title: Single brain death examination is equivalent to dual brain death examinations.
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 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Neurology, Henry Ford Hospital, Detroit, MI, USA. varelas@neuro.hfh.edu
authors: Panayiotis N
authors: PN
authors: Varelas
authors: Mohammed
authors: M
authors: Rehman
authors: Tamer
authors: T
authors: Abdelhak
authors: Aashish
authors: A
authors: Patel
authors: Vivek
authors: V
authors: Rai
authors: Amy
authors: A
authors: Barber
authors: Susan
authors: S
authors: Sommer
authors: Jesse J
authors: JJ
authors: Corry
authors: Chethan P
authors: CP
authors: Venkatasubba Rao
references: Crit Care. 1997;1(2):65-70
references: 11056697
references: N Engl J Med. 2004 Dec 23;351(26):2730-9
references: 15616207
references: Virtual Mentor. 2010 Nov 01;12(11):879-84
references: 23186795
references: Neurology. 2011 Jan 11;76(2):113-4
references: 21172837
references: BMJ. 2009 Apr 21;338:b991
references: 19383730
references: J Trauma. 1990 Jun;30(6):728-32
references: 2352301
references: Neurology. 2004 Nov 23;63(10):1955-7
references: 15557523
references: Neurology. 2008 Jan 22;70(4):284-9
references: 18077794
references: Neurology. 2011 Jan 11;76(2):119-24
references: 21172836
references: Neurology. 2010 Jun 8;74(23):1911-8
references: 20530327
references: Neurology. 2010 Jul 6;75(1):77-83
references: 20603486
references: Am J Transplant. 2007 Dec;7(12):2769-74
references: 17927805
references: Br J Surg. 2009 Mar;96(3):299-304
references: 19224513