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Repeat exams for brain dead patients bad for organ donation
December 15th, 2010
04:01 PM ET

Repeat exams for brain dead patients bad for organ donation

For brain dead patients, a second examination to declare death is not only unnecessary but may also have the unwanted effect of steering family members away from donating the patient's organs, according to a new study published in the journal Neurology.

Not one brain dead patient in the study recovered brain function between the first and second exams.

"This is a game changer," said Dr. Dana Lustbader, the North Shore University Hospital chief of palliative medicine, and lead study author, via email. "A single examination is sufficient to diagnose brain death and should be the medical standard. There is simply no benefit to a second exam. None."

Study authors reviewed the medical records of 1,311 patients, across 88 hospitals in New York, between 2007 and 2009. Among those hospitals the average time between the first and second exams was more than 19 hours.

As the space between the first and second exams increased, so did the likelihood of a family refusing to donate organs - from 23% to 36% - according to the study. Conversely, the longer it took to declare a patient brain dead, the less likely the patient's organs would be donated - decreasing from 57% to 45%.

"One of the most disturbing findings of our study is the prolonged anguish imposed on grieving families in the intensive care unit waiting for the second brain death exam," said Lustbader. "Not only is the opportunity for organ donation reduced, but families may endure unnecessary suffering while waiting an average of 19 hours for the second exam to confirm that their loved one is, in fact, still dead."

Most of us die when our heart stops functioning, but about 5% die when the brain stops functioning, according to Lustbader. Once a patient is declared brain dead, the clock starts ticking - the longer it takes to diagnose brain death, the more chance that the organs will become damaged.

"Organ viability decreases the longer a patient is brain dead," according to an editorial for the study. "There is significant harm in the delay of proper brain death diagnosis from a moral and ethical standpoint..."

A second exam declaring brain death is practiced at many hospitals, based on guidelines released in 1995 by the American Academy of Neurology. The AAN revised its guidelines this year, suggesting that a single examination is sufficient to diagnose brain death.

"If one of the goals of the New York State law was to improve the availability of organs for donation, the requirement for 2 brain death examinations clearly interfered, at least if carried out at longer intervals," said editorial authors Dr. Gene Sung and Dr. David Greer.

One reason for delaying diagnosis may be to dispel any notion that physicians are rushing the organ donation process, according to the study. However, dispelling that notion may be thwarting transplantation.

"We have to just get over it," said Lustbader, who is also assistant medical director of the New York Organ Donor Network. "No one wants to talk about death or diagnose it, but we have to and we have to do it in a sensitive, compassionate and timely way."

According to the National Institutes of Health, more than 105,000 people are currently waiting for organ transplants; about 18 die each day because of organ shortages.

"One organ donor can save up to eight lives," said Lustbader. "Preserving the opportunity for organ donation is not only life saving, but may provide patients and families comfort during their tragedy. Our study showed that a second examination reduces this opportunity."


soundoff (25 Responses)
  1. Dan Adams

    Brain death is certainly a tragic experience for any family. But with our modern technology in the medical field it should not be something that has to be second guessed. A brain is electrically activated just like a motor in an appliance. If the active electricity has shorted then nothing works. Although it is possible to rewire a motor there is no such procedure available for the brain. We should not chance loss of functioning organs that can save other lives simply to appease the concience and/or liability of the attending physicians. I am certain that the brain dead person would be more than gratified to know that the life of a young child was saved by their kidney or other vital organ. The second exam is just a waste of time and money that can only prolong the agony of the brain dead patient family while depriving a chance for those waiting for an for a life giving organ. If they are in doubt of the first confirmation of brain death then what makes them think they can be any more certain with a second testing. Why not a 3rd, 4th, 5th and so on. If they can't be certain from the first testing then they need to stop the machine testing altogether and let an Old Time Doctor come in and let them know when a person is dead. They managed to do it for years ... long before electronic diagnostic machines existed.

    December 16, 2010 at 11:04 | Report abuse | Reply
    • sandi

      I lost my son who was an only child in july of this year and I am greatful for the second opinion because you are looking for some explanation and the second test gives you that. My son was an organ donor and all & people whos life he saved are doing well . Unless you have had to deal with a death by brain death you dont know what the family goes through . My son was a healthy 35 year old man the doctors could not find the reason why the bloos vessel broke in the back of his brain . I believe God is the only one who will know why but having as many opinions as it takes to give you some kind of peace in knowing there is no chance. . I dont think it prolongs the pain of the family believe me there is nothing that prolongs the pain or makes it better. It is an unbareable pain that you go through and changes your life . My son was my best friend and the father of a beautiful 2 year old boy and left a wife who was 3 monthes pregnant so that pain will always be with us and it only by the grace od god that we are trying to accept his death and move on. I will say that the fact that my son saved 7 lives was conforting to me.

      December 20, 2010 at 22:13 | Report abuse |
    • Allison Morrison

      What if the first test was WRONG...this happened to my daughter, Chelsea Keenon. Google her name!

