Study: A Second Exam for Brain Death is Unnecessary — and Reduces Organ Donations

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Deciding to remove a loved one from life support is a heart-wrenching decision. But for families of eligible organ donors, their decision has an even wider impact — there are 108,725 people currently waiting for organs for transplant, but, to date, only 7,136 patients have donated.

According to new research, one possible impediment to acquiring organs for donation is a New York State policy that requires doctors to conduct a second exam to confirm brain death in patients. (More on Time.com: Why Do Black Patients Get Unwanted End-of-Life Care?)

Researchers from the North Shore LIJ Health System in Manhasset, NY, reviewed data from the New York Organ Donor Network on 1,229 adults and 82 children who had been declared brain dead between January 2007 and December 2009. Although the state recommends waiting six hours between the first and second exams to confirm brain death, the patients in the study waited an average 20 hours.

As the waiting time between the exams dragged on, it became less likely that the patients’ families would agree to donate their organs. The study did not delve into the particular reasons why, but the authors speculate that families became more reluctant to donate, after spending another emotionally draining day at the hospital waiting to decide whether to remove life support. (More on Time.com: Major Health Systems Team Up to Improve Care and Lower Costs)

In addition, patients’ organs are less likely to be viable for transplant the longer the patient remains brain dead. The study found that 12% of patients suffered an additional cardiac between the first and second exams for brain death, rendering them ineligible to donate.

“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,” study author Dr. Dana Lustbader, chief of palliative care at the North Shore LIJ Health System, told HealthDay’s Jenifer Goodwin, who reports:

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.

Worse, the second-exam policy costs the state a great deal: the extra day of intensive care costs New York about $1 million each year, HealthDay reports. (More on Time.com: NY Pilot Expands Organ Recovery to At-Home Deaths)

The American Academy of Neurology’s guidelines recommend only one exam for brain death, and neurologists in many other states are already dropping the second test.