Delays in Brain Death Certification in an Opt-out Deceased Organ Donation System: Causes, Ethical Problems, and Avoidance.

Brain death certification can be a clinically and ethically challenging affair. Healthcare workers are expected to refer patients for brain death certification to identify potential organ donors, but family members may be ill-prepared for this turn of events. Already distraught families may not appreciate delays in brain death certification, but such delays are common because of the need to manage the patient's altered physiological state to allow testing. Opportunities for donation are sometimes lost because of the unnecessary delay. With focus on an opt-out organ donation law, we discuss causes of delays in brain death certification, and the ethical issues faced by clinicians in using tests to certify patients. To resolve the issues, we argue for the use of supplementary confirmatory tests as part of a more protocol-driven approach to brain death certification to avoid delays. Such tests should be regarded as part of the donation process funded by the state. © National University of Singapore and Springer Nature Singapore Pte Ltd. 2018.