Angelia Carissa Setiadi, 20

School: National University of Singapore

Topic: In some countries, family members often bring up the patient’s intent on organ donation to the doctors as part of end-of-life care. Is this a utopian dream for Singapore or an impossible fallacy?

Giving Life at the Edge of Death

When my Ah Gong was diagnosed with end-stage renal disease earlier this year, it highlighted to me the importance of handling patients’ end-of-life care with professionalism, efficiency, and empathy. End-of-life care refers to the support given to individuals who are entering the final phase of their lives¹. Amidst conversations with doctors about my grandfather’s health condition, one topic noticeably struggled to enter the room: organ donation. For many Singaporeans, organ donation still feels like a distant subject, doused with unfamiliarity and fear. However, in some countries, this is juxtaposed with families being willing to bring up a patient’s intent on organ donation as part of end-of-life care. This then begs the question: is achieving this open-mindedness and proactiveness in Singapore a utopian dream, or simply an impossible fallacy? While such a shift may present its challenges, I believe it is closer to an idealistic goal than a logical impossibility. Through greater awareness, stronger advocacy and more compassionate support, it can become an attainable goal for Singapore to move towards.

Detractors may assert that this is an unrealistic belief, as families may harbour discomfort towards organ donation due to a lack of knowledge about the procedures and the patient’s wishes before death. In some other countries, families may find that starting the conversation on organ donation is a form of honouring the patient’s autonomy, especially within opt-in systems where donation is framed as an active personal decision. For instance, the United States employs an opt-in donation system where individuals register their decision to become a donor². For people such as Mary Desin, a nurse who became a donor after a brain aneurysm³, organ donation can be seen as a final altruistic act that continues the values they lived by. On the other hand, Singapore’s system starkly contrasts this with its opt-out approach and a culture that still lacks prominent conversations surrounding organ donation.

In Singapore, the first key source of discomfort surrounding organ donation lies in the perceived erosion of personal autonomy under an opt-out system. To better understand this, it is necessary to know one of the key pieces of legislation that governs Singapore’s cadaveric organ donation system: the Human Organ Transplant Act (HOTA)⁴. Under HOTA, Singapore Citizens and Permanent Residents aged 21 and above are included as donors for kidneys, liver, heart and corneas upon death, unless they have opted out. This means that, on the donor registry, there may be no visible difference between a healthcare worker who consciously wishes to save a life after death and an average person who is simply unaware of the policy. Yet in practice, some people may remain registered not because they made a clear personal choice, but because they were unaware of the system. As a result, families may feel blindsided when organ donation is raised after death, due to their lack of awareness of HOTA. This discomfort is made even sharper by the timing of the process. Under HOTA, organ donation is only considered after death has been certified, and in cases such as brain death, the process becomes highly time-sensitive. Families are therefore left to confront death, uncertainty and the possibility of organ recovery within a short timeframe. In that moment, bringing up organ donation may feel like admitting that death is inevitable before the family has even emotionally processed it. Thus, expecting them to be the first to initiate such a conversation may appear emotionally unrealistic, if not insensitive.

Another key source of discomfort comes from Singapore’s culture of silence surrounding death, which further contributes to the animosity towards organ donation. Within a society where conversations about death are often avoided until they become unavoidable, families are naturally left at a painful and confusing juncture when they are unaware of the patient’s intentions. They may resist donation not because they are selfish, but because objection may feel like the safest way to respect the body of the one who has passed. Therefore, it could be argued that it is highly unachievable for Singaporean families to be expected to be the first to bring up organ donation under a system that does not always provide emotional comfort, and within a culture that does not yet encourage clarity on the topic.

However, these concerns do not necessarily mean that we should dismiss this as an impossible fallacy. Instead, they reveal the exact gaps Singapore can address to bring what feels like a utopian dream closer within reach through awareness, advocacy and more compassionate support.

Firstly, raising more awareness surrounding organ donation can allow Singaporeans to make more informed choices while they are alive and communicate these decisions to their families. Registered donors deserve full autonomy over their medical decisions, and such autonomy can only exist when people understand what HOTA means, which organs may be donated, and how their families may be affected after death. Under an opt-out system like Singapore’s, public education should not be treated as less important simply because people are already automatically included. In fact, awareness becomes even more critical as silence can too easily be mistaken for consent. This is where Singapore can learn from countries that continue to emphasise family communication even after adopting opt-out systems. A prime example would be England, which moved to an opt-out system in 2020⁵. Despite this policy shift, its National Health Service continued to encourage people to discuss their organ donation decisions with loved ones through campaigns such as “Leave Them Certain”, which reminds individuals that families should not be left guessing during grief⁶. This shows that presumed consent alone is insufficient. For Singapore, this means organ donation must become part of everyday conversations about end-of-life wishes, just like wills or funeral preferences.

