Deceased organ donation in Singapore : knowledge, attitudes and challenges

• Main Author: Chua, Jacqueline Jie Lin
• Other Authors: Kwek Tong Kiat
• Format: Final Year Project
• Language: English
• Published: 2017
• Subjects: DRNTU::Science::Medicine
• Online Access: http://hdl.handle.net/10356/72620
• Institution: Nanyang Technological University

Background: With organ transplantation being the standard of care for end-stage organ failure today, the shortage of transplantable organs is a global problem. To address this, Singapore adopts an opt-out approach to deceased organ procurement in the form of the Human Organ Transplant Act (HOTA). Consent to organ donation is presumed in the absence of objection. This is complemented by an opt-in system under the Medical (Therapy, Education, Research) Act (MTERA). Although these laws are not new, public awareness continues to be poor, contributing to a falsely low objection rate. Aims and Methods: After reviewing the recruitment workflow for potential deceased donors, studying cases in the Intensive Care Unit (ICU) and conducting a survey of knowledge and attitudes amongst healthcare workers, we studied the impact of an opt-out system in Singapore. The main concerns with the status quo are the uncertainty families face in second-guessing the deceased’s non-objection status, the resulting emotional trauma and breakdown in physician-family relations. Results: Our results highlight strong public support for organ donation, with 90.5% of respondents (n=201) willing to do so. 77.0% were willing to donate any useable organs. However, knowledge about the specifics of HOTA was poor, with 38.3% not even knowing it is opt-out and 92.5% being unclear of who the law applied to. This supports our postulation that objector rates are falsely low due to ignorance and apathy and raises a mandate for improving publicity efforts. Conclusion: There is scope for renewed public outreach efforts. In order to improve deceased organ donation rates, public engagement should encourage individuals to register their views whether as HOTA objections or as MTERA pledgers. It should also be more systematic and consistent in engaging individuals throughout their life to reevaluate end-of-life decisions. Such a conscientious, proactive public may eventually be weaned off presumed consent to fully exercise their right to autonomy.