Thinking anew about death: Presenting the rationale for an Australian study of health professionals and public attitudes on death and organ donation

Dr Cynthia Forlini1, Dr George Skowronski1,2, Dr Michael O’Leary3,4, Prof Ian Kerridge1,5

1Sydney Health Ethics, The University Of Sydney, Camperdown, Australia, 2Intensive Care Unit, St. George Private Hospital, Sydney, Australia, 3New South Wales Organ and Tissue Donation Service, Sydney, Australia, 4Intensive Care Service, Royal Price Alfred Hospital, Sydney, Australia, 5Haematology Department, Royal North Shore Hospital, Sydney, Australia

The ‘Dead Donor Rule’ (DDR) stipulates that organs for transplantation can only be removed after the death of the donor. For the past 50 years, it has underpinned peri-mortem organ donation and is widely regarded as ethically sacrosanct. Around three quarters of all donated organs are acquired around the time of the donor’s death, and most of these follow the development of the syndrome of ‘brain death’. ‘Donation after circulatory death’ (DCD) is now responsible for a growing proportion of organs obtained around the time of death. Reconciling brain death and DCD under the DDR has polarized debates both in academic literature and clinical practice as organ donation increasingly relies on notions of death that no longer conform to traditional concepts of biological death. Debates are further complicated by emerging evidence on the meaning of remaining neural activity in brain dead donors and the incidence of auto-resuscitation in DCD donors. In this paper, we question whether organ donation can be justified ethically without the need for a DDR. Our line of inquiry is based on the potential moral distress caused by determinations of death that could underlie conscientious objection on the part of clinicians and legal recourse on the part of families. To begin, we present a four-part rationale for conducting a mix-methods study in Australia where there are currently no data on the attitudes of healthcare professionals and the general public toward the concepts and protocols underlying death and organ donation. Understanding to what extent, if at all, the determination of death and the DDR cause moral distress in the context of intensive care is an important first step in thinking anew about death as a prerequisite for organ donation.


Dr Forlini an interdisciplinary researcher with expertise in neuroethics, an established field within contemporary bioethics that ensures the ethical, efficient and effective translation of advances in neuroscience research in the clinic, and social and public policies that meet the needs of stakeholders. Her research program addresses the shifting boundaries between treatment, maintenance and enhancement of cognitive performance.