Kerala becomes first state to issues brain death certification guidelines

Kerala : The health ministry department of Kerala, on Saturday, has come up with standard operating procedure in the backdrop of the increasing tension over possibilities of manipulation or compulsion to make organs available for transplant process. For now, Kerala has become the first state to approve a standard operating procedure (SOP) for determining brain death cases.

As per the health ministry, all the government and private hospitals in the state will have to abide by the guidelines for organ donation from the deceased 

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 standard operating procedure also states that the 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, then medical team can begin the steps to determine the possibility of brain death.

To determine brain death, the doctor 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 declare if the patient will be able to breathe by himself/herself at any stage in future.

If any doctor 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 immediately to the relatives of the patients. All four members of the team should sign the brain dead certificate collectively.

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

These recommendations have been divided into three stages.

Stage 1: Precautions to be taken for declaring one brain dead

Stage 2: Analyses of reflective actions of brain,

Stage 3: Apnea tests.