Dear Editor,Organ transplantation is the treatment of choice for end-stage organ failure. However, there still exists a great imbalance between organ demand and organ availability worldwide, limiting the application of organ transplantation. 1 The Human Organ Transplant Act (HOTA) was enacted in Singapore in 1987, with amendments made in 2004 and 2008 to expand the organ donor pool. Currently, HOTA includes donation of kidneys, liver, heart and corneas after certification of brain death. It remains an opt-out scheme in which all Singapore citizens and permanent residents aged 21 years old and above, who are not mentally disordered, are presumed to consent for organ donation. 2,3 For a patient who is eligible, the process briefly starts with the certification of brain death by 2 independent specialists, activation of the transplant coordinator, followed by assessment of suitability of organs, and if suitable, proceeding to organ retrieval. This is coordinated by a trained brain death coordinator.Despite legislative amendments, the rate of organ donation in Singapore has remained low at 6.6 to 8.9 organ donors per million population (pmp) (unpublished data from the National Organ Transplant Unit, Ministry of Health, Singapore), in contrast to other developed countries such as the United States, Spain and the United Kingdom. [4][5][6] Healthcare workers caring for potential brain-dead donors face highly stressful circumstances. A perceived "ethical dilemma" between the physician's primary responsibility of acting in the patient's best interests and supporting the social objectives of HOTA may make some intensive care unit (ICU) physicians reluctant to actively identify and refer potential donors. 4 Other barriers include unfamiliarity, variability in the conduct of brain death certification, and lack of knowledge about donor identification. 4,7 Good working knowledge and positive attitudes of healthcare workers towards organ donation may result in increased donor actualisation rates, as well as improved holistic care of the donor's family-2 goals that are not mutually exclusive. A survey of medical students in Singapore found that the majority had favourable attitudes towards organ donation, but knowledge on HOTA was inadequate. 8 To date, there is scant literature on the attitudes of ICU healthcare providers in Singapore.