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Brain Death in Asia

Do Public Views Still Influence Organ Donation in the 21st Century?

Liu, Christopher W., MBBS, MMed1; Yeo, Charlene2; Lu Zhao, Boyu2; Lai, Clin K.Y., BA2; Thankavelautham, Suhitharan, MBBS, MMed1; Ho, Vui Kian, MBBS, MMed, FANZCA1; Liu, Jean C.J., BPsych, PhD2,3

doi: 10.1097/TP.0000000000002562
Original Clinical Science—General

Background. Historically, brain death legislation was adopted in Asia at a much later stage than it was in the West, with heated public debates surrounding these laws. In this study, we investigated whether the poor acceptance of brain death continues to the present day, focusing on the following: (1) what the Asian public understands brain death to be; (2) how views toward brain death are compared with those of cardiac death; and (3) the extent to which brain death perception contributes to the low rate of deceased organ donation that has been observed amongst Asians.

Methods. Using a door-to-door sampling strategy, we recruited 622 residents in Singapore between September 2016 and July 2017.

Results. Our results suggest that resistance toward brain death persists, with the majority of respondents equating this as a bleak outcome but not as death. Correspondingly, they considered cardiac death a better indicator of death and were more fearful of being alive during organ donation. In turn, these views predicted a decreased willingness to donate either their own or their family members’ organs.

Conclusions. Taken together, our results suggest that views of brain death continue to hamper organ donation, and are seemingly resistant to both time and legislation.

1 Division of Anaesthesiology, Singapore General Hospital, Singapore.

2 Division of Social Sciences, Yale-NUS College, Singapore.

3 Neuroscience and Behavioral Disorders Programme, Duke-NUS Medical School, Singapore.

Received 23 September 2018.

Accepted 21 November 2018.

The authors declare no conflicts of interest.

This work was supported by a grant awarded to C.W.L., S.T., V.K.H., and J.C.J.L. from the National University of Singapore Humanities and Social Sciences research fund (grant HSS-1502-P02).

C.W.L. and C.Y. contributed equally to this article. C.W.L. participated in research design, data analysis, and the writing of the article. C.Y. participated in the performance of the research, data analysis, and the writing of the article. B.L.Z. and C.K.Y.L. participated in research design, performance of the research, and data analysis. T.S. and V.K.H. participated in research design. J.C.J.L. participated in research design, data analysis, and the writing of the article.

Correspondence: Jean Liu, BPsych, PhD, 16 College Avenue W #02-221, Singapore 138527. (

Christopher W. Liu, MBBS, MMed, Department of Pain Medicine, Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore 169608. (

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