‘Train docs on brain death protocol’

The city’s performance in the cadaver transplant programme is improving but there is plenty of room for improvement, say experts.

Under the programme, vital organs are harvested from patients who have been declared brain dead, after obtaining permission from their families, and transplanted on to those in need. Four city government hospitals and 21 private hospitals are currently part of the programme, run by the State government.

Two hospitals – Rajiv Gandhi Government General Hospital and Apollo Hospitals – are the top two contributors of donors. Since 2008, there have been 285 donors from Chennai, resulting in 513 kidneys, 255 livers, 57 hearts and 22 lungs being donated, according to the programme’s officials.

However, certification of brain death is still relatively low among hospitals owing to multiple factors, the primary one being a lack of awareness about the protocol among medical professionals.

For instance, last year, a city hospital accounted for 48 brain deaths, but this translated into only one donor.

“Studies show that at least 3 to 6 per cent of all deaths in any large hospital are brain deaths. At present, hospitals only certify brain death intermittently. With more certification, there can be more organs available,” said Sunil Shroff, managing trustee, MOHAN Foundation, an organisation that coordination organ donations and transplantations.

“The government should conduct an audit and ask hospitals to submit monthly data on their brain deaths,” Dr. Shroff said.

The State, as yet, has no comprehensive data on the number of brain deaths that occur per year or their cause. According to the programme’s officials though, 83 per cent of the brain deaths reported over four years were due to road traffic accidents or head injuries.

Some hospitals, experts said, just do not have the expertise to harvest organs, the facilities to maintain cadavers or transplant coordinators to talk to grieving families.

So what goes into certifying a brain death? A senior neurologist at a government hospital explained, “The patient should be unconscious and on ventilator support. The hospital should know the reason for the brain death. A neurologist should certify that the person is brain dead and a second doctor should confirm this after six hours. Then, the duo should do a confirmation test.”

“Even though there are clear-cut protocols for certifying brain death, there is a lack of awareness about them. Medical professionals need to be educated about the protocol,” said K. Sridhar, director of neurosciences at Global Hospitals.

C.E. Karunakaran, trustee of the National Network for Organ Sharing, said doctors should be motivated to certify brain deaths. “Under the present system, doctors who certify brain deaths need to be empanelled with the directorate of medical services and this, I believe, is a needless complication,” he said. There should be peer pressure from other doctors. We are encouraging a few hospitals to certify more brain deaths,” he said.

J. Amalorpavanathan, State convenor of the cadaver transplant programme said they were planning to reach out to two or three major hospitals to promote certification. “The potential for cadaver donation is 10 times higher than our current level. We need to simplify the protocol and explain the medico-legal process to hospitals,” he said.