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Single Brain Death Examination Likely Sufficient

Two-exam requirement may result in fewer viable organs for donation

THURSDAY, Dec. 16 (HealthDay News) -- A second clinical examination to determine brain death may not be necessary and could result in a loss of viable organs for donation, according to research published online Dec. 15 in Neurology.

Dana Lustbader, M.D., of the North Shore University Hospital in Manhasset, N.Y., and colleagues sought to determine the impact of a second brain death examination on organ donation. They correlated the time interval between two brain death examinations and day of the week, hospital size, and organ donation for 1,229 adults and 82 pediatric patients pronounced brain dead in New York hospitals. In New York state, a Department of Health panel has recommended two brain death examinations six hours apart.

The researchers found that none of the patients regained brainstem function by the second examination, which occurred at a mean of 19.2 hours after the first examination. As the interval increased, consent for organ donation decreased from 57 to 45 percent and refusal of organ donation rose from 23 to 36 percent. They found a 26 percent reduction in brain death examination frequency on weekends versus weekdays, and the mean brain death declaration interval was 19.9 hours for hospitals with up to 750 beds compared with 16 hours for those with more than 750 beds.

"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 three times longer than the proposed guideline and associated with substantial intensive care unit costs and loss of viable organs," the authors write.

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