Abstract
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.
Highlights
Socio-cultural perceptions surrounding death have profoundly changed since the 1950s with develop‐ ment of modern intensive care and progress in solid organ transplantation
The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death
The scoping review was guided by the PRISMA protocol with conceptualisation of the research question as ”What quantitative evidence is available regarding the acceptance of and attitudes towards the concepts of brain death (BD), Donation after Circulatory Determination of Death’ (DCDD) and the dead donor rule’ (DDR), and how these relate to attitudes and decision-making regarding organ donation?" Assessment of relevance was done following the ‘methodologyissue-participant approach’ described by Strech et al [17] (Table 1)
Summary
Socio-cultural perceptions surrounding death have profoundly changed since the 1950s with develop‐ ment of modern intensive care and progress in solid organ transplantation. Longstanding and almost universal socio-cultural perceptions surrounding death were radically changed by the more-or-less simultaneous emergence of several medical technologies in the 1950s–60s. These included mechanical ventilation and the development of modern. Documentation of the World Brain Death Project [6], developed by international consensus, has improved uniformity in the diagnostic process for BD, but it has done little to address fundamental philosophical questions around its meaning and significance [7]
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