Rationality or Relationality in Life and Death: Regulating Organ Donation in Singapore and Taiwan

Lawmakers often attempt to settle conflicting values. However, we know little about how regulatory reasoning influences organizational practices and shapes the conditions under which people respond. This article examines unexpected outcomes of deceased organ donation in Singapore and Taiwan, whose governments have had to address cultural and emotional resistance to the practice. Adopting an opt-out law, Singapore created a larger pool of legal organ donors yet generated worse donation outcomes than Taiwan, whose opt-in regulation has resulted in a smaller pool of potential organ donors. Drawing from interviews and archival research to solve this puzzle, I argue that moral infrastructure—the regulation-endorsed organizational arrangements to tackle cultural and emotional tensions—determines whether and when people change their minds regarding shared cultural norms. Singapore’s regulation prioritizes instrumental rationality and generates efficiency-driven organizational practices. These practices lead to affective circumvention, sidestepping emotions to expedite organ procurement and, in turn, prompting patients’ families to withdraw from hospital care. By contrast, in Taiwan, relational reasoning creates arrangements that promote affective coordination, a process that empowers intermediaries to work with grieving families and morally reframe donation. An institutionalized emphasis on relationality fosters cooperation and provides opportunities to remoralize a contested practice.