Second brain death examination may negatively affect organ donation

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.