Are Singaporeans open to organ donation?

Almost half of Singaporeans are unwilling to donate their relatives’ organs after brain death, while nearly 70 percent are open to donating their own, according to a recent study. Such high levels of hesitation are driven by religious considerations and fears about organ donation.

“Our findings underscore how decision-making differs when one considers a family member rather than the self,” the researchers said. “Consequently, addressing the decision-maker’s mindset may increase actualization rates amidst a worldwide organ shortage.”

A total of 973 adults who were qualified as organ donors participated in the present cross-sectional survey. Questionnaires were designed to collect information regarding decisions on organ donation for themselves and for a family member after death. Participants were also asked how confident they were in their decisions, whether they had discussed such prospects with their family or not, and the extent to which they thought they knew they family member’s wishes.

Almost half (45.8 percent; n=404) of the respondents were classified as consistent donor who said they were willing to donate theirs or their family member’s organs after death. Meanwhile, 25.9 percent (n=228) were consistent nondonors and said that they would refuse both donations. [BMJ Open 2021;11:e051273]

Notably, almost a third of respondents showed inconsistencies in decision-making. For instance, 22.3 percent (n=197) were willing to donate their own organs after death but would not do the same for family members. A small percentage (6.0 percent; n=53) responded inversely and said that they were open to donating their family member’s organs but not theirs.

The researchers then performed classification tree analysis to identify factors that affected participants’ openness to organ donation. They found that consistency in decision-making was driven by strong fears and beliefs. For instance, consistent nondonors harboured significantly greater fear of the procedure for themselves (p≤0.003) and for family members (p≤0.008). Consistent nondonors were also more likely to report religious affiliation and subscribe to traditional beliefs.

In contrast, inconsistent decision-making was more difficult to predict. Some putative characteristics included higher fear for their family members but not for themselves, subscribing to traditional Buddhist or Christian beliefs, and not holding extreme views about power in society. None of which, however, were unique identifiers of inconsistent decisions.

The researchers pointed out that participants tended to be overconfident in their decisions. When asked to rate how confident they were that they would respect the wishes of their family members upon death, they scored a median of 5 on a 5-point scale, suggesting absolute confidence. However, 78 percent of participants admitted that they had never discussed organ donation with family.

“Likewise, when individuals considered decisions made on their behalf, they expressed confidence that family members would do their bidding—despite not having made their wishes known previously. In both cases, being assured of the family decision-making process far exceeded the basis for doing so,” the researchers said.

“Donation programmes may benefit from focusing on decision-makers willing to donate their own organs, urging them to become aware of their relatives’ wishes or undergo a more thorough decision-making process to work out their relatives’ wishes,” they added.