*Purpose: The diagnosis of brain death in adults has historically required two brain death examinations (TBD) before considering organ donation. Despite American Academy of Neurology recommendations that a single brain death examination (SBD) is sufficient to determine brain death, a vast majority of hospitals still utilize a TBD policy. The purpose of this study was to investigate whether a SBD policy is associated with shorter time to brain death declaration and improved organ donation outcomes.

*Methods: We retrospectively reviewed all adult patients declared dead by neurological criteria between 2010 and 2018 at Grady Memorial Hospital, a Level 1 trauma center. We identified eligible patients from our organ procurement organization registry. The study population was divided into TBD (2010-2014) and SBD (2015-2018) cohorts following a change in brain death policy in 2014. Primary outcomes included time to organ donation, terminal donor creatinine and bilirubin, organ donor rates (ODR: organ donors/total eligible donors), and total organs procured. We compared continuous outcomes with student t-tests and categorical variables with chi-square tests; multivariable linear regression controlled for age, gender, and admitting service.

*Results: A total of 327 patients comprised the study population: 66.7% SBD (n=218/327), 33.3% TBD (n=109/327). Both had similar demographics and injury characteristics. The SBD group had a shorter median time from brain death examination to organ procurement (38 vs 44 hours, p=0.02) as well as lower terminal donor creatinine (1.1 vs 1.35 mg/dL, p=0.004) and bilirubin (0.8 vs 1.1 mg/dL, p=0.04). On multivariable regression, TBD was associated with longer time to organ procurement (β 5.35, 95% CI 0.74-9.97, p=0.023) and greater terminal creatinine (β 0.82, 95% CI 0.33-1.32, p=0.001). Although there was no significant difference in overall ODR between SBD and TBD (59.2% vs 55.1%), the SBD group had a significantly greater proportion of kidneys (90.6% vs 81.6%, p=0.02), lungs (11.8% vs 4.6%, p=0.02), and total organs (58.2% vs 46.6%; p=0.001) procured. On multivariable regression, SBD was associated with an increased number of organs procured (β 0.28, 95% CI 0.03-0.58, p=0.031) compared to TBD.

*Conclusions: A SBD policy is independently and significantly associated with a shorter time to organ donation, lower terminal donor creatinine and bilirubin, and a greater number of organs procured.

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