Looi Ee Xin (Zheng Yuxi), 18

School: Raffles Institution (Secondary)

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?

Echoes of Antigone: Duty, Grief, and the Body’s Gift

A family stands in a room, contemplating whether to donate the organs of their loved one, who has just been declared brain dead. No one would want to be in this situation. However, this is the reality that some may face in their lifetimes. They struggle to respect the wishes of their loved one to donate their organs, and often, the decision to donate their organs comes down to a “coin toss”. It should not look like that.

I argue that the conversation on organ donation that expresses a donor’s intent to donate as a part of end-of-life care is neither utopian nor impossible. Instead, it is a one that bridges policy, hope to society, and compassion towards the family members.

The conversation on organ donation is a hard topic to breach, especially in cases when family members may still be holding out hope for the dear ones to survive. Notably, in 2024, when the mother of Isaac Loo, was approached on donating her son’s organs, she agreed while he was in a vegetative state. Days later, she changed her mind and opposed having her son’s organs donated. This change in mind was fuelled by her unwillingness to see her son being put through further operation to have his organs collected for donation. While some may have jumped to quick conclusions, calling her “unkind”, one can never underestimate a mother’s deep love for her child, and the grief that she was in. However, she ultimately made the decision to donate her son’s organs, with her son’s organs being used to save 3 people. This decision was made in lieu of the fact that over 400 people were waiting for organ donations, and the respect for her son’s wishes. She believed that her son, with a kind heart, would have wanted to help others, which is in line with his religious beliefs. Shifts in Fiona’s mindset are accompanied by 2 key ideas when discussing organ donation: the patient’s intent to donate and the hope donation brings to society. Although this case study illustrates the tension involved behind discussions of organ donation, it is important to note that this is an isolated case. Oftentimes, organ donation involves more complex feelings and opinions, such as religious beliefs that are difficult to navigate when dealing with the loss of loved ones. Death, after all, is not an easy topic for many to come to terms with.

Presumed Consent: The Struggle Behind HOTA

Introduced in 1987, Singapore was the first country to adopt this legislature, the Human Organ Transplant Act (HOTA), with the kidney, liver, cornea and heart being the 4 main organs that could be collected from deceased donors. Till this date, Singapore is the only Asian country to adopt an opt-out system with regard to presumed consent. However, Singapore has not seen a significant improvement in organ donation even with low opt out rates of 2% to 3%, at a low rate of 7–9 pmp per year. Till this date, Singapore remains reliant on presumed consent in order for organ donation to still be viable, and this is due to a multitude of factors. One such of is society’s attitudes towards organ donation, which is hinged on cultural and religious attitudes. For example, Confucious beliefs dictate that an intact body during funeral rites outweigh possible wishes for organ donation while more conservative religions argue that the sacredness of the body, in which the organs will act as “witnesses” to an individual’s life on Judgement Day – preventing organ donation from being discussed, even if it is at the expense of the patient’s wishes. Still, the younger generation seems to remain more open towards the idea of organ donation, but still struggle to deal with their duties towards their parents as part of filial piety. In order to balance these beliefs, the conversation on organ donation as part of end-of-life care is a delicate topic that may not be one that a more conservative Singaporean society is willing to have on its agenda yet. There has yet to be an ethical balance that our society has struck between human autonomy over one’s body at the end of their life, the role of the family in decisions over organ donation and legislature – HOTA.

Autonomy over one’s body is primarily prioritised in medical care but is often heavily influenced by family and religious values. During end-of-life care, some patients might not be able to make these decisions for themselves and defer to these figures of authority to make these decisions. The older generation, generally holding less progressive views, may advise against organ donation, and often, the duty of one towards their family triumphs above all.

However, the disincentive to opt out of organ donation adds another layer of complexity on this issue. The system deprioritises those who choose to opt out if they do eventually require an organ, and this decision is based on principles of solidarity and reciprocity for those who choose to contribute. While one may think this can encourage organ donation, this disincentive might create more resistance instead of receptiveness. Doctors report not wanting to increase emotional stress on the family of the patient, by bringing up the topic of organ donation, even when the patient is in critical condition and has expressed intent to donate.

Reality: A Complex Matter

The reality is that these cultural attitudes, religious objections and a general taboo around death in society can never be eliminated, only navigated. It is crucial for Singaporeans to recognise that these challenges are all valid, and there are indeed ways to navigate this matter. Cultural attitudes are beliefs that have been rooted in society for generations, decades and can only be gradually changed with more exposure and discussions taking place. Indeed, the grief of a family can never be related to, only empathised with. As a society, there must be space left for these challenges to still bear their weight and importance, as any disregard may under-weigh the human nature behind these decisions. Instead of looking at organ donation as simply a matter of saving more lives, we should still pause and leave space for these discussions to continue to take place, withholding any rush behind these decisions. Considering these factors, the family involvement in these difficult discussions is still crucial to provide the trust in these organ donation systems and respecting a patient’s wishes to donate. Navigating them will require time, and it’s not a matter of whether it is impossible or definitively possible, but it is always one that respects all parties involved in this decision.

Beyond the Individual: Society

If we zoom out, one may observe that the decision to donate one’s organs brings hope to many others. With the donation from a deceased donor, many people can be saved. Hence, it is crucial that family conversations take place, as they can lead to broader changing cultural mindsets in Singapore. Imagine a society, where discussions on organ donation in Singapore are normalised, stigmas are reduced and the reality behind organ donation are brought to light. This society might be able to take steps closer towards achieving what may seem utopian, even while imperfect, it may be just sufficient to strike the ethical balance talked about earlier. A society where respect for a patient’s wishes to donate can exist in the same conversation, where the family’s grief is taken into account, and cultural stigmas are less present.

There are some steps we can take, such as additional training for medical staff besides transplant coordinators when approaching these topics. This training can prove to be important throughout the process of care for the patient, as they are the main caregivers during this period. Additionally, information campaigns can be held to debunk common myths and stigma, encouraging more open conversations regarding organ donations.

Utopian Dream or the Realisation of a Nirvana Fallacy?

The family still stands in that room, torn between grief and duty. In Singapore, such crossroads are real. The dream of fulfilling donation wishes is not utopian – it is the path toward a more compassionate end‑of‑life care.

If society can embrace changing cultural attitudes, the Nirvana fallacy – that perfection is unattainable – falls away. We may never reach a flawless system, but we can build one that honours patient autonomy, respects family grief, and sustains hope for those waiting.

After all, what is grief, if not love persevering?

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)