The government has set up a five-member expert committee to draw up the processes and guidelines for universal brain death certification in intensive care units in hospitals in the State, so that clinicians have a clear way forward when it comes to managing patients with grievous brain injuries, who are not likely to recover.
Kerala’s move to delink brain death certification and organ donation and to make brain death certification mandatory in all cases where neurological death has been confirmed comes in the wake of sincere attempts by the government to revive the once-robust Mrithasanjeevani, its deceased donor organ donation programme.
Delinking brain death and organ donation could clear any apprehension in the minds of the public that brain death declaration is a process done only to aid organ donation, it is hoped.
Members
The five-member committee constituted by the Health Department includes Thomas Iype, Head of Neurology, Government Medical College, Thiruvananthapuram (GMCT) as convenor; K.V. Sohan, State Attorney; Muraleedharan Nair, Head of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST); Mathew Abraham, Head of Neuro Surgery, SCTIMST, and Sathish Chandra, Neuro Surgeon, GMCT.
The modality of brain death certification has already been set in the Transplantation of Human Organs Act (THOA)1994.
The committee will now develop the parameters for universal brain death certification in cases where patients have irrevocable brain injuries.
Concept
In India, the concept of brain death is only defined in the THOA in connection with organ donation. Hence, brain death certification is not mandatory in the ICUs here, unless it is to aid organ donation.
No clarity
There is no clarity in the law at present as to how clinicians are expected to proceed in managing a brain-dead patient in the ICU, if the family does not wish to donate organs.
Keeping such patients for prolonged periods on life support, just because of the want of clear guidelines, causes unnecessary agony to families and is a strain on scarce ICU resources, especially when there are other lives that might be saved.
In all developed countries, mandatory brain death certification is a norm in cases where irreversible brain injuries have occurred.