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    Better awareness needed on brain death declaration

    Procedure of declaring brain death continues to be a blur among the public. From ensuring there is no confusion that comes up in the examination of brain stem function to conducting a complete neurological examination, there are a number of steps before a panel of doctors can declare a patient’s brain-dead.

    Better awareness needed on brain death declaration
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    Chennai

    While experts in the state Health Department allege that these steps are mandatorily followed in every hospital in the state, awareness about the procedure continues to be low.

    Stating that it becomes an issue when people who are not educated are made to believe that their family member is brain-dead without any proof, Saranya S, a health activist said, “They do not question the possibility of their family member not having actually died as they blindly believe whatever the doctors tell them and eventually agree to donate the organs of the ‘deceased’.”

    However, doctors say that the relatives know about the entire process before the topic of organ donation is brought up. “Each hospital has a transplant coordinator, who also serve as grief counsellors. After informing the family about the death, they put forth the option of the possibility of bringing a family doctor who can also be a witness,” said Dr J Amalorpavanathan, former Transtan Convener.

    “A patient is declared brain-dead by a panel of four doctors – an authorised neurosurgeon/neurologist, the head of the hospital, a medical officer treating the patient and a doctor who is not involved in the case at all and it is also ensured that every hospital in the state forms a panel to take such decisions. The relatives of the patient are explained everything from the beginning,” he added. 

    Alleging that he has never received any complaints pertaining to patients being declared brain-dead merely for organs, he added, “We ensure that the family members are given the option of brining a family doctor, or if there is a medical student or junior doctor in the family, to witness the tests that are done. It is not possible for all four doctors to forge the document certifying the patient as brain-dead.”

    Before a patient is declared brain-dead
    • Ensure that there is no confusion that comes up in the subsequent examination of brain stem function
    • Complete neurological examination is performed including the standard apnoea test 
    • Brainstem reflexes are assessed
    • Clinical observations compatible with the diagnosis of brain death are made
    • The clinical assessment is repeated to confirm the status of the patient
    • A panel of four doctors then certifies the brain death and documents it

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