New York University School of Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.
Neurology. 2011 Jan 11;76(2):119-24. doi: 10.1212/WNL.0b013e3182061b0c. Epub 2010 Dec 15.
Little is known about the impact of the requirement for a second brain death examination on organ donation. In New York State, 2 examinations 6 hours apart have been recommended by a Department of Health panel.
We reviewed data for 1,229 adult and 82 pediatric patients pronounced brain dead in 100 New York hospitals serviced by the New York Organ Donor Network from June 1, 2007, to December 31, 2009. We reviewed the time interval between the 2 clinical brain death examinations and correlated this brain death declaration interval to day of the week, hospital size, and organ donation.
None of the patients declared brain dead were found to regain brainstem function upon repeat examination. The mean brain death declaration interval between the 2 examinations was 19.2 hours. A 26% reduction in brain death examination frequency was seen on weekends when compared to weekdays (p = 0.0018). The mean brain death interval was 19.9 hours for 0-750 bed hospitals compared to 16.0 hours for hospitals with more than 750 beds (p = 0.0015). Consent for organ donation decreased from 57% to 45% as the brain death declaration interval increased. Conversely, refusal of organ donation increased from 23% to 36% as the brain death interval increased. A total of 166 patients (12%) sustained a cardiac arrest between the 2 examinations or after the second examination.
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 3 times longer than the proposed guideline and associated with substantial intensive care unit costs and loss of viable organs.
对于第二次脑死亡检查对器官捐献的影响知之甚少。在纽约州，卫生署的一个专门小组建议进行两次相隔 6 小时的检查。
我们对 2007 年 6 月 1 日至 2009 年 12 月 31 日期间，在纽约器官捐赠网络服务的 100 家纽约医院被诊断为脑死亡的 1229 名成年患者和 82 名儿科患者的数据进行了回顾。我们检查了两次临床脑死亡检查之间的时间间隔，并将此脑死亡宣告间隔与星期几、医院规模和器官捐献相关联。
没有发现任何被宣告脑死亡的患者在重复检查时恢复了脑干功能。两次检查之间的平均脑死亡宣告间隔为 19.2 小时。与平日相比，周末进行脑死亡检查的频率降低了 26%（p=0.0018）。0-750 床医院的脑死亡间隔平均为 19.9 小时，而 750 床以上医院的脑死亡间隔为 16.0 小时（p=0.0015）。随着脑死亡宣告间隔的增加，同意进行器官捐献的比例从 57%降至 45%。相反，随着脑死亡间隔的增加，拒绝器官捐献的比例从 23%增至 36%。共有 166 名患者（12%）在两次检查之间或第二次检查后发生心脏骤停。
对于 1 岁以上的患者，进行一次脑死亡检查即可确定脑死亡。实际上，观察到第二次神经检查的时间是建议指南的 3 倍，这与大量的重症监护室费用和有活力的器官损失有关。
