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Kerala issues norms to decide brain dead cases

As per the guidelines, a medical board comprising four doctors, including one in government service, will be the competent authority to declare a patient brain-dead. For determining brain death, the team should perform apnea test twice with an interval of six hours.

Updated On Apr 8, 2018 at 06:16 PM IST

THIRUVANANTHAPURAM: The Kerala government on Saturday issued a set of guidelines to confirm brain death cases, thereby becoming perhaps the first state in India to put in place a standard operating procedure (SOP) in this regard. The guidelines will be applicable to all government and private hospitals in the state.

The guidelines have been issued in the backdrop of prevailing concerns among the public about brain death and organ donation. "A patient will be declared brain-dead only if there is no chance for him/her coming back to life. A series of scientific procedures will help us confirm brain death," said health minister KK Shailaja.

As per the guidelines, a medical board comprising four doctors, including one in government service, will be the competent authority to declare a patient brain-dead. The guidelines, modelled on international recommendations, have been divided into three stages - precautions to be taken before tests to determine brain death, analysis of reflective actions of brain and apnea test (known as sleep test). The guidelines also distinguish between brain death and state of coma. "Coma is a state of unconsciousness caused by damage to particular nerves of brain. Brain death is a state of permanent destruction of brain cells caused by excessive bleeding in brain," define the guidelines. The norms say only if a patient in coma is having ventilator support, steps to determine possibility of brain death can be initiated.

For determining brain death, the team should perform apnea test twice with an interval of six hours. The results will determine if the patient can breathe by himself/herself at any stage in future.

If there is little chance of resuming breathing, legally and scientifically the patient can be declared brain-dead and procedures for harvesting his vital organs can be initiated after relatives' nod. The procedures should be recorded on Form 10 of Transplantation and Tissue Rules 2014 and all four doctors on the board should sign on the form.