Medicine, Health Care and Philosophy

, Volume 16, Issue 3, pp 457–467

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


    • Institute of Philosophy, CCHSSpanish National Research Council, CSIC
    • Laboratoire d’Éthique MédicaleUniversité Paris-Descartes
  • J. C. Tortosa
    • Anesthésie RéanimationHôpital Saint Camille
    • Laboratoire d’Éthique MédicaleUniversité Paris-Descartes
  • C. J. Burant
    • Frances Payne Bolton School of NursingCase Western Reserve University
    • Geriatric Research, Education, and Clinical CenterLouis Stokes Cleveland VA Medical Center
  • P. Aubert
    • Department of BioethicsCase Western Reserve University
    • National Institutes of Health
  • M. P. Aulisio
    • Department of BioethicsCase Western Reserve University
  • S. J. Youngner
    • Department of BioethicsCase Western Reserve University
Scientific Contribution

DOI: 10.1007/s11019-011-9369-1

Cite this article as:
Rodríguez-Arias, D., Tortosa, J.C., Burant, C.J. et al. Med Health Care and Philos (2013) 16: 457. doi:10.1007/s11019-011-9369-1


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 deathTissue and organ procurementEthicsAttitude of health personnelDonation after circulatory deathBrain deathFranceSpainUnited States

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© Springer Science+Business Media B.V. 2011