Clinical Decisionmaking

Many people still misunderstand "brain death" and its relation to organ donation

In the United States, brain death is clinically defined as irreversible loss of all brain functions in patients whose hearts continue to beat and who are maintained on mechanical ventilators in the intensive care unit. No one correctly diagnosed as brain dead has ever regained consciousness or independent functioning. Brain death and the dead donor rule (patients may not be killed through organ retrieval) are clinically and legally accepted in the United States as prerequisites for organ removal. Yet, many adults are unaware of, misinformed about, or hold beliefs that are not congruent with current definitions of brain death, according to a recent study that was supported by the Agency for Healthcare Research and Quality (HS10047).

This highlights the need for more public dialogue and education about brain death and organ donation, notes lead investigator Laura A. Siminoff, Ph.D., of Case Western Reserve University. Dr. Siminoff and her colleagues conducted a telephone survey of 1,351 adult residents of Ohio. Participants were asked to assess whether the patient in each one of three hypothetical scenarios (brain dead, in a coma, in a persistent vegetative state [PVS]) was dead and whether they would be willing to donate that patient's organs.

Only one-third (34 percent) of respondents knew that someone who was brain dead was legally dead in Ohio. Also, 28 percent mistakenly believed that brain-dead patients can still hear, and nearly 60 percent mistakenly thought that the respirator is stopped before, rather than after, organs are taken. The majority (86 percent) identified the brain dead patient in the first scenario as dead, 57 percent identified the patient in a coma as dead, and 34 percent identified the patient in a PVS as dead. Most who said that the patient was alive were not willing to donate that patient's organs. Yet, 34 percent were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule.

See "Death and organ procurement: Public beliefs and attitudes," by Dr. Siminoff, Christopher Burant, and Stuart J. Youngner, M.D., in Social Science and Medicine 59, pp. 2325-2334, 2004.

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