WEDNESDAY, Dec. 15 (HealthDay News) -- Making families wait for
a second exam to confirm a brain death diagnosis is not only
unnecessary but may make it less likely that the family will agree
to donate their loved one's organs, a new study finds.
Researchers reviewed records from the New York Organ Donor
Network database of 1,229 adults and 82 children who had been
declared brain dead. All of the people had died in New York
hospitals over a 19-month period between June 2007 and December
Patients had to wait an average of nearly 20 hours between the
first and second exam, even though the New York State Health
Department recommends a six-hour wait, according to the study.
Not only did the second exam add nothing to the diagnosis -- not
one patient was found to have regained brain function between the
first and the second exam -- lengthy waiting times appeared to make
families more reluctant to give consent for organ donation.
About 23 percent of families refused to donate their loved ones
organs, a number that rose to 36 percent when wait times stretched
to more than 40 hours, the investigators found.
The converse was also true: Consent for organ donation decreased
from 57 percent to 45 percent as wait times were dragged out.
Though the research did not look at the causes of the refusal,
for families, waiting around for a second exam means another
emotionally exhausting, stressful and uncertain day waiting in an
intensive care unit to find out if it's time to remove their loved
one from life support, said study author Dr. Dana Lustbader, chief
of palliative care at The North Shore LIJ Health System in
At the same time, the patient's already precarious condition can
further decrease the odds of organ donation occurring as waiting
times go up. Organ viability decreases the longer a person is brain
dead, Lustbader said.
About 12 percent of patients declared brain dead had a cardiac
arrest while waiting for the second exam or after the second exam,
making them ineligible for organ donation, Lustbader added.
"We wanted to determine the accuracy of the first exam and determine if the second exam adds anything. The answer to that is an emphatic 'No,'" Lustbader said. "The second exam does not add anything and in fact, has several negatives or harmful effects, including prolonged anguish for families who are waiting to find out if their loved one is dead or alive."
The study is published in the Dec. 15 online issue of
Though New York's health department requires two exams,
elsewhere, neurologists are already moving away from two exams. The
American Academy of Neurology's 2010 guidelines call for one,
comprehensive exam done by an experienced and qualified physician.
The exam includes a step-by-step checklist of some 25 tests and
criteria that must be met before a person can be considered brain
Dr. Gary Gronseth, a professor of neurology at the University of
Kansas, said this is the right strategy.
More important than doing two exams is the waiting period
between the time the person suffered the catastrophic injury that
caused the brain death, determining the person is unlikely to ever
regain consciousness and doing the first exam to make the official
"This insistence on the second exam has been a distraction from the main issue, which is selecting an appropriate observation period from the time of the catastrophic brain injury to the first exam," Gronseth said.
For example, the waiting period might be relatively shorter for
someone who has devastating structural injury to the brain itself
such as from a hemorrhage than the waiting time for someone who is
brain dead due to other causes that aren't as obvious.
According to the study, lengthy waiting periods for the exam are
also costly, with the extra day of intensive care for brain dead
patients costing about $1 million a year in New York alone,
according to the study.
For more on end-of-life issues, visit the
U.S. National Library of Medicine.