Sydney Health Ethics, University of Sydney, Camperdown, New South Wales, Australia.
Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2020 Oct;50(10):1192-1201. doi: 10.1111/imj.15028.
Despite brain death (BD) being established as a definition of death for over 50 years, the concept remains controversial. Little is known about public perception of death determination in decision-making about withdrawal of organ support and organ donation (OD), and the importance of the 'Dead Donor Rule' (DDR). We examined perceptions about death in a BD patient and their relationship to decisions about withdrawal of vital organ support, OD and the DDR, using an online survey of 1017 Australian adults. A BD patient scenario was presented, followed by a series of questions. Statistically significant differences in responses were determined using repeated measures analyses of variance and t tests. Seven hundred and fourteen respondents (70.2%) agreed that a hypothetical BD patient was dead. Those disagreeing most commonly cited the presence of heartbeat and breathing. Seven hundred and seventy (75.7%) favoured removal of 'life support', including 136 (13.3%) who had not agreed the patient was dead. Support for OD was high, but most favoured organ removal only after heartbeat and breathing had ceased. Where OD was in keeping with the patient's known wishes, 464 (45.6%) agreed that organs could be removed even if this caused death. Forty-one (20%) of those who had indicated they considered the patient was not dead agreed to organ removal even if it caused death. Australian public views on BD, withdrawal of 'life support' and OD are complex. Emphasis on prognosis and the impact of significant brain injury may be more appropriate in these situations, rather than focussing on death determination and upholding the DDR.
尽管脑死亡（BD）作为死亡的定义已经确立了 50 多年，但这一概念仍然存在争议。人们对在决定停止生命器官支持和器官捐献（OD）时公众对死亡判定的看法以及“死囚规则”（DDR）的重要性知之甚少。我们使用澳大利亚成年人的在线调查（共 1017 人），调查了 BD 患者的死亡观念及其与停止重要器官支持、OD 和 DDR 决定的关系。我们呈现了一个 BD 患者的场景，随后提出了一系列问题。使用重复测量方差分析和 t 检验来确定对答复的统计学差异。714 名受访者（70.2%）同意假设的 BD 患者已经死亡。最不同意的人通常引用了心跳和呼吸的存在。770 人（75.7%）赞成移除“生命支持”，其中包括 136 人（13.3%）不同意患者已经死亡。OD 得到了广泛支持，但大多数人赞成仅在心跳和呼吸停止后才进行器官移除。如果 OD 符合患者的已知意愿，那么 464 人（45.6%）同意即使这导致死亡，也可以移除器官。在表示他们认为患者未死亡的 41 人（20%）中，有 20%的人同意即使这会导致死亡，也可以进行器官移除。澳大利亚公众对 BD、停止“生命支持”和 OD 的看法是复杂的。在这些情况下，强调预后和严重脑损伤的影响可能比关注死亡判定和维护 DDR 更为合适。
