Tryphena Ang Xin Min, 16

School: St. Anthony's Canossian (Secondary)

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

HOTA or MTERA: Making an Informed Choice on Organ Donation

Hey Bob,

I am really glad that you are taking the time to think seriously about organ donation and to involve your parents instead of making a decision alone. As you mentioned, this is not an easy topic to discuss and the fact that all of you already see it as a meaningful and life-saving act is a very good starting point. In order to make your parents understand your stance on the issue, it may be helpful to first know what differentiates remaining under the Human Organ Transplant Act (HOTA) from pledging under the Medical (Therapy, Education and Research) Act (MTERA).

You asked about the difference between remaining under HOTA and pledging under MTERA and whether MTERA is the “right” choice. As far as I am concerned, pledging under MTERA and remaining under HOTA differ in terms of their intention.

First off, HOTA is based on presumed consent. This means that as long as a person does not opt out, they are automatically considered a donor for specific organs [kidneys, liver, heart and corneas] after death. Its main purpose is to increase the supply of organs for transplantation and save lives efficiently. Therefore, we can say that HOTA was developed specifically to fulfil a societal need.

On the other hand, pledging under MTERA reflects a more active and personal decision. It is a voluntary opt-in system that involves one actively deciding to donate their organs. Unlike HOTA, where its purpose is mainly for transplantation, MTERA allows a person to register as a donor for a wide range of organs and tissues or one’s entire body in order to not only save lives but to also facilitate scientific and medical research and education. This means contributing to the training of doctors and the development of future treatments. While HOTA is about fulfilling a societal need through default inclusion, MTERA represents a deliberate and broader commitment to helping others even beyond one’s lifetime. While remaining under HOTA can be seen as a solution to social needs, pledging under MTERA implies doing something beneficial to society.

That being said, it is completely understandable that your parents may have some reservations. One common concern is discomfort with the idea of how the body might be handled after death especially if they have cultural or personal beliefs about keeping the body intact. Another common misconception is that organ donation affects funeral arrangements or delays the process. Moreover, there is a concern that physicians might try less hard at reviving patients who are registered as donors. However, this is not accurate since such patients will receive the same quality of care as others.

You might also want to consider that older generations sometimes prefer to avoid making decisions about death in advance because they may see it as unwise or unnecessary. For them, remaining under HOTA may feel “safer” as pledging under MTERA might feel like a greater commitment from their perspective.

Due to these concerns, it is important to address some common myths clearly. For example, organ donation only takes place after a person has been certified dead according to strict medical criteria. Doctors treating a patient will always prioritise saving the patient’s life regardless of organ donor status. Some people assume that the body will be disfigured. In reality, organ retrieval is done respectfully, and the body can still be prepared for an open-casket funeral if the family wishes. Additionally, organ trading is illegal in Singapore so there are strict laws in place to ensure the process is ethical and regulated.

When you speak to your parents, one piece of advice from me is to watch out for your tone. Since this is a sensitive topic, it is important to not sound aggressive like you are forcing your opinion onto them even if you strongly believe that pledging under MTERA is the “right” choice. Instead, it would be better to try to present it as your personal perspective and explain why it matters to you. For instance, you could say that you see MTERA as a way to make a more meaningful contribution especially by helping future patients through research and education.

Furthermore, it would also help to acknowledge their points of view and show that you understand their concerns. From my personal experience, being a good listener and responding calmly is the key to making the conversation more respectful and productive. Make an attempt to not dismiss their worries as “wrong” or “irrational,” because that might make them defensive and it could lead to further disagreement. Thus, it is better to gently clarify any misconceptions with facts and reassure them.

An alternative strategy would be to stress the point that making a pledge to MTERA does not mean that they lose their power to decide. They can determine which organs and tissues they want to donate for whichever reason. It is not an either-or situation. Alternatively, you can tell them that even just discussing the matter with their families counts as a positive action, no matter what they end up deciding on.

To conclude, there is no one right answer that fits everyone’s circumstances. Choosing to remain under HOTA makes a huge difference on its own and opting into MTERA simply expands the contribution further. I feel that the key here is to make the decision wisely and thoughtfully based on a shared understanding.

Finally, I think that it is really admirable that you want to have this conversation with your parents. Even if they do not immediately agree with you, being open and respectful will bring you far. In the long run, they may even become more comfortable with the idea itself.

I really hoped that this was helpful. All the best for your discussion and feel free to contact me again if you have anything to add on.

Take care,
Tryphena

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)