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The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?

ABSTRACT: A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2-5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain arrest is not death itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2-5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that patients in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2-5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently.

SUBMITTER: Joffe AR

PROVIDER: S-EPMC2211498 | biostudies-literature | 2007 Nov

REPOSITORIES: biostudies-literature

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The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?

Joffe Ari R AR

Philosophy, ethics, and humanities in medicine : PEHM 20071125

A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2-5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain arrest is not death itself. Brain death ...[more]

PMID: 18036254

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Project description:BackgroundSocio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not been studied.ObjectivesIn order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations.Study appraisalA search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria.Results32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained.ConclusionsOur review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death.

Project description:BackgroundDespite the importance of organ donation and transplantation in improving the quality of life, still, there is a shortage of organ donations, worldwide. Lack of knowledge among the public could be the reason. In previous studies, the focus was predominantly on medical students at universities. The aim of this study was to assess university students' knowledge and attitude about organ donation and transplantation among different colleges at the university.MethodA cross-sectional study was conducted among university students between August 2021 and February 2022 using a validated self-designed questionnaire. The questionnaire consisted of five sections. The first section was about the research information. The second section was informed consent. The third section was about sociodemographic information. The fourth section was about the knowledge of organ donation. The last section was about the attitude toward organ donation. The data were analyzed by descriptive statistics and chi-square tests.ResultsThe study included 2,125 students. 68.1% were females, and 93.1% were in the age group 17-24 years old. Only 34.1% had good knowledge about organ donation, 70.2% had a low attitude, and 7.53% had adequate information about brain death. The most common reason for supporting donating organs among university students was to save a life (76.8%) and the most common reason for refusing organs, was I am still unaware. In addition, only 25.66% of the participants had a high attitude toward people with poor knowledge about organ donation. The majority of the students (84.13%) used online sources and social networks as the primary sources of information about organ donation.ConclusionThe knowledge and attitudes of university students toward organ donation and transplantation were low. Saving a life was the most common reason for supporting organ donation, and knowledge was the biggest obstacle. Online sources and social networks were the primary sources of knowledge. The attitude was greatly influenced by knowledge. Organizing campaigns, and events, and incorporating organ donation and transplantation into university curricula will increase university students' knowledge and attitudes.

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The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?

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The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?

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