Singapore Grapples with Organ Donation Shortage as 500 Await Transplants

Singapore faces a significant challenge in organ transplantation, with over 500 patients currently on the waiting list. The situation is particularly dire for kidney patients, who experience the most acute shortages. In the past year, only 10 percent of those on the transplant waiting list received a transplant, leading to an average wait time of up to nine years as of the end of 2024. The Ministry of Health (MOH) attributes this shortage to a limited pool of deceased organ donors.

A poignant moment in the organ donation process occurs during what is known as an honour walk. This solemn procession involves healthcare staff accompanying a patient certified brain-dead to the operating theatre, where their organs will be retrieved. These walks serve as a final tribute to organ donors and provide emotional support to their grieving families. According to Sally Kong, deputy director of the National Organ Transplant Unit (NOTU), families have responded positively to this gesture, feeling that their loved one’s donation is being valued at a profoundly difficult time.

Organ donation in Singapore is regulated by two primary legal frameworks. The Human Organ Transplant Act covers organs such as kidneys, hearts, livers, and corneas. It applies to all citizens and permanent residents aged 21 and above, provided they are not mentally disordered, unless they have opted out. Those who do opt out will face lower priority on waiting lists for future organ transplants. Currently, opt-out rates remain stable at 3 percent annually.

Another framework, the Medical (Therapy, Education and Research) Act, allows individuals aged 18 and above, regardless of nationality, to pledge organs, tissues, or even their entire bodies for transplantation, education, or research. On average, approximately 800 individuals have made such pledges annually over the past five years. However, organ donation can be hindered by various factors, including unsuitable medical conditions or lack of consent from the donor’s next-of-kin. In the previous year, 16 patients with end-stage kidney failure did not receive transplants due to these challenges.

The MOH emphasizes the significance of having open discussions about organ donation preferences. These conversations can help loved ones make informed decisions during times of grief. Ms. Kong recounted a case where a donor’s son struggled with doubts about whether his mother truly understood the implications of her decision to donate. With support from healthcare staff, he eventually found comfort in knowing that her gift could save many lives, including impacting his own family positively.

Healthcare professionals are now receiving training to help navigate these sensitive discussions as part of end-of-life care. The MOH also promotes the Live On campaign to foster awareness and discussion about organ donation in Singapore. Interested individuals can log in to the Organ Donor Registry using Singpass to update their donor status.

Regarding brain donations, these are managed by both NOTU and Brain Bank Singapore, the first tissue bank in Southeast Asia dedicated to studying human brain tissue for various neurological disorders. Questions have arisen regarding the existence of separate registries, but the MOH has stated there are no current plans to consolidate them into a single national registry. This follows inquiries from Dr. Choo Pei Ling, a neurologist and Member of Parliament, who raised concerns about the complexity of the existing system. While she appreciates the MOH’s safeguards, she noted that addressing the public’s knowledge gaps could encourage more Singaporeans to pledge their organs.

In summary, Singapore’s organ donation landscape faces significant challenges as it strives to meet the needs of more than 500 patients awaiting transplants. Initiatives to raise awareness and support families in making informed decisions are crucial in addressing this pressing issue.