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Second Brain Death Exam Unnecessary, Study Finds
Date:12/15/2010

out 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 Neurology.

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 dead.

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 diagnosis.

"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 o
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