With more than 110,000 people awaiting the gift of an organ in the United States, health professionals know they can ill afford to squander the chance that a grieving family will say "yes" to organ donation. And yet, in this season of gift-giving, two new studies find that the gift of life is all too often lost to delay and imperfect hospital practices.
With the exception of some kidney and liver transplants, organs and tissues used in transplantation come from the bodies of those who have been declared brain-dead, usually as a result of trauma, stroke or a sudden blockage of blood flow to the brain. In the interest of ensuring that such patients are not hastily declared hopeless cases, most states have adopted a policy that requires two separate medical examinations--separated by at least six hours--before organ donation is considered. To proceed, a qualified physician must conclude after each exam that the patient's brain has sustained irreparable damage inconsistent with life.
A study published Wednesday in the journal Neurology finds that such a policy, while well intended, is unnecessary, allows organs to go to waste and leaves families of a prospective organ donor in agonizing limbo, often causing them to decline organ donation or withdraw initial support for such a gift.
To study the impact of those practices, physicians and researchers in New York, at the Mayo Clinic in Minnesota and at Dalhousie University in Canada tracked all cases of patients declared brain dead in 100 New York hospitals during a 30-month period between 2007 and 2009.
[Updated Dec. 15, 3:55 p.m. An earlier version of this article said researchers tracked all cases of patients declared brain dead in New York.] Of the 1,229 adult cases and 82 pediatric cases during that period, they found that busy hospital staff stretched the time between the exams to a median of 18.5 hours, well past the six-hour span originally foreseen.
In that time, 12% of the patients suffered a cardiac arrest, making their organs unuseable for transplant. The rate at which families of the victims consented to organ donation decreased from 57% to 45% as the time between the two exams expanded, and the rate at which families refused to donate their loved one's organs went from 23% to 36% as the gap between exams grew.