Introduction: Under Singapore’s opt-out system governed by the Human Organ Transplant Act (HOTA), organ donation rates have remained persistently low despite long-standing implementation since 1987. While there is broad awareness and support for organ donation, actual consent and donation rates remain suboptimal. Existing literature has identified various psychosocial, cultural, and structural barriers, but local data remains limited. This study aims to examine public perceptions, uncover key barriers to organ donation, and assess receptivity to targeted initiatives that could improve donation outcomes in Singapore.
Method: A cross-sectional online survey was conducted with a nationally representative sample of 1,000 Singapore citizens and permanent residents, recruited by a professional survey firm. The 20-minute questionnaire, developed with input from national transplant stakeholders and academic institutions, assessed knowledge, attitudes, willingness to donate (self and family), and views on proposed initiatives. Stratified sampling was used to ensure proportional representation by age, gender, ethnicity, and housing type. Descriptive and comparative analyses were performed using quantitative data.
Results: Although 93% of respondents were aware of HOTA and 83% acknowledged the importance of organ donation, only 64% expressed willingness to donate their own organs. Willingness declined further in the context of family member donation, with only 54% consenting to donate a relative’s organs. Common reasons for refusal included concerns about bodily integrity, mistrust of medical institutions, and religious or cultural beliefs. Notably, only 74% of those initially opposed indicated they would eventually consent donation if they knew their family member had expressed desire to donate. Attitudes varied across ethnic and religious groups (p < .05), with certain communities expressing stronger objections rooted in mistrust and spirituality.
Conclusion: Despite high awareness levels, a significant gap exists between general support for organ donation and actual willingness to donate—especially in decisions involving family members. This study underscores the need to address underlying concerns around autonomy, medical mistrust, and religious sensitivities. Interventions that focus on culturally tailored education, intergenerational dialogue, and early consent discussions may help bridge this divide and improve actual donation rates in Singapore.