FAQ

The decision not to be an organ donor is a personal choice. If you do not wish to donate your organs, please complete the pink Objection to Organ Removal form and submit it digitally via this link or mail it to NOTU.

For more information, visit “How can I make my decision known?”

Yes. Individuals can opt out for all or specific organ(s) listed under HOTA. Please complete the pink Objection to Organ Removal form and indicate the organ(s) that you would like to to opt out of donating. You may scan and submit the completed form via this link or mail it to NOTU.

For more information, visit “How can I make my decision known?”

Those who opt out of HOTA will be of a lower priority for an organ transplant (should they need one in the future) than those who remain in HOTA. For more information, visit “How can I make my decision known?”

Yes, an objection can be withdrawn at any time before death. However, you will continue to be of a lower priority as a proposed recipient, compared to a person who did not register an objection, for 2 years after the date the Director of Medical Services receives your withdrawal.

For more information, visit “How can I make my decision known?”

Organs donated under HOTA are intended for donation to the common pool of patients on the respective national organ transplant waiting lists. It is therefore not possible to specify or specifically exclude certain individuals from receiving your organs.

For more information, visit “Who is eligible to be a donor?”

Yes. You may pledge to donate additional organs, tissues and/or your whole body under the Medical (Therapy, Education and Research) Act (MTERA) for the purpose of transplant, therapy, and/or education and research.

For more information, visit “Who is eligible to be a donor?”

Yes, under the Medical (Therapy, Education and Research) Act (MTERA), anyone 18 years old and above, regardless of nationality, can pledge to be an organ, tissue and/or whole body donor for the purpose of transplant, therapy, and/or education and research. Your next of kin can also give consent for the donation under MTERA if you did not make a prior pledge.

For more information, visit “Who is eligible to be a donor?”

No. Donation of organs is usually only possible after brain death, as the organs may still function for a period of time if you are supported on a ventilator. If death occurs outside of the hospital, your organs deteriorate rapidly and will not be suitable for transplantation.

Nonetheless, there are certain tissues which may still be donated if NOTU is contacted promptly when death occurs.

For more information, visit "When does organ donation happen?"

Yes. Under HOTA, if you are a Singapore Citizen or Permanent Resident, 21 years and above, not mentally disordered and are not a registered objector, your organs can be donated for the purpose of transplantation if assessed to be suitable and if there are suitable recipient(s) to benefit from the organ(s) recovered.

Under MTERA, regardless of your nationality, your organs can be donated for the purpose of transplantation, if you have pledged to donate your organs for transplantation, or your next of kin gives consent for your organs to be donated (if you did not make a prior pledge). This is provided your organs are assessed to be suitable and if there are suitable recipient(s) to benefit from the organ(s) recovered.

No. HOTA and MTERA do not apply to deaths that occur overseas.

No. The identities of the deceased organ donor and the transplant recipients will not be revealed to recipients and donor families. NOTU will provide non-identifiable demographics of the recipients to the donor’s next-of-kin.

Organ trading is illegal in Singapore. Any person who is involved in the buying and selling of organs shall be liable on conviction to a maximum fine of $100,000 or a maximum imprisonment term of 10 years or both.

Brain death refers to the irreversible and total loss of brainstem functions. It usually happens where there is a severe brain injury (e.g. due to accident or stroke). Brain death is not the same as being comatose. Unlike comatose patients, brain dead patients have total and irreversible loss of brain function and will not recover.

For more information, visit "When does organ donation happen?"

Singapore follows a stringent criterion as per international practices for brain death certification. It is performed by two qualified independent doctors who are not:

• involved in the care or treatment of the patient;

• the team of medical practitioners who will recover the organ(s);

• involved in the selection of the proposed recipient(s) of the organ(s); and

• involved in the care or treatment of the proposed recipient(s) of the organ(s) during his hospitalisation for the deceased donor organ transplant.

