Singapore Struggles with Organ Donation Shortage as 500 Await Transplants

A significant shortage of organ donations in Singapore has left over 500 patients on waiting lists for vital transplants. As the nation grapples with this pressing issue, healthcare professionals have introduced solemn practices to honor donors and support grieving families. This initiative, known as an honour walk, provides a final tribute to organ donors and serves as a reminder of the lives that can be saved through donation.

Sally Kong, deputy director of the National Organ Transplant Unit (NOTU), emphasized the importance of these gestures. She noted, “I think the families have reacted very positively to this, because they can see how much the donation is being valued and they are being cared for at the time when they are hurting the most.” Despite these efforts, Singapore continues to face a persistent shortage of available organs. Currently, patients suffering from kidney failure experience the most acute need, with only 10 percent of those on the transplant waiting list receiving a transplant last year. The average wait time has now reached nine years, largely due to the limited number of deceased organ donors.

According to the Ministry of Health (MOH), a single donor can potentially save up to seven lives. Yet, the annual number of deceased donors remains in the low double digits. Each organ donation requires meticulous coordination among various hospital units, while ensuring that the donor’s and family’s wishes are respected.

Understanding Organ Donation in Singapore

In Singapore, organ donation is regulated by two key legal frameworks. The Human Organ Transplant Act applies to kidneys, hearts, livers, and corneas, affecting all citizens and permanent residents aged 21 and above who are mentally competent, unless they have opted out. Those who choose to opt out will find their priority on waiting lists diminished should they require a transplant in the future. Currently, the opt-out rate remains stable at approximately 3 percent annually.

The second framework, the Medical (Therapy, Education and Research) Act, allows individuals aged 18 and above to pledge additional organs, tissues, or even their entire bodies for transplant, education, or research. Over the past five years, an average of 800 individuals have made such pledges each year. However, various factors can impede the actualization of organ donations, including unsuitable medical conditions or the lack of consent from a donor’s next-of-kin under the Medical Act. Notably, last year, 16 patients with end-stage kidney failure were unable to receive transplants due to these complications.

An MOH spokesperson highlighted the necessity of timely discussions regarding organ donation preferences. “This underscores the importance of having timely conversations and making one’s organ donation preferences known, so that our loved ones are able to make informed decisions with clarity and confidence,” they stated.

Kong acknowledged the sensitivity of these conversations, citing a case in which a donor’s son questioned whether his mother fully understood her decision to donate. “At the end of it, he found comfort that his mother’s action could impact so many lives,” she shared. For families unexpectedly facing loss, the support provided during such critical moments can create a significant difference between clarity and uncertainty.

Efforts to Increase Awareness and Participation

Healthcare workers are undergoing regular training to facilitate these difficult conversations as part of end-of-life care. In addition, the MOH has launched the Live On campaign to promote discussions and awareness surrounding organ donation in Singapore. Individuals interested in expressing their donation wishes can access the Organ Donor Registry using their Singpass to update their donor status.

Regarding brain donations, they are managed by both NOTU and Brain Bank Singapore, the first tissue bank in Southeast Asia dedicated to human brain tissue research for neurological disorders. Some concerns have emerged regarding the existence of separate registries, yet the MOH currently has no plans to create a single national registry that consolidates organ, body, and brain donations. This response follows a parliamentary inquiry by Dr. Choo Pei Ling, a neurologist and Member of Parliament, who emphasized that residents perceive the current system as complex.

Dr. Choo acknowledged the importance of maintaining distinct expertise and protocols for different types of organs, while also highlighting the need for better communication between the public and the MOH. “There is an information and knowledge asymmetry between the public and the Ministry. Addressing it can foster better understanding and encourage more Singaporeans to pledge the gift of life,” she stated.

As Singapore continues to confront this critical shortage of organ donations, the combined efforts of healthcare professionals, government bodies, and community awareness campaigns remain vital in addressing the pressing needs of patients awaiting transplants.