Ethical assessments of brain death and organ procurement policies: a survey of transplant personnel in the United States.

The Questionnaire on Prolonging and Shortening Life was developed to assess the views of medical personnel regarding brain death, organ procurement policies, and related issues. The questionnaire was completed by 189 transplant physicians, 197 clinical coordinators, 150 medical students, and 70 nursing students. Ninety-five percent supported the so-called dead donor rule. What this rule means in practice appeared unclear among the population. More than 60% supported procuring organs from anencephalic and "higher brain-dead" patients, although patients in both groups are not dead by current legal standards. Performance on items relating to so-called non-heart-beating organ donation suggested that 75% of the group do not support non-heart-beating organ donation without assurance that the donors are brain-dead before procurement begins. Given that current recommendations to increase organ donation look to non-heart-beating organ donation rather than to anencephalic patients and those in a persistent vegetative state, these findings suggest that further ethical discussion and analysis are urgently needed.