A/Prof George Skowronski1, A/Prof Michael O’Leary2, Ms Lisa O’Reilly3, Dr Cynthia Forlini5, Dr Narcyz Ghinea3, Dr Linda Sheahan3, Prof Cameron Stewart6, Prof Ian Kerridge6
1St George Hospital Sydney, Kogarah, Australia, 2Royal Prince Alfred Hospital, Camperdown, Australia, 3South East Sydney Local Health District, , Australia, 4University of Sydney, , Australia, 5Deakin University, Geelong, Australia, 6University of Sydney, Sydney, Australia
Withdrawal of vital organ support in the context of organ donation (OD) evokes medical, ethical, and legal issues. Ongoing controversies surround the ‘Dead Donor Rule’ (DDR), as well as the two protocols for determining death – brain death (BD) and the circulatory determination of death (DCDD). Little is known about public perceptions of determining death in decision-making about the withdrawal of organ support and OD, and the importance to the lay public of the DDR.
We surveyed 1017 adults in a sample representative of the Australian population. Survey questions were based on three hypothetical scenarios of BD and DCDD patients to ascertain (1) understandings of death in BD and DCDD, (2) their relationship to decisions about withdrawal of vital organ support and OD, and (3) the DDR. Statistical analysis revealed better acceptance of BD as death of the person (70.2%) than DCDD (54%). In both cases, support for OD was high: 75.7% for the BD patient, 80% for the DCDD patient. Almost half the respondents supported OD in both BD and DCDD patients (45.6% and 48%, respectively) even if it caused the patient’s death, and 61% of respondents accepted a hypothetical high quadriplegic patient’s request to be allowed to donate organs under anaesthesia.
Our results indicate that for many Australians, the overall prognosis, rather than the presence of death, dominates decision-making about the withdrawal of organ support and OD. This calls into question the current emphasis on upholding the DDR in organ donation.
George Skowronski retired from a 40 year clinical career as an intensive care physician in 2019. He subsequently pursued a longstanding interest in medical ethics, leading to his appointment to a newly created position as Clinical Ethics Lead at St George Hospital in Sydney.