Single Brain Death Examination Is Equivalent to Dual Brain Death Examinations
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ETHICAL MATTERS
Single Brain Death Examination Is Equivalent to Dual Brain Death Examinations Panayiotis N. Varelas • Mohammed Rehman • Tamer Abdelhak Aashish Patel • Vivek Rai • Amy Barber • Susan Sommer • Jesse J. Corry • Chethan P. Venkatasubba Rao
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Published online: 21 May 2011 Ó Springer Science+Business Media, LLC 2011
Abstract Background Although the new Practice Parameters for brain death support a single examination, there is paucity of data comparing its impact to dual brain death (DBD) examinations. Methods We reviewed all brain deaths in our hospital over a 39-month period and compared the optional single brain death (SBD) exam requiring an apnea and a mandatory confirmatory blood flow test to the DBD for organ function at the time of death, rate of donation, and cost. Results Thirty-six patients had a SBD and 59 DBD exams, without any of them regaining neurological functioning. There was no difference in serum electrolytes (except for higher Na+ and Cl- in the SBD group), blood urea nitrogen, creatinine, blood gases, incidence of diabetes P. N. Varelas M. Rehman T. Abdelhak A. Patel V. Rai J. J. Corry C. P. Venkatasubba Rao Department of Neurology, Henry Ford Hospital, Detroit, MI, USA P. N. Varelas M. Rehman T. Abdelhak J. J. Corry Departments of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA A. Barber Transplant Institute, Henry Ford Hospital, Detroit, MI, USA S. Sommer Gift of Life of Michigan, Ann Arbor, MI, USA P. N. Varelas (&) Henry Ford Hospital, K-11 & Henry Ford West Bloomfield Hospital, 2799 West Grand Blvd, Detroit, MI 48202, USA e-mail: [email protected] P. N. Varelas Department of Neurology, Wayne State University, Detroit, MI, USA
insipidus, apnea completion, consent for donation, and organs recovered and transplanted. During the second BD exam, 35% of patients with DBD were on higher dose of vasopressors, but had lower systolic blood pressure (P = 0.046). For DBD patients, the mean interval between the two exams was 14.4 h, which contributed to a higher cost of $43,707.67 compared to SBD. There was a trend for increased consent rates (adjusted for age, race, and type of exam) when patients were declared by the neurointensivist service following a strict family approach protocol (P = 0.06). Conclusion SBD exam is easier, faster to perform, with no brain function recovery and leads to similar donation rates, equivalent or better organ function status at the time of BD and lower cost than conventional DBD exams. Keywords Brain death Single Critical care Cost effectiveness Organ donation Transplantation
Introduction Definition of death in the United States of America is based on the Uniform Determination of Death Act (UDDA), which was adopted by most States with or without amendments. UDDA defines death as either the irreversible cessation of circulatory or respiratory function or the irreversible cessation of all functions of the entire brain, including the brainstem (also known as ‘‘Brain Death’’ [BD]) [1]. The word ‘‘irreversible’’ inherently imp
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