Impact of the Life-Sustaining Treatment Decision Act on Brain Death Organ Tissue Donation in Korea: A Qualitative Study of Emergency Physicians’ Experiences and Perspectives

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Abstract Background: In Korea, a new law was enacted in January 2016 allowing life-sustaining treatment (LST) of patients in end-of-life to be stopped, popularly known as the LST Decision Act. It came into effect in February 2018. Since then, brain death organ tissue donation affiliated with emergency physicians has decreased. This study aimed to explore emergency physicians’ experiences of and perspectives toward the impact of the LST Decision Act on brain death in Korea. Methods: A qualitative study was conducted using thematic analysis methods. Ten emergency physicians with experience in brain death, organ tissue donation, and LST were interviewed. Data analysis was performed following the six steps proposed by Braun and Clarke. Results: Data analysis revealed 14 subthemes and 5 themes: 1) The LST Decision Act is a legitimate way to stop LST, but it is not enough; 2) Many family members stop LST first, often more quickly and actively than physicians expect them to; 3) Stopping LST makes the patient more comfortable; thus, caregivers do not wish to opt for organ tissue donation, which is seen as distressing; 4) Not all patients experience brain death, and LST is stopped before brain death; and 5) Since the LST Decision Act, brain death organ tissue donation has decreased. Conclusion: Emergency physicians generally welcomed the LST Decision Act. However, family members seemed to perceive stopping LST as the means to making the patients comfortable, resulting in the loss of potential organ tissue donors. There is a need for a supplementary policy that connects stopping LST to brain death organ tissue donation.

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