Abandoning the dead donor rule? A national survey of public views on death and organ donation

Abstract

Brain dead organ donors are the principal source of transplantable organs. However, it is controversial whether brain death is the same as biological death. Therefore, it is unclear whether organ removal in brain death is consistent with the ‘dead donor rule’, which states that organ removal must not cause death. Our aim was to evaluate the public's opinion about organ removal if explicitly described as causing the death of a donor in irreversible apneic coma. We conducted a cross-sectional internet survey of the American public (n=1096). Questionnaire domains included opinions about a hypothetical scenario of organ removal described as causing the death of a patient in irreversible coma, and items measuring willingness to donate organs after death. Some 71% of the sample agreed that it should be legal for patients to donate organs in the scenario described and 67% agreed that they would want to donate organs in a similar situation. Of the 85% of the sample who agreed that they were willing to donate organs after death, 76% agreed that they would donate in the scenario of irreversible coma with organ removal causing death. There appears to be public support for organ donation in a scenario explicitly described as violating the dead donor rule. Further, most but not all people who would agree to donate when organ removal is described as occurring after death would also agree to donate when organ removal is described as causing death in irreversible coma.

When Do DCD Donors Die?

“…This is not a new concept. 9,[18][19][20] The idea that living donation could be extended to patients in whom death is imminent 9 has been described previously. 18 Indeed, many patients have a significant desire to donate organs.…”

“…Thus, this practice would violate the dead-donor rule. [19][20][21] Conversion of DCD donors to living donors should be thought of in the context of several important considerations. Firstly, families (and, in some cases, patients themselves) have already made the decision to withdraw support.…”

Clinical and ethical perspectives on brain death

“…Furthermore, most (but not all) participants who were willing to donate organs "after death" were also willing to donate in irreversible coma with organ retrieval causing death, and willingness to donate after death correlated positively with willingness to donate in irreversible coma. 84 This survey suggests that many members of the US public would support organ procurement in situations that violate the dead donor rule, casting doubt on the assertion that the dead donor rule is necessary to preserve trust and organ donation rates (at least in the USA), and …”

“…In a recent national survey, Nair-Collins et al 84 presented US residents (n=1,096) with a hypothetical scenario of organ procurement that violated the dead donor rule. A patient was described as being in an irreversible coma but biologically alive, and organ procurement was described as causing the biological death of the donor.…”

The price of our illusions and myths about the dead donor rule

“…This ‘intuition’ is not, however, borne out in the sociological literature. One recent study, for example, found that about 70% of the US adults surveyed would donate their organs if they had devastating brain damage, even though the scenario clearly stipulated that removal of their organs would be the direct cause of their death 7. The point is not that everyone agrees with this view, but rather that honest discussion about the merits of the DDR is not a ‘non-starter’.…”