The government is considering de-linking the process of brain death certification from organ donation so that the public do not perceive the former as an activity done only to aid organ donation.
This would mean that brain death certification becomes a mandatory clinical practice in intensive care units (ICUs), whether or not organ donation takes place.
The reluctance of neurologists and neurosurgeons to report and certify brain death in ICUs has been a major hurdle in the way of deceased donor organ donation in Kerala, after the government tightened the norms for brain death certification and made the procedure more stringent.
With allegations flying thick and fast about the monetary compulsions of major private sector hospitals where more brain death certification and transplants have been taking place, followed by threats of litigation and police interrogation, a deeply wounded transplant community took a step back. The result was the nosediving of deceased donor organ transplantation, Mrithasanjeevani, almost grinding to a halt in the State in the past two years.
Brain death
In India, brain death has been defined only in connection with organ donation in the Transplantation of Human Organs Act 1994. Brain death certification thus has not been mandatory in the ICUs here, unless organ donation is proposed.
The public thus perceives brain death certification as an activity strictly linked to organ donation.
In the current atmosphere of mistrust, there could be apprehensions that brain death is being facilitated so that organ donation can take place.
Recommendation
The suggestion to delink brain death certification from organ donation had been one of the main recommendations that Luc Noel, a WHO expert on Clinical Practices, had made to the government last month, after a review of Mrithasanjeevani.
“We are moving that forward. Also, we are thinking of setting up a committee to ensure that all brain deaths in hospitals, both private and public sector, are reported to the government,” Additional Chief Secretary Rajeev Sadanandan told The Hindu .
At a meeting of neurologists and neurosurgeons he convened here on Friday, a few more suggestions have been proposed to revive Mrithasanjeevani.
“First, we want government medical college hospital ICUs to improve brain death reporting/certification. Haemodynamic maintenance of a potentially brain dead patient in an ICU is an intense, full-time job, which our MCHs cannot manage, given their heavy patient load. Through Kerala Network for Organ Sharing (KNOS), we will provide these hospitals an additional ICU-trained nurse just to manage such patients,” Mr. Sadanandan said.
One problem in brain death certification faced by private hospitals was that it was difficult to get government doctors, who are mandatorily required to be on the certifying panel, to come twice six hours apart for the sleep apnoea test, often at odd hours.
The State government has now clarified that it is not necessary that the same doctor be called in for the second test.
