms opened at their most emotional and irrational moments. Furthermore, continued acquiescence towards societal stigma and deep-seated misconceptions around taboo topics of death and deceased organ donation can lead to a continued detrimental impact to the ever-shrinking repository of viable organs for transplantation. These emphasise the necessity of dialogue surrounding the moral grey area, be it when providing recourse to the family members of a donor or impugn preconceived notions in the public limelight.

Conversely, dialogue by itself is not a panacea. Dialogue alone cannot guarantee that deceased organ donors will be able to donate their organs. Public trust in the healthcare system is also instrumental to this issue to abolish fear and mistrust in systems intertwined with organ donation. Without support from other factors such as cultural sensitivity and institutional support, organ donation would never go beyond words. Action must also be taken alongside dialogue to ensure a society that is ready to act upon these conservations.

With dialogue comes a better understanding of the matter at hand, and with it the clearing of obstacles to the truism of organ donation. This will take time, but with each bit of progress we make, comes the near-ideal scenario that seems less and less out of reach.

References

1.    Seah, S., & Tang, L. (2025, December 19). Singapore faces shortage of organ donations; more than 500 patients waiting for Transplant. CNA. https://www.channelnewsasia.com/singapore/organ-donation-shortage-transplant-moh-kidney-patients-5646451#:~:text=Singapore%20faces%20a%20persistent%20shortage,received%20a%20transplant%20last%20year ↗ (opens in new tab).

2.    Miller, C., & Breakwell, R. (2018, April 23). What factors influence a family’s decision to agree to organ donation? A critical literature review. London journal of primary care. https://pmc.ncbi.nlm.nih.gov/articles/PMC6074665/ ↗ (opens in new tab)

3.    Weeks, S., Fanstone, J. W., Marcu, V., Barash, B., Thompson, C., & Vincent, B. P. (2025). Barriers to conversations about deceased organ donation among adults living in the UK: a systematic review with narrative synthesis. BMJ Open, 15(3), e091873. https://doi.org/10.1136/bmjopen-2024-091873 ↗ (opens in new tab)

4.    VG P, MB A, Jayachandran M, et al. (September 23, 2025) Awareness, Attitudes, and Perceptions Toward Deceased Organ Donation Among Healthcare Students and Professionals: A Mixed-Methods Study. Cureus 17(9): e92994. doi:10.7759/cureus.92994

5.    Health & Family Welfare Department, Delhi Government. (n.d.). Awareness and campaign for organ donation – Health & Family Welfare Department, Delhi. https://aangdaan.delhi.gov.in/site/awareness-campaigns#:~:text=Awareness%20campaigns%20dispel%20myths%20and,to%20take%20the%20first%20step ↗ (opens in new tab).

6.    Baker, J. A. (2026, January 20). “Are you sure he is dead?”: Doctors struggle with families’ lack of understanding of HOTA. CNA. https://www.channelnewsasia.com/singapore/human-organ-transplant-act-doctors-families-understanding-887136 ↗ (opens in new tab)

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)