Do Medical Students Understand Brain Death? A Survey Study

Tawil, Isaac; Gonzales, Sylvia M.; Marinaro, Jonathan; Timm, T. Craig; Kalishman, Summers; Crandall, Cameron

doi:10.1016/j.jsurg.2011.11.009

Cited by 30 publications

(30 citation statements)

References 21 publications

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“…For example, our highest scoring subgroup, attending neurologists and neurosurgeons (score on the five core brain death questions 4.6±0.7, n=35), approached the expert level reported by Tawil et al (4.8 ±1.1, n=13, p=0.458 when compared to our sample) [26]. The scores for medical students and nurses were also similar to their Western counterparts [35][36][37][38]. About 65 % of our sample correctly differentiated between the vegetative and brain dead states, which is below the 82 % reported for American medical students but above the 48 % reported for medical students in Hong Kong [28,35].…”

Section: Discussionsupporting

confidence: 66%

“…The scores for medical students and nurses were also similar to their Western counterparts [35][36][37][38]. About 65 % of our sample correctly differentiated between the vegetative and brain dead states, which is below the 82 % reported for American medical students but above the 48 % reported for medical students in Hong Kong [28,35]. In our sample, advanced degrees, working in neuroscience specialties, and past encounters with presumed brain dead patients positively correlated with performance on the knowledge test, suggesting that education and clinical experience are the main sources of knowledge for the providers.…”

Section: Discussionmentioning

confidence: 59%

“…In our sample, advanced degrees, working in neuroscience specialties, and past encounters with presumed brain dead patients positively correlated with performance on the knowledge test, suggesting that education and clinical experience are the main sources of knowledge for the providers. However, as is the case in American medical schools, there is very little instruction about brain death in the formal curricula in China [18,35]. The providers most likely have accumulated knowledge through self-directed learning during actual patient care, and learning from colleagues, specialty literature, and the media [35].…”

Section: Discussionmentioning

confidence: 99%

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Acceptance in Theory but not Practice – Chinese Medical Providers’ Perception of Brain Death

Yang

Cheng

et al. 2015

Neuroethics

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Background The brain death standard allowing a declaration of death based on neurological criteria is legally endorsed and routinely practiced in the West but not in Asia. In China, attempts to legalize the brain death standard have occurred several times without success. Cultural, religious, and philosophical factors have been proposed to explain this difference, but there is a lack of empirical studies to support this hypothesis. Methods 476 medical providers (72 attending physicians, 84 residents, 210 medical students, 110 nurses) from three academic hospitals in Hunan, China, completed a selfadministered survey including a 12question brain death clinical knowledge assessment and hypothetical vignettes describing brain dead patients.Results The response rate was 95.2 %. Almost all of the providers had heard of the term "brain death." More than half have encountered presumed brain dead patients. Two-thirds accepted brain death as an ethical standard to determine human death. The mean knowledge score was 8.50±1.83 out of 12. When given the description of a brain dead patient, 50.7 % considered the patient dead, 51.9 % would withdraw life support, and 40.6 % would allow organ procurement. Both provider and patient characteristics contributed to the providers' decisions. Ethical acceptance was the most important independent predictor for brain death acknowledgement, followed by high knowledge scores, and the belief that the soul lives in the brain. Religious faith and associated beliefs did not have a significant effect. Conclusions Notwithstanding scarce official accounts, recognition of the brain death standard is not uncommon in China. Chinese medical providers can adequately define the medical characteristics of brain death and accept it in theory, but hesitate to apply it to practice in the vignettes. Legalization is paramount in providing the protection providers need to comfortably declare brain death. However the medical decision-making surrounding brain death is complex and the provider's past experiences and emotions may also influence the process.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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Acceptance in Theory but not Practice – Chinese Medical Providers’ Perception of Brain Death

Yang

Cheng

et al. 2015

Neuroethics

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“…19 One would hope that medical students have a strong understanding of DNC, but a brief test showed that their level of understanding of this topic was low. 20 These results were mirrored in a test on DNC given to practicing neurologists, who were able to correctly answer only 54% of questions. 21 It is important for medical students to receive a solid education on this topic and for neurologists and other clinicians who are responsible for declaration of DNC to receive continuing education throughout their careers.…”

Section: Solo Practice 21 20mentioning

confidence: 92%

Organ support after death by neurologic criteria

et al. 2016

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Objective: We sought to evaluate how neurologists approach situations in which families request prolonged organ support after declaration of death by neurologic criteria (DNC). Methods:We surveyed 938 members of the American Academy of Neurology (AAN) who treat critically ill patients, including 50% who practice in states with accommodation exceptions (states that require religious or moral beliefs to be taken into consideration when declaring death or discontinuing organ support: California, Illinois, New Jersey, New York), and 50% who practice in nonaccommodation states.Results: The survey was completed by 201/938 individuals (21% response rate), 96 of whom were from accommodation states and 105 of whom were from nonaccommodation states. Both groups reported encountering situations in which families requested continuation of organ support after DNC (48% from accommodation states and 46% from nonaccommodation states). In a hypothetical scenario where a request is made to continue organ support after DNC (outside of organ donation), 48% of respondents indicated they would continue support due to fear of litigation. In reply to an open-ended question, respondents requested that the AAN generate guidelines and advocate to codify laws regarding organ support after DNC, and to improve public and physician education on DNC.Conclusions: Our findings suggest that it is relatively common for neurologists who treat critically ill patients to encounter families who object to discontinuation of organ support after DNC at some point during their career. It would be beneficial for physicians, families, and society to rely on clear medicolegal guidelines on management of this situation. Death by neurologic criteria (DNC) is legally accepted throughout the United States as equivalent to cardiopulmonary death.1 The American Academy of Neurology (AAN) advises that organ support be discontinued after declaration of DNC unless donation is planned, 2 but families sometimes request continuation of support. [3][4][5][6][7][8][9] Four states have legal accommodation exceptions.10-13 New Jersey's statute states that DNC cannot be declared in violation of a patient's religious beliefs.11 In California and New York, hospitals are instructed to make reasonable efforts to accommodate religious or moral objections to DNC. 10,12 In Illinois, hospitals are told to take religious beliefs into account when determining time of death. 13The questions of what constitutes reasonable accommodation and how these situations should be handled in states that do not have accommodation exceptions have left physicians, nurses, administrators, and ethics committees flustered. 3,[7][8][9] Although there are case reports 3-9 on management of objection to DNC, there are no universal legal or medical society guidelines to dictate behavior in these challenging cases. As a result, the frequency of objection to DNC and the manner in which individual centers handle From the

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“…El hecho de que la mitad de los estudiantes que no donarían manifieste temor a que se tomen los órganos antes de estar realmente muerto pareciera demostrar una desconfianza hacia el sistema de salud o una falta de comprensión real del significado de muerte encefálica, es decir, de pérdida de vida equivalente a la «muerte tradicional» por paro cardiorrespiratorio irreversible. Más de la mitad de los estudiantes refirieron entender el concepto de muerte encefálica, sobre todo los que cursaban grados superiores, similar a lo reportado en un estudio previo del CENATRA 11 , e inferior a lo descrito por Najafizadeh, et al 10 y Tawil, et al 12 en sus estudios. El presente trabajo reveló que dos terceras partes de los encuestados habían hablado de donación con su familia o amigos, cifra superior a lo encontrando por Symvoulakis, et al 8 y por otras encuestas efectuadas en población general en México 13 .…”

Section: Discussionunclassified