(130) Does Time Matter? Exploring the Interval Between Brain Death Exams and Organ Donation

Introduction: Guidelines for establishing death by neurological criteria in the pediatric population recommend an observation period of at least 12 hours between two separate brain death exams. Due to a myriad of factors, the observation period is often longer than 12 hours. Patients who progress to brain death make up the majority of deceased organ donors; however, it is unknown whether the length of the observation period is associated with consent to organ donation. We hypothesize that a longer time interval between the two exams will be positively associated with the decision to donate.

Methods: This is a retrospective cohort study of patients < 18 years old declared dead by neurological criteria between 2017-2022 at Comer Children’s Hospital in Chicago, IL. The electronic health record was used to collect demographic and brain death exam data. Qualitative data was also abstracted from provider notes to better understand the timing of brain death exams and families’ decision to donate. STATA was then used to perform descriptive statistics and logistic regression (p < 0.05).

Results: 55 patients met inclusion criteria. 35 of 55 (63.6%) patient families consented to organ donation, and 20 (36.4%) patient families declined. The average time between brain death exams for all patients was 25.3+/-17.1 hours. Of those who consented to donation, the average time between exams was 23.7+/-15 hours, while those who did not consent had an average time between exams of 28.0+/-19.8 hours. African American patients represented 67.3% (n=37) of study participants and 74.3% (n=26) of organ donors. There were no statistically significant findings associated with likelihood to consent to donation.

Conclusions: In this single institution retrospective cohort study, more time between brain death exams was not associated with the decision to pursue organ donation. A shorter time interval between clinical exams may indicate a family’s acceptance of brain death and therefore willingness to consider donation. Longer time intervals may be related to grieving time and a reluctance to accept the diagnosis of brain death. Future work should focus on identifying the qualitative factors that may impact families’ decisions around donation as well as how to optimize donation discussions with a family-centered approach.