The two independent doctors must confirm that the patient meets all seven clinical criteria¹ before brain death can be certified. The seven clinical criteria are as follows:

• Pupils do not constrict when exposed to direct, strong light. [Absent pupillary light reflex]
  Normal response: Pupils constrict when exposed to direct, strong light.

• There is no blink reflex when the corneas are stimulated. [Absent corneal reflex]
  Normal response: The eyelid blinds when the cornea (area over the pupils) is stimulated with a cotton wisp

• There is no response to painful stimulus, excluding spinal reflexes [Absent pain response]
  Normal response: The subject will attempt to withdraw from, localise or remove the pain stimulation.

• The eye gaze follows the direction of the head when turned from side to side. [Absent oculocephalic reflex]
  Normal response: The eyes will remain fixed on forward gaze even when the head is turned from side to side

• There is no gag reflex in response to stimulation of the throat or upper air passages. [Absent gag reflex]
  Normal response: Stimulation of the throat or the upper air passages will induce gagging.

• There is no eye response on instillation of 50 cubic centimetres of ice-cold water into each ear. [Absent vestibulo-ocular response]
  Normal response: The eye will twitch when each ear is instilled with cold water.

• There is no spontaneous breathing when removed from the ventilator even with rising carbon dioxide concentration in the blood. [Positive apnea test]
  Normal response: Spontaneous breathing will occur with rising carbon dioxide concentration (> 50 millimetres of mercury) in the blood.

If one or more of the seven clinical criteria cannot be performed, supplementary tests will be performed to confirm brain death. These tests are carried out to demonstrate the presence or absence of blood flow in the brain. The absence of blood flow in the brain confirms brain death.

However, these supplementary tests are not substitutes for the clinical criteria. If six of the seven clinical tests can be performed, the criteria for these six tests must be fully met, before a supplementary test can be performed.

For more information, visit "When does organ donation happen?"

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¹ Ref: MOH website:
https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/singapore-renal-registry-annual-report-2018.pdf?sfvrsn=de5a657f_0

No. Brain death is an irreversible and total loss of brainstem function. As such, patients who are declared brain dead will not come back to life.

The goal of medicine is to do no harm. Should a patient require critical care, the medical team will do their utmost best to save his life. Organ donation will only be considered after every effort to save his life has been exhausted.

For more information, visit "When does organ donation happen?"

When death occurs, organs, tissues and the whole body can be donated. The organs and tissues that can be donated include the heart, liver, kidneys, corneas, lungs, trachea, pancreas, heart valves, iliac vessels and skin.

Under HOTA, all Singapore Citizens and Permanent Residents, 21 years old and above, who are not mentally disordered, may donate their kidneys, liver, heart and corneas upon death for the purpose of organ transplantation, unless they have opted out.

Under MTERA, anyone 18 years old and above, regardless of nationality, can pledge to be an organ, tissue and/or whole body donor for the purpose of transplant, therapy and/or education and research.

For more information, visit "What organs can be donated?"

The donor’s body will always be cared for with the utmost respect. The same surgical standards applied to any living person undergoing surgery are also applied to organ donors during organ retrieval surgery. Any incisions made during the removal of organs are carefully closed up after the procedure.

The recovery of organs occurs only if the organs are assessed to be medically suitable and when there is a compatible recipient. To ensure optimum transplant outcomes, the allocation of organs from deceased donors will be based on the recipient’s blood group and tissue compatibility with the deceased donor and clinical parameters, as well as the recipient’s medical fitness to undergo a transplant.

In addition, individuals who are suffering from end-stage organ failure will be on a higher priority on the organ transplant waiting list, if they remain in HOTA.

With increasing life expectancy, healthier ageing and improvement in health technology, suitability to donate organs is not always linked to age. There is no upper age limit for organ donation.

The deceased donor’s family will not be charged for any deceased organ donation-related procedures and/or tests.

Yes, you can, as there is no lower or upper age limit for whole body donation. In fact, we even had a whole body donor who was 99 years old!

Individuals with cancer or chronic illnesses (such as diabetes, hypertension or even organ failure) can donate their whole body for the purpose of education and research.