Furthermore, greater advocacy through familiarising Singaporeans with the positive impact of organ donation can help normalise a rather taboo topic and become the catalyst for more proactive conversations. When Singaporeans consistently see content discussing organ donation, whether through government campaigns, school outreach or personal testimonials, the topic becomes less foreign and less daunting to bring up during end-of-life care. Highlighting its positive effects can also encourage people to view donation not as a violation of the body, but as a final act of generosity. To illustrate this, Jeremiah Tang, an NUS medical student and TikTok content creator, shared his experience registering as a donor under the Bone Marrow Donor Programme. After a simple cheek swab, he was later called up as a match to donate bone marrow to a terminally ill patient. Whether in the context of living or deceased donation, such stories show that organ donation is not merely a cold medical procedure, but a deeply personal act that can give another person a chance at life. Many Singaporeans may already be automatically included under HOTA but remain unaware of what this means. Therefore, given the ubiquitous nature and vast reach of social media, these stories can be especially effective in reaching Singaporean families, particularly Generation Z. These youths are part of families who will one day need to discuss these decisions and planting the seed of knowledge early can help cultivate a culture that does not avoid this conversation.

Lastly, Singapore also has the potential to make organ donation a more emotionally supported conversation for families. While Singapore involves donor coordinators who provide families with relevant information after preliminary brain death testing⁷, more support can still be given in the lead-up to a patient’s death. This could better equip families with guidance on the donation process, the patient’s intentions, or emotional counselling. To illustrate this, Australia provides a good example of how critical timely support can be. According to DonateLife’s 2025 data, 5 in 10 families agreed to donation when supported by a donation specialist nurse – 5 times more likely than when they were not supported by one⁸. This suggests that families do not only need information but also compassionate guidance. Singapore already has donor and transplant coordinators, but more can be done to make their role visible and effective to the public before death occurs. If families know that trained professionals will support them sensitively, organ donation may feel less like a shocking request and more like a guided conversation that they can bring up.

Ultimately, the expectation for families to become catalysts for conversations surrounding a patient’s intent on organ donation is not an impossible fallacy, but closer to a utopian dream that can be achieved with the right efforts. Although Singapore may not be fully ready for such a cultural shift, it can move closer through greater awareness, stronger advocacy and more robust emotional support systems. What now seems like a utopian dream may one day become a compassionate part of end-of-life care where Singaporean families can reframe their perspectives to view organ donation with greater depth: It is more than just a medical procedure. It is a testament to how, even at the edge of death, there can be beauty and selflessness in giving life to another.

References

1.    Singapore Hospice Council. (2024, November 25). Singapore Hospice Council. https://www.singaporehospice.org.sg/palliative-care-vs-end-of-life-care-whats-the-difference/ ↗ (opens in new tab)

2.    Aguiar, Hedi. “Opt-in vs Opt-out Donation Systems.” The Organ Donation and Transplantation Alliance, 2023, www.organdonationalliance.org/insight/opt-in-vs-opt-out-donation-systems/ ↗ (opens in new tab).

3.    Tang, E. (2019, June 12). Over 100 hospital employees line halls to honor late nurse who became organ donor. Good Morning America; ABC News. https://www.goodmorningamerica.com/wellness/story/100-hospital-employees-line-halls-honor-late-nurse-63635404 ↗ (opens in new tab)

4.    Organ donation. (2025). Ministry of Health. https://www.moh.gov.sg/seeking-healthcare/organ-donation/ ↗ (opens in new tab)

5.    “Organ Donation Law in England.” NHS Organ Donation, 2020, www.organdonation.nhs.uk/organ-donation-laws/organ-donation-law-in-england/ ↗ (opens in new tab).

6.    “New NHS Campaign Urges People to Talk to Family and “Leave Them Certain” about Organ Donation.” NHS Organ Donation, 2021, www.organdonation.nhs.uk/news/new-nhs-campaign-urges-people-to-talk-to-family-and-leave-them-certain-about-organ-donation/ ↗ (opens in new tab). Accessed 29 May 2026.

7.    “Deceased Organ Donation Process in Singapore.” www.nuh.com.sg/docs/nuhlibraries/adhoc-carousels-document/deceased-organ-donation-process-in-singapore202f25cb-448f-44d4-92f5-c97b0f226643.pdf?sfvrsn=4fc2b411_1 ↗ (opens in new tab).

8.    “Donation and Transplantation Data.” DonateLife, 2025, www.donatelife.gov.au/all-about-donation/donation-and-transplantation-data?section=consent ↗ (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)