Scientific Contribution

Medicine, Health Care and Philosophy

, Volume 16, Issue 3, pp 457-467

First online:

One or two types of death? Attitudes of health professionals towards brain death and donation after circulatory death in three countries

  • D. Rodríguez-AriasAffiliated withInstitute of Philosophy, CCHS, Spanish National Research Council, CSICLaboratoire d’Éthique Médicale, Université Paris-Descartes Email author 
  • , J. C. TortosaAffiliated withAnesthésie Réanimation, Hôpital Saint CamilleLaboratoire d’Éthique Médicale, Université Paris-Descartes
  • , C. J. BurantAffiliated withFrances Payne Bolton School of Nursing, Case Western Reserve UniversityGeriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center
  • , P. AubertAffiliated withDepartment of Bioethics, Case Western Reserve UniversityNational Institutes of Health
  • , M. P. AulisioAffiliated withDepartment of Bioethics, Case Western Reserve University
  • , S. J. YoungnerAffiliated withDepartment of Bioethics, Case Western Reserve University

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This study examined health professionals’ (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors’ loss of circulatory function could be reversed, and raises questions about “death” as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs’ discomfort must be further identified and addressed.


Attitude to death Tissue and organ procurement Ethics Attitude of health personnel Donation after circulatory death Brain death France Spain United States