Kerala issues brain death certification guidelines, first state to do so

Kerala has become the first state to adopt a standard operating procedure (SOP) for determining brain death cases.

All government and private hospitals in the state will have to follow these guidelines for organ donation from the deceased.

The state health ministry on Saturday formulated an SOP in view of the rising concern among the public over possibilities of manipulation or coercion to make organs available for transplant.

According to the SOP, a medical board comprising four doctors — at least one should be from the government service — will be authorised to declare a patient brain dead. As per the Transplantation of Human Organ Act, two experts are required for brain death certification.

The SOP also stated that the main condition for declaring a patient brain dead would be that he/she is 100% out of reversible cause of coma. To check any misuse, the SOP defines brain dead and state of coma in detail.

“Coma is a state of unconsciousness triggered by a damage to a particular nerve of the brain. But the brain death is a state of permanent destruction of brain cells caused by excessive bleeding in brain,” said the SOP.

The use of intoxicants, neuro-mascular relaxants, depressant drugs, hypothermia or some endocrine disorders may induce coma which may be reversible and these should not come under the ambit of brain dead, it said.

Only when a patient is in coma and on ventilator support can the medical team initiate steps to determine the possibility of brain death.

To determine brain death, the team should perform Apnea test twice six hours apart. The aim of Apnea test is to establish death of the respiratory centre in the brainstem. The test results will show if the patient can breathe by himself/herself at any stage in future.

If any member of the team feels that residual neuro-masular block should be tested, they may perform the peripheral stimulation test, the SOP said.

After the first round, there is another round of Apnea, and all results of the procedure should be communicated to the immediate relatives of the patients. All four members of the team should sign the brain dead certificate unanimously.

The guidelines prepared by a team of expert doctors are based on international recommendations on brain death.

These recommendations have been divided into three parts — first, precautions to be taken for declaring one brain dead, then, analyses of reflective actions of brain, and finally, apnea tests.