Cultural sensitivity in brain death determination: a necessity in end-of-life decisions in Japan

Terunuma, Yuri; Mathis, Bryan J.

doi:10.1186/s12910-021-00626-2

Cited by 20 publications

(12 citation statements)

References 24 publications

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“…Our findings indicate that the time from admission to organ procurement in Japan is longer than that reported in other countries [ 15 , 16 ]. This variation may be attributed to the extensive discussions required around end-of-life care options, including organ donation, which are further complicated by the cultural emphasis on family involvement in medical decision-making processes [ 17 ]. Moreover, we noted that donors who underwent ECPR experienced longer delays to organ procurement compared to those who did not receive ECPR.…”

Section: Discussionmentioning

confidence: 99%

Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study

Yumoto,

Tsukahara,

Obara

et al. 2024

Crit Care

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Background Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest. Methods We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor’s management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups. Results Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death. Conclusions This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation.

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Section: Discussionmentioning

confidence: 99%

Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study

Yumoto,

Tsukahara,

Obara

et al. 2024

Crit Care

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“…Therefore, it is necessary to add courses related to brain death and organ donation in medical education. However, some studies have shown that there was only mild correlation between knowledge and attitude about brain-death organ donation [8,12], while the attitude was also in uenced by cultural and family factors [4,5,17]. Therefore, the courses about brain death should not only focus on the knowledge of brain death.…”

Section: Discussionmentioning

confidence: 99%

“…Cultural and religious traditions have been referenced to explain that Asians are less likely to approve of brain death or organ transplant from brain dead donors [4,5]. However, the lack of knowledge about brain death and organ donation among health professionals and the public in China might be another important factor [6,7].…”

Section: Introductionmentioning

confidence: 99%

Medical students’ knowledge and attitude toward brain death and the influence of medical education: a cross-sectional study

Liu

2022

Preprint

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Background The medical students’ knowledge and attitude toward brain death has not been investigated in China. The aims of this study were to assess the knowledge and attitude toward brain death among medical students in China and assess the influence of medical education on the knowledge and attitude. Methods An online questionnaire consisting of 17 questions was developed and completed by undergraduates majoring in clinical medicine in China Medical University. The students’ demographic data, knowledge and attitude toward brain death were collected and analyzed. Results A total of 1075 medical students participated in the survey, and 1051 of them completed the valid questionnaire. The exploratory factor analysis grouped the 17 items into four dimensions, which explained 63.5% of the total variance. These dimensions were named as knowledge (5 items), attitude (5 items), concern (3 items) and education (4 items) respectively. The global Cronbach α of the questionnaire was 0.845 and the Cronbach α of the four dimensions ranged from 0.756 to 0.866. The mean dimension scores of knowledge, attitude, concern and education was 3.67 ± 0.89, 3.67 ± 0.87, 3.10 ± 1.03 and 4.12 ± 0.12 respectively. The clinical students had a better knowledge than the preclinical students (P < 0.001). The clinical students had a more favorable attitude in stopping the treatment for a brain-dead family member and using the organs and/or tissues of brain-dead patients for transplantation (P < 0.001). The clinical students showed more concerns than the preclinical students (P < 0.001). There was no significant difference in the education between the clinical and pre-clinical students. Conclusions Most medical students in China had insufficient knowledge about brain death. Although their knowledge of brain death increased with their university degree, their attitude toward organ donation after brain death did not evolve accordingly. Their concerns about brain death increased with seniority. Most students had great education need about brain death.

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“…For example, in Japan there is societal resistance to the concept of brain death, and Japan has amended its law to allow individuals to declare their acceptance of brain death for the purposes of organ donation alone, although family may override this. 3 …”

Section: Why Is a Legal Definition Of Death Needed And What Are The L...mentioning

confidence: 99%

Legal considerations for the definition of death in the 2023 Canadian Brain-Based Definition of Death Clinical Practice Guideline

Chandler

Pope

2023

Can J Anesth/J Can Anesth

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Purpose The new 2023 Canadian Brain-Based Definition of Death Clinical Practice Guideline provides a new definition of death as well as clear procedures for the determination of death (i.e., when that definition is met). Since physicians must practice in accordance with existing laws, this legal analysis describes the existing legal definitions of death in Canada and considers whether the new Guideline is consistent with those definitions. It also considers how religious freedom and equality in the Canadian Charter of Rights and Freedoms might apply to the diagnosis of brain death. Method We performed a legal analysis in accordance with standard procedures of legal research and analysis—including reviews of statutory law, case law, and secondary legal literature. The draft paper was discussed by the Legal-Ethical Working Subgroup and presented to the larger Guideline project team for comment. Results and conclusion There are some differences between the wording of the new Guideline and existing legal definitions. To reduce confusion, these should be addressed through revising the legal definitions. In addition, future challenges to brain death based on the Charter of Rights and Freedoms can be anticipated. Facilities should consider and adopt policies that identify what types of accommodation of religious objection and what limits to accommodation are reasonable and well-justified.

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Cultural sensitivity in brain death determination: a necessity in end-of-life decisions in Japan

Cited by 20 publications

References 24 publications

Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study

Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study

Medical students’ knowledge and attitude toward brain death and the influence of medical education: a cross-sectional study

Legal considerations for the definition of death in the 2023 Canadian Brain-Based Definition of Death Clinical Practice Guideline

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