Abstract
Background: Organ shortage is still a world-wide problem, resulting in long waiting lists for kidney, liver, and heart transplant candidates across many transplant centers globally. This has resulted in the move toward presumed consent to increase deceased organ donation rates. However, there remains a paucity of literature on public attitude and barriers regarding the opt-out system, with existing studies limited to Western nations. Therefore, this study aimed to understand public sentiment and different barriers toward organ donation from the perspective of Singapore, a highly diverse and multiethnic Asian society.Methods: A cross-sectional community semi-structured interview was conducted in a public housing estate in Singapore. Pilot test was undertaken before participants were interviewed face-to-face by trained personnel. All statistical evaluations were conducted using Stata. The χ2-test compared subgroups based on patient characteristics while multivariable logistic regression identified predictors of willingness to donate/ assent. Effect estimates were quantified using odds ratio (OR).Findings: Out of 799 individuals, 85% were agreeable to organ donation after death and 81% were willing to assent to donations of family members' organs, which declined by 16% (p < 0.001) after a clinical scenario was presented. Demographic factors including ethnicity, education, marital, and employment status affected willingness to donate and assent. Knowledge correlated significantly with willingness to donate and assent. In particular, knowledge regarding brain death irreversibility had the strongest correlation (AOR 2.15; 95% CI 1.60–2.89).Conclusions: Organ donation rates remain low albeit presumed consent legislation, due to patient-level barriers, including but not limited to knowledge gaps, cultural values, religious backgrounds, and emotional impact at relatives' death. To effectively boost donor rates, it is crucial for policy makers to invest in public education and improve transplant provisions and family protocols.
Highlights
The shortage of organs for transplant is a major limitation faced by transplant programmes worldwide
Compared to Western nations where the rates of donation from presumed consent range from to 5.9 to 46.9 per million population [7], Singapore remains the sole Asian country adopting an opt-out system where the number of deceased organ donors remains low at 7–9 pmp per year despite the low national opt-out rate of 2.0–3.0%
Given that living donor organ transplantation remains limited with only 32 living kidney donors and 19 living liver donors in 2017 [9], this has resulted in an average waiting time of 9 years for kidney transplant and around 1–2 years for liver and heart transplanation [10]
Summary
The shortage of organs for transplant is a major limitation faced by transplant programmes worldwide. Compared to Western nations where the rates of donation from presumed consent range from to 5.9 to 46.9 per million population (pmp) [7], Singapore remains the sole Asian country adopting an opt-out system where the number of deceased organ donors remains low at 7–9 pmp per year despite the low national opt-out rate of 2.0–3.0%. Organ shortage is still a world-wide problem, resulting in long waiting lists for kidney, liver, and heart transplant candidates across many transplant centers globally. This has resulted in the move toward presumed consent to increase deceased organ donation rates. This study aimed to understand public sentiment and different barriers toward organ donation from the perspective of Singapore, a highly diverse and multiethnic Asian society
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