Govt SOPs for brain-death certification

The State government has brought out Standard Operating Procedures (SOP) for certifying irrevocable brain stem death in patients, which have to be followed mandatorily by all government and private hospitals in the State, prior to the consideration of deceased donor organ donation.

While these SOPs are already in practice in all registered organ transplant centres in the State, this is the first time that these procedures and tests for brain-death certification are being documented officially as standard guidelines that need to be followed without fail, before any person can be declared as brain dead by any hospital.

Expert committee

The government was prompted into setting up an expert committee under the Director of Medical Education to draw up these SOPs after the process of brain-death certification that was earlier being followed had been challenged in the High Court. S. Ganapathy, a physician, argued for more fool-proof measures for the same, to rule out any possibilities of manipulation or coercion to make organs available for transplant.

The SOPs thus state that the main prerequisite, before subjecting a patient to the tests for declaring brain death, is to exclude any reversible causes of coma. Intoxicants, use of neuro- muscular relaxants, depressant drugs, hypothermia, hypovolemic shock, or some endocrine disorders may induce coma which might be reversible and these should be ruled out.

Clinical or neuro imaging evidence of an acute central nervous system catastrophe which is compatible with clinical diagnosis of brain death should be established before subjecting a person to further tests for evaluating brain stem death. Assessment of brain stem reflexes should be done using a series of tests, which are to be repeated within an interval of six hours by a panel of four doctors, including a doctor attached to the State Health Service. It is mandatory that all four doctors witness these tests done six hours apart and that the procedures are videographed.

The Apnoea test is the last brain stem reflex test to be performed, and that too, only if the previous tests confirm that there are no more brain stem reflexes. If any member feels that residual neuromuscular blockade should be tested, they may perform the peripheral stimulation test, which has also been detailed in the SOP.

All four member-doctors of the brain death certifying team should sign in the relevant documents. The patient may be declared brain dead after the results of the second Apnoea test and the relatives informed, the SOP states.