Kerala is moving towards the mandatory certification of brain death at intensive care units in all medical facilities in the State, irrespective of whether organ donation takes place or not.
The government, after legal consultations, will soon issue executive orders delinking brain death certification and organ donation, so that there is more clarity as to how clinicians should proceed with intensive care unit (ICU) care in the case of a patient who has been declared brain-dead, but whose family has refused consent for organ donation.
Once brain death is diagnosed as per the existing legal and clinical requirements and the certification process is completed, ICU care will be continued only if organs are to be retrieved for possible donation.
If organ donation is not a possibility, then all care will be stopped so that the much valuable ICU resources are not wasted and may be utilised for a salvageable person.
The decisions were taken at a meeting of senior health administrators, transplant surgeons, neurologists, and critical care specialists on developing parameters for universal brain death certification here on Tuesday.
“We are separating the process of organ donation from brain death certification, so that the latter is a part of standard ICU practices and quality care norms. This will mean that once a patient has been certified brain-dead, he/she need not be kept unnecessarily in the ventilator, unless the family wishes to donate organs. This will also give an opportunity for families to choose appropriate end-of-life care options for their loved ones outside ICUs,” Rajeev Sadanandan, Additional Chief Secretary (Health), told The Hindu .
Lack of clarity
At present, there is lack of clarity on how clinicians should proceed if there is a brain-dead patient in the ICU and the family has refused consent for organ donation.
In India, brain death has been defined only in connection with organ donation, in the Transplantation of Human Organs Act, 1994.
The Act does not specify whether ventilation and ICU care may be withdrawn if a patient is brain-dead but organ donation has not been proposed.
“Once brain death declaration becomes a standard ICU procedure (after performing the first apnea test as specified under the THO Act), we can discuss with families and treatment can be terminated. Any new therapeutic ventilatory strategies will only be adopted for preserving organs for organ donation. This is the standard practice all over the world. But the lack of clarity in our law had been posing a lot of problems for clinicians. The public too was being led to believe that brain death certification is done only to aid organ donation,” Noble Gracious, Nodal Officer, Kerala Network for Organ Sharing, said.