To protect student doctors, nurses, dentists and other researchers, individuals with infectious diseases (e.g. tuberculosis [TB], hepatitis, human immunodeficiency virus [HIV]) are considered unsuitable for whole body donation.

Whole body donation is still possible for deaths that are reported to the Coroner unless an autopsy has been performed.

Whole body donation for research and education cannot proceed if organs have been donated for transplant purposes as long-term embalming would not be possible. Whole body donation for research and education is still possible after tissue (e.g. cornea and skin) donation.

Whole body donors provide medical doctors, dental surgeons, nurses and other allied healthcare professionals the opportunity to master the complex anatomy of the human body, study new life-saving medical and surgical procedures. In addition, whole body donors also provide researchers with an essential tool for discoveries to help patients.

The research study may take up to three years. Upon completion of the research study, the medical institution informs the family and arranges for the cremation. Families can choose to collect their loved one’s ashes or if the family prefers not to collect the ashes, the institution will arrange for a sea burial which the family will be invited to attend.

Information on the whole body donation process can be found at "When does organ donation happen?"

Organs that can be donated while the donor is alive include the kidney and part of the liver.

Information on the living organ donation process can be found at "When does organ donation happen?"

Donors do not have to be biologically related to the recipient (i.e. unrelated donations are allowed in Singapore). Individuals may also donate to any patient on the national waiting list i.e. they do not specify the recipient. Such donors are called non-directed donors.

Some patients find it difficult to broach the subject of living donations with their family and loved ones. They hesitate to ask for a donation from their children or loved ones for fear that they (the donors) might experience organ failure in future. There are also instances of willing donors who are assessed to be unsuitable to proceed with the donation.

If the option of living donor organ transplant is not available and the patient is assessed to be suitable to receive a deceased organ donor transplant, the patient can be placed on the national waiting list for a suitable organ match from a deceased donor.

Prospective donors undergo robust assessments to ensure their safety and well-being before donation. All physicians involved, the transplant centre and the transplant team are responsible for ensuring that the prospective donors are medically fit before submitting the application for review by the Transplant Ethics Committee (TEC).

All living organ donations can only take place after authorisation by the TEC. The TEC provides independent scrutiny to ensure that the donor has been informed about the medical risks, the present and future implications of the organ donation. The TEC also checks if there are ethical concerns and that the donor has given informed consent without fraud, duress or undue influence. After approval from the TEC is obtained, there will be a cooling off period for the donor to carefully consider and confirm his or her decision.

In addition, organ trading is prohibited in Singapore. Any person who is involved in any contract or arrangements of the sale or supply of organs, or is involved in organ trafficking activities can be fined and/or imprisoned.

More information about the TEC can be found at "When does organ donation happen?"

In living organ donation, transplant physicians first evaluate the medical suitability of the potential donor through stringent physical examinations and medical tests, which includes assessments by an independent physician, medical social worker and psychiatrist. The potential donor is also counselled on the donation process and procedures, medical risks, and present and future implications of the organ donation, so that he or she can make an informed decision on whether to proceed with organ donation.

As with any surgical procedure, there may be risks involved in living donors undergoing surgery for organ donation and also according to the organ donated. Donors who have been evaluated thoroughly and cleared for donation are expected to lead a normal life after surgery. Post-donation, annual check-ups are necessary to ensure that the donor remains in good health.

HOTA allows for payments to living donors, only for reimbursing or defraying the costs or expenses or loss of earnings that may be reasonably incurred as a result of organ donation. This includes costs for health checks, laboratory tests, donation operations, follow-up visits and limited indirect costs such as loss of earnings by self-employed or daily-wage workers.

It is important for a donor to fully understand the medical and financial implications of donation. Once this is done, the donor may choose to seek reimbursement for expenses incurred in relation to the donation. However, this is not compulsory. Donors can waive the right to receive reimbursement or payment from the recipient.

For more information, visit "When does organ donation happen?"