December 15th, 2010
04:01 PM ET
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."
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