      January 13, 2011 at 08:52 | Report abuse |
  2. razzlea

    leave people and their organs alone! http://razzlea.blogspot.com/

    December 16, 2010 at 11:44 | Report abuse | Reply
  3. Oleg

    Woah I am all for organ donation, but let's sure someone is truly kaput before cutting them up for parts. I don't buy the claim that this particular medical test is magically immune to errors when countless babies and adults were left for dead and then recovered spontaneously. 19 hours is a not a lot of time. Having a second exam by an independent specialist and after making sure sedatives and other factors that could temporarily knock out brain have worn off is a must in ethical society.

    December 17, 2010 at 11:42 | Report abuse | Reply
  4. I dunno...

    It seems sort of callus to me. On one hand you're saying, "Get over it" and deal with the death quickly and efficiently...so on the other hand you can "save lives." Is this really about life or is it about something else?

    December 17, 2010 at 12:16 | Report abuse | Reply
  5. Lisa

    I lived through this during the death of my daughter. We desperately wanted to donate her organs when we were told she wouldn't survive, because we wanted her to live on in some way. She was clinically brain dead, but in following guidelines the physicians did 2 rounds of exams to determine brain death and although there was no hope they then did an additional brain perfusion test. That test showed that blood was still flowing to her brain even though there was no activity. We were no longer able to donate her organs, even if we waited, because her organs would fail long before blood stopped perfusing her brain. It added an extra 24 hours to our horror, and wen o longer had the peace of knowing that her precious life would help someone else. It took me a long time to work through the anger and frustration that added to our overwhelming grief. I practice medicine and I understand the medico-legal quagmire that end of life discussions entail, but no matter your background, prolonging the pain makes it so much harder.

    December 17, 2010 at 21:23 | Report abuse | Reply
  6. queenbee

    here is something you may not know:
    Organ donation surgery is done WITHOUT any anesthesia.
    I email CORE.ORG and asked them.
    Anesthetizing the donor would interfere with the procedure.
    ALSO: People who are brain dead still feel pain. Unless the 'brain stem' is dead also, pain is felt. I know this because my mother was declared brain dead, but still responded to painful stimuli (the doctor poked her with a needle).

    December 23, 2010 at 00:06 | Report abuse | Reply
  7. queenbee

    continued: I don't think I will be donating my organs or giving the OK for my loved ones to have theirs donated either.

    December 23, 2010 at 00:07 | Report abuse | Reply
    • Softship

      Queenbee, ... please reconsider. If you are honest and truly would refuse organ donation, then you would also refuse to accept an organ of you were ever in need of one.

      Having said that – some donors do have reflexes which do not involve the brain. That does not mean that they are feeling any pain, because the reflexes are spinal.

      I will always be grateful to the wonderful person and her family who donated her organs – which included the lungs with which I have been breathing for almost 8 years.

      December 26, 2010 at 21:16 | Report abuse |
    • Softship

      Queenbee, ... If you are honest and truly would refuse organ donation, then you would also refuse to accept an organ if you were ever in need of one.

      Having said that – some donors do have reflexes which do not involve the brain. That does not mean that they are feeling any pain, because the reflexes are spinal.

      I will always be grateful to the wonderful person and her family who donated her organs – which included the lungs with which I have been breathing for almost 8 years.

      December 26, 2010 at 21:18 | Report abuse |
    • Softship

      Queenbee, ... If you are honest and would refuse organ donation, then you would also refuse to accept an organ if you were ever in need of one.

      Having said that – some donors do have reflexes which do not involve the brain. That does not mean that they are feeling pain, because the reflexes are spinal.

      I will always be grateful to the wonderful woman and her family who donated her organs – which included the lungs with which I have been breathing for almost 8 years.

      December 26, 2010 at 21:20 | Report abuse |
  8. Malady

    @ queenbee.... Please reconsider donation. I work for an eye bank. Like the article stated, only 5% of donors are organ donors. There is much more then can be donated after a cardiac death. Corneas, whole eye, the heart for valves, bones, and skin. Rarely do these donations hinder an open casket/veiwing funeral, as well.

    December 26, 2010 at 16:24 | Report abuse | Reply
  9. razzlea

    http://razzlea.blogspot.com/

    December 31, 2010 at 09:12 | Report abuse | Reply
  10. Natalie

    People will probably not believe this, but our very close friend was diagnoised as brain dead after suffering a pulmonary embollism after the birth of a child. She had no brain activity and her family was facing the situation many people here are talking about. However, her husband fought to have them check again and the next day, they found brain activity and no signs of what they had seen before. A year later, there are no signs of brain damage although she still has a long recovery. I mention this because, although "statistically" unnecessary, unexplainable things do still happen and technology is not perfect.
    Best wishes to all of you who have experienced this pain- my thoughts are with you.

    January 4, 2011 at 15:55 | Report abuse | Reply
    • ukrish

      Natalie:
      I think you need to make this story more public. I always had a nagging feeling that such a thing could happen, but had not come across a true case of this sort. With the consent of your friend, if you can bring this story to TV or newspaper it will be a great service to the general public and to the medical community. Thanks for sharing.

