Brain Death in Asia: Do Public Views Still Influence Organ Donation in the 21st Century?

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.