When my mother was diagnosed with liver cancer in June, my first thought was: Would she need a liver transplant? If so, I was ready to give her mine.

However, that treatment option is currently on hold because my mother also suffers from other medical issues that make surgery a dicey business. So, for the moment, she’s undergoing a procedure that delivers targeted chemotherapy to her liver, while her doctors deliberate over the problems that might arise from a surgery and how best to tackle them.

Even though a liver transplant is off the table for now, it’s a thought that’s always present at the back of my mind should her condition worsen. I’ve already been made aware of the risks and complications involved in giving my liver as a living donor, as well as the need to go through extensive mandatory counselling before doing so.

When I read about the emotional meeting between the parents of Malaysian girl Carmen Mark, who had her heart donated when she died two years ago from an arterial rupture in her brain, it was at once heartbreaking and heartening. Her heart recipient was Singaporean Serene Lee, who was suffering from heart failure at the time, and has now been given a new beginning with her family because of Carmen’s heart.

 

Parents of heart donor listen to dead daughter’s heartbeat for the first time since her death. str.sg/4joM

Carmen Mark’s heart was donated to recipient Serene Lee.

Posted by The Straits Times on Thursday, September 14, 2017

 

But many people aren’t so lucky.

While the number of organ transplants conducted in Singapore has increased from an average of 174 cases per year between 2004 and 2007, to 220 cases per year between 2008 and 2015, it should be noted, for instance, that “Singapore’s combined (both deceased and living) organ transplant rate for kidneys was 20 per million population (pmp) in 2015”.

Which, if you think about it, means far more organ donors will need to step up to help patients suffering from organ failure – a number that’s expected to rise due to increasing life expectancy. So, why are people reluctant to donate their organs?

For the most part, this could be due to the sensitivities regarding this touchy subject. The negative sentiment surrounding organ donation isn’t new, although the idea of living donors seems to be viewed a little more positively.

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Growing up, I remember hearing talk (strangely, this usually took place during a wake itself) among the more traditional generation about how a person needed to depart this world with his or her body physically intact. When I asked why, they would offer up vague explanations about it being culturally associated with keeping one’s body whole for prayer ceremonies, or going into the afterlife with no organs missing.

And because the act of organ donation is shrouded in taboo, there’s also much confusion as to whether certain religions condone or condemn it. For instance, did you know that the Islamic Religious Council of Singapore (Muis) issued a fatwa in 1986 to permit organ transplants out of “dire necessity, that is to save human lives”?

Neither did a Muslim friend I spoke to – in part, because of the differing opinions on it. That said, based on its principle of saving lives, it would appear that all religions and cultures do support and embrace organ donation.

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Image Source: The Pride

On a separate note, the deficiency of organ donors could also be a result of general apathy. Unless you’ve been personally touched by it, or have a relative that suddenly needs a new heart, liver or kidney, organ donation isn’t something you think about at all – which was sort of the case with me.

Also, talk of death and dying is sombre (morbid, even), so people would rather not talk about it, much less about organ donation – a conversation which might make them even more fearful or uncomfortable.

A couple of friends I spoke to about the subject also admitted that they find the notion of patients being declared brain dead – versus a clinical death when their heart and lungs stop functioning – iffy. This misconception stems from a mistaken belief that brain death is akin to being in a coma.

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Under Singapore’s Human Organ Transplant Act (HOTA), brain death is diagnosed when there is irreversible brain damage – when blood flow and oxygen to the brain stops and all brain functions are lost. It is recognised both medically and legally as death in Singapore, and doctors follow a strict clinical criteria to determine brain death.

A coma, on the other hand, is when a person remains in a state of unconsciousness, but retains some brain functions. Such persons are considered legally alive.

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After our discussions, I could see that my friends were slightly more at ease with the idea of organ donation. And it’s precisely this shift in societal views and attitudes towards organ donation that will encourage more people to consider this act of saving someone’s life.

Currently, all Singaporeans and Permanent Residents who turn 21 years of age are automatically covered under HOTA, which allows for four organs – heart, liver, kidney and corneas – to be donated in the event of death. Those who are uncomfortable with the idea of organ donation may opt out of the Act, but will need to be aware that they would be placed on a lower priority on the organ transplant waiting list should they require one in future.

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Most organ donations come in the form of deceased donors or living donors who have a direct emotional bond with the patient, but last year saw an unprecedented case of a man who donated his liver to a complete stranger, a young teen who was suffering from a rare liver condition.

With over 400 patients on the waiting list for an organ transplant at any given time, how many of them will die before they receive a second chance at life?

When my mother and I had our initial medical consultations during which the topic of a liver transplant was brought up, I did not have to think before volunteering to be a living donor for my mother. Perhaps it’s because, unlike other organs, the liver regenerates, so I don’t feel very frightened at its prospect.

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However, I could see that my mother wasn’t very inclined to accept my liver, if it ever came to that. When I asked her about it, she admitted fearing that if something were to go wrong, my life would be drastically altered. Also, I suspect she might never forgive herself if that happened.

However, I didn’t think that far – I was just glad there was something I could do.

And that made me think about all the caregivers who were powerless to help their loved ones when their own organs proved not to be a match and could only wait, sometimes in vain, for a potential donor to turn up.

At that moment, I was profoundly grateful to have an opportunity to give my mother the gift of life, just like how she gave me mine.

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