Knowledge, acceptance and perception towards brainstem death among medical students in Hong Kong: a questionnaire survey on brainstem death

Med Teach. 2008 Jun;30(5):e125-30. doi: 10.1080/01421590801932236.


Background: Brainstem death (BSD), defined as the irreversible loss of consciousness, brainstem reflexes and the capacity to breathe, is not an uncommon scenario seen in the day to day practice of medical personnel. Upon the diagnosis of BSD, controversial issues of withdrawing life-supporting treatments and organ procuring for transplantation inevitably arise. This study evaluated the knowledge, acceptance and perception of BSD amongst medical students in Hong Kong.

Methods: A total of 126 medical students completed a self-administered questionnaire. Ten questions were used to assess their knowledge of BSD and this was correlated with their responses in three hypothetical vignettes.

Results: The mean score of the subjects' knowledge was 6.03 out of 10. Less than half (48.8%) of the subjects' knew that BSD is different from persistent vegetative state while 49.2% and 36.3% knew that BSD is accepted as death medically and legally in Hong Kong, respectively. When 'diagnosed' with BSD, 63.7%, 46.8% and 52.4% of the subjects would agree to the withdrawal of life-support from themselves, their most-loved one/family member and a stranger, respectively. Subjects with better knowledge and those who thought that doctors may tend to diagnose BSD to save resources or procure organs for transplantation were more ready to accept the withdrawal of life-support.

Conclusions: We concluded that knowledge of BSD amongst medical students was unsatisfactory and that urgent actions should be taken to remedy the situation. A better knowledge of BSD positively influenced the decision-making on withdrawing life-support and that adequate information regarding the outcome of BSD should be provided. On the other hand, the perception of doctors' intentions behind diagnosing BSD has no direct influence on the decision-making. More emphasis is required on medical education, including a specific emphasis in the undergraduate lecture curriculum and bedside exposure to BSD diagnosis and subsequent counselling of patients' family members.

MeSH terms

  • Brain Death / diagnosis*
  • Brain Stem / physiopathology*
  • Cross-Sectional Studies
  • Decision Making
  • Female
  • Hong Kong
  • Humans
  • Knowledge*
  • Male
  • Perception*
  • Students, Medical / psychology*
  • Surveys and Questionnaires
  • Withholding Treatment