      January 4, 2011 at 23:21 | Report abuse |
    • Allison Morrison

      Thank you for sharing...My daughter, Chelsea Keenon, was incorrectly called brain dead.after a brain injury from a car accident. Our whole family was told she was brain dead before a second test revealed that there was enough blood flow to her brain to support life. Chelsea is alive and well today. Feel free to google her name as it was reported in our local news paper.

      January 13, 2011 at 09:06 | Report abuse |
  11. Kenneth Sharp

    I am writing to you about the loss of money in supporting organ donation
    Myself I have lived Hemo Kidney dialysis for 34 years starting dialysis at 20 years of age I am now 54
    2 years age Dr. Ben L>ipps flew over from Germany to Richmond Hiill Ontario to present me with the Gerd Krick Achiev ement Award (put that award in google and you will see me)

    I feel that transplants are not a cure as you have to take heavy suppress drugs and the organ only stays so long
    We need to get m ore behind Dr. Shuvo Roy at UCSF he nhas already developed then prototype for a Bio-Kidney with no drugs and no rejection
    That is what I am waiting for
    Thanks for listening
    Ken Sharp]
    P.S. Though I know there are no machines for the heart and lungs there is no choice here

    January 8, 2011 at 20:52 | Report abuse | Reply
  12. Allison Morrison

    My daughter, Chelsea Keenon, would not be ALIVE today if we had listened to the first brain death results. Please feel free to Google her name and read her story. Chelsea is alive today and still using her organs! Two tests are NEEDED as recovery rates can vary is some cases. So, there is a case out here where the wait for the second test was NEEDED!!!!!!! Would you want your organs harvested if you were still alive??? You can visit Chelsea's facebook page and confirm this so your statistics will be correct!

    January 13, 2011 at 07:27 | Report abuse | Reply
  13. shawn

    If the families wouldn't normally donate the organs, they shouldn't be pressured into doing so. It's absurd to encourage people not to value life enough to check a second time simply because it might jeopardize the value of their organs. I don't believe the issue should even be discussed at all, unless the family mentions it first. Otherwise, it's a tacky pathetic attempt to overwhelm and pressure voluneerable people into doing something they (or their now dead family member) likely never intended to do.

    January 19, 2011 at 09:50 | Report abuse | Reply
  14. Kenneth Sharp

    Hi: CNN
    With March being Kidney Month I have a fund raiser at the Trent Winds Hotel in Peterborough, Ontrario, Canada on Sunday March 13th
    With all donations going to Dr.Shuvo Roy research to help develop the Bio-Kidney to replace kidney dialysis at UCSF
    Thanks for listening
    Ken Sharp Peterboropugh, Ontario, Canada

    February 13, 2011 at 14:38 | Report abuse | Reply
  15. Peggy

    My 16 year old son died in january. He was declared braindead but they pressured me to stop life support before the two tests. I am thankful that in my state it is law that a minor child has to be given two tests and allowed so many hours to be on life support. I did not donate because he was a minor and I got so angry at the pressure to donate. I was beliving for a miracle untill there was no hope-I would do the same if I had it to do over. When they tell me that my child would have wanted to save a life I didnt know that. All I cared about was giving my son a fighting chance. If my adult children want to donate then its their choice. I am not comfortable with someone I love being alive to get the organs.

    August 8, 2013 at 23:19 | Report abuse | Reply
  16. bmmg39

    The author seems blissfully unaware that some diagnoses prove to be FALSE. Such ignorance can prove needlessly tragic.

    January 10, 2014 at 00:03 | Report abuse | Reply
  17. Charles O'Connell

    A film now obscure but once upon a time influential, "Coma" (1978), showed healthy patients being gassed with carbon monoxide in "Operating Room 8", then warehoused alive until their organs could be tissue-matched and sold to the highest bidder. In 2006, a doctor in California, Hootan C. Roozrokh, allegedly hastened Reuben Navarro's death with drugs and removed his organs for transplant into one of the many hopeful patients awaiting organ "donation".

    Such practices are currently, but temporarily illegal. All that is needed to release the brakes is for an organized interest group to develop a marketing plan, designate one class of human bodies as futile non-persons, "life unworthy of life", then once public opinion has been sufficiently molded to fit the "free transplant" interest group's goals, marshal a highly-paid litigation team to get a legal ruling able to be enforced in all jurisdictions.

    Think this is objectively "evil"? How naive you are! Where does this "myth" of objective good and evil hold sway? In your legislatures and courts, your churches and classrooms, your minds and hearts? The latter is the most easily melded to the group with the strongest will. Your only hope is that there is some Higher Power that can save you from death coming to reign in your very person.

    January 11, 2014 at 09:22 | Report abuse | Reply
    • Ed

      Verbosity is a disease. Maybe we should harvest your brain.

      January 11, 2014 at 10:32 | Report abuse |

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