Singaporeans are still not donating their organs despite several legislative changes made over the years to enlarge the donor pool.
"The numbers of deceased organ transplantation for kidney, heart and liver (have) remained low for the past 10 years," said a Ministry of Health (MOH) spokesman.
There were 58 such organ transplants last year, compared with 69 in 2006, the latest figures from the National Organ Transplant Unit show. These numbers are a far cry from those in other developed countries such as Spain and Norway, which have eight times the number of cadaveric kidneys for every million people.
Donations from living donors - which are much better for recipients than cadaveric organ donations - have seen only modest growth. Last year, 58 people donated their kidneys and livers, up from 34 in 2006.
Despite legislative changes, such as including Muslims as donors, the average wait for a kidney is still nine to 10 years and one to two years for a liver or heart. Many people with heart and liver failure here die each year, and thousands with kidney failure are on dialysis.
The availability of organs for transplantation is influenced by factors such as public awareness, and societal views and religious beliefs, said the MOH spokesman.
"Even with legislation aimed at improving deceased organ donations, there is a need to continuously engage the public to raise awareness about the issues around organ donation and transplantation, including the benefits of transplantation," she added.
Last year, 334 people were on the waiting list for kidney transplants, with 54 people waiting for a liver and 23 for a heart.
While the number of people waiting for liver and heart transplants has risen, the figure for those waiting for a kidney has plunged by about 70 per cent over the last 10 years. People are usually taken off the waiting list because they could not get the organs in time and had either died, or become too old or sick for a transplant.
The National Kidney Foundation (NKF) said eight in 10 of its patients are above 51 years old.
"We hope that more people will come forward to donate because there is still a long way to go, with the kidney failure population continuing to increase at an alarming rate," said the NKF spokesman.
On average, about five people here lose the use of their kidneys each day. Singapore has one of the highest kidney failure rates in the world, as a result of more people getting diabetes and hypertension, the main causes of kidney failure.
Low transplant rates here are partly due to worries about surgical risk, poor health after donation and the cost. Surgeons say the lack of "buy-in" by other doctors to harvest organs upon death is also a factor, as organs have to be retrieved during a certain time period.
Donating an organ does not only save lives. Many studies have shown that it is cheaper for the country and better for a kidney patient to get a transplant than to stay on dialysis.
"Organ donation is an emotive and sensitive issue, especially for the next of kin who are coping with the loss of their loved ones," said the MOH spokesman.
"With greater social awareness, acknowledgement and acceptance about the realities of (the) sufferings of patients with organ failure and the life-saving acts of organ donations, we are hopeful that the organ donation rates in Singapore will improve in the coming years."