There are so many complicated issues to grapple with when faced with a diagnosis of terminal illness. Not many will have the time or energy to even consider the prospects of organ or whole body donation after death.
If you are curious about the types of donation options available or want to consider being a donor (like Dr Karen J Warren who donated her body for medical education and research), this post is for you!
Organ and whole body donations are a form of charity. It has the potential to change the lives of multiple individuals and may result in many far-reaching positive effects e.g. pledging to make a donation for research purposes may result in scientific breakthroughs for novel treatments in the future.
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Resistance to donation
Donation of organs/body after death is not common.
As of June 2020, according to the government website Live On the total number of patients awaiting a transplant in Singapore are as follows:
Kidney 332
Heart 15
Liver 45
Cornea 80
Lungs 2
Pancreas 1
In 2003, National University of Singapore (NUS) had to stop its dissection classes for medical students due to its shortage of cadavers. The elective could only be re-introduced in 2016 when there was an increase in the number of donated bodies.
Although the overall numbers of pledged organ and body donations are still small relative to the size of the Singapore population, there has been heartening improvements in numbers over the years and this has largely been attributed to increase in public education efforts. In 2018, more than 500 people pledged to donate their bodies after death to be for purposes such as organ transplant, research into new life-saving procedures or education.
There are many barriers that prevent people from making the pledge to be an organ or body donor:
Belief that the body should be kept intact after death or there will be repercussions in the afterlife - it can be a personal or a family member's belief
Religious reasons (for a more detailed explanation on the dilemmas within each religion - including the debate of what each religion defines as brain death - read this page)
Inadequate knowledge about the options of organ/body donations available and the procedures required
Inertia ("aiya, I'll think about it tomorrow, or maybe next year")
If you have a terminal illness, are you still able to donate your organs or body after death?
Organ donation for transplant
This will depend on whether the organ in question is affected by the disease itself. Some examples are as such:
If the cancer has spread to the liver, it will not be possible to donate the liver.
If a person has gastric cancer, it will still be possible to donate corneas for transplant
For more information, you can reach out to National Organ Transplant Unit at 63214390 or organ.transplant@notu.com.sg.
Organ and body donation for research and education
There are two opt-in schemes in place:
1) Medical (Therapy, Education and Research) Act (MTERA)
This is a scheme that allows people to pledge their organs or any body parts for the purposes of transplant, education or research after they pass away.
You will need to be 18 years and above to indicate your consent for this. The adult next-of-kin can also pledge the organs of deceased patients of any age for donation. All organs and tissues can be donated, including skin and bone.
2) Brain Bank Singapore (BBS)
BBS was set up in 2018 to study neurological diseases for future generations. As it is fairly new, most Singaporeans have not have heard about it. Under the Human Biomedical Research Act, you can donate your brain and cerebrospinal fluid for research purposes after death.
Both healthy individual as well as those with neurological disorders (e.g. dementia) above 21 years of age are eligible for registration. Next-of-kin or legal representatives may also pledge a donation on behalf of individuals lacking mental capacity.
How do you become a donor?
If you decide to pledge a donation, the most important thing to do is to inform your family members of your decision. Upon death, certain types of tissue donation are time-sensitive. Hence, if your family members are aware of your intentions and which organisations to contact upon death, the process can happen more smoothly.
Some family members can be shocked at the announcement of the decision to donate one's organ or body after death and may object. Do have an open conversation about your beliefs and the motivations driving your actions to allow them to understand you better.
Under MTERA
Fill up the organ donation pledge form. You will need to fill up a simple short form (screenshot available below) and obtain the signature of two witnesses. Seal and mail the completed form to the National Organ Transplant Unit.
If you would like to make a donation specifically to Yong Loo Lin School of Medicine, NUS, tick the option "Any organs or parts specified here" and write in 'whole body to the Department of Anatomy, NUS'. Additionally, tick the selection that specifies that your donation is for the purposes of "Education and Research only". For more information, visit this website.
Under BBS
Contact BBS to obtain an informed consent form. Once registered as a donor, you will received a BBS Donor card to be carried with you at all times.
Can I do both?
Yes you can! You will be known as a dual donor. Upon death, the Brain Bank coordinator will need to be notified as soon as possible in order to coordinate the process. The retrieval of the whole brain and other consented tissues should ideally happen within 24 hours in order to result in the most benefit.
What is the workflow that happens after death?
Upon death, contact the National Organ Transplant Unit transplant coordinator as soon as possible so that they can advice on the necessary arrangements.
Most types of donations will need to happen within 24 hours in order to provide the most benefit. Brain donations should ideally be received within 24 hours of death (although tissues can still be retrieved up to 48 hours). Whole body donation used for surgical workshops will need to arrive at the right facilities within 8 to 10 hours.
After the transplant coordinator is notified about the death, the transplant centre will need to conduct some assessments to make the final decision on the suitability for donation. Do note that there is a small possibility that the donation may be rejected such as the presence of a communicable disease (e.g. tuberculosis, hepatitis B & C, HIV) or if an autopsy is done.
How does this affect funeral arrangements?
For most organ donations (including brain donations), open casket viewing remains possible. Upon death, the retrieval of consented organs take place first (usually within 24 hours). Following which, the casket company will facilitate collection of the body to continue with the funeral proceedings.
For whole body donations to NUS intended for educational purposes: the cadavers are typically used for 6 months to 3 years. Afterwards, the remains are cremated and the ashes will be returned to the families of the deceased. NUS often holds appreciation ceremonies for the families to remember the deceased's contributions and to show gratitude.
For brain or whole body donations intended for research purposes, it is not always possible for the tissues to be returned to the family.
Conclusion
Organ and whole body donations has the potential to change the lives of multiple individuals and may result in many far-reaching positive effects. If you decide to pledge a donation, it is important to inform your family members about your decision.
If you have any concerns regarding donation suitability, speak to your healthcare provider or explore some of the links provided below for more information.
Helpful links