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Second brain death examination may negatively affect organ donation
D Lustbader1, D O'Hara, E F M Wijdicks
1New York University School of Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA. Lustbader@nshs.edu
Insights
A single brain death examination may suffice for patients over one year old. The current two-examination protocol delays organ donation and increases costs, with no patients regaining brainstem function.
Area of Science:
- Medical research
- Neurology
- Organ donation
Background:
- The impact of requiring two brain death examinations on organ donation is not well understood.
- New York State recommends two examinations, six hours apart, for brain death determination.
Purpose of the Study:
- To evaluate the necessity of a second brain death examination.
- To assess the effect of the interval between examinations on organ donation rates and patient outcomes.
Main Methods:
- A retrospective review of 1,229 adult and 82 pediatric patients pronounced brain dead.
- Data collected from 100 New York hospitals serviced by the New York Organ Donor Network (June 2007-December 2009).
- Analysis of the time interval between two clinical brain death examinations and its correlation with hospital size, day of the week, and organ donation.
Main Results:
- No patients regained brainstem function upon repeat examination.
- The mean interval between brain death examinations was 19.2 hours.
- Organ donation consent decreased from 57% to 45% as the interval increased, while refusal increased from 23% to 36%.
- 12% of patients experienced cardiac arrest between examinations.
Conclusions:
- A single brain death examination should be sufficient for patients over one year old.
- The current practice of a second examination significantly exceeds recommended guidelines, leading to increased intensive care unit costs and loss of viable organs.
- Streamlining the brain death declaration process could improve organ donation rates and reduce healthcare costs.
Background:
Little is known about the impact of the requirement for a second brain death examination on organ donation. In New York State, 2 examinations 6 hours apart have been recommended by a Department of Health panel.
Methods:
We reviewed data for 1,229 adult and 82 pediatric patients pronounced brain dead in 100 New York hospitals serviced by the New York Organ Donor Network from June 1, 2007, to December 31, 2009. We reviewed the time interval between the 2 clinical brain death examinations and correlated this brain death declaration interval to day of the week, hospital size, and organ donation.
Results:
None of the patients declared brain dead were found to regain brainstem function upon repeat examination. The mean brain death declaration interval between the 2 examinations was 19.2 hours. A 26% reduction in brain death examination frequency was seen on weekends when compared to weekdays (p = 0.0018). The mean brain death interval was 19.9 hours for 0-750 bed hospitals compared to 16.0 hours for hospitals with more than 750 beds (p = 0.0015). Consent for organ donation decreased from 57% to 45% as the brain death declaration interval increased. Conversely, refusal of organ donation increased from 23% to 36% as the brain death interval increased. A total of 166 patients (12%) sustained a cardiac arrest between the 2 examinations or after the second examination.
Conclusion:
A single brain death examination to determine brain death for patients older than 1 year should suffice. In practice, observation time to a second neurologic examination was 3 times longer than the proposed guideline and associated with substantial intensive care unit costs and loss of viable organs.
