The Centre has asked states to ensure that hospitals and medical institutions under their jurisdiction follow the national guidelines for Brain Stem Death (BSD) certification. It is meant to bring in a uniform and transparent system of brain stem death declaration and to enhance deceased organ donation and transplantation services in India.
The national guidelines, launched in August, are being marketed as a first-of-its-kind framework to standardise the certification of brain stem death across the country. The guidelines aim to establish an evidence-based and legally standardised approach so that hospitals follow consistent procedures when deciding whether a patient has suffered irreversible loss of brain stem function.
According to Dr Anil Kumar, Director of the National Organ and Tissue Transplant Organisation (NOTTO) under the Union Health Ministry, states have been urged to direct hospitals and institutions in their respective jurisdictions to implement the guidelines. More implementation of the framework would help to increase the number of deceased organ donors in India.
The push is also coming against the background of the relatively low contribution of deceased donors to India’s organ donation pool. While brain-dead patients constitute the bulk of organ donors in several Western countries, deceased donation in India presently represents only 5-6% of organ donors. It is the authorities who think the more systematic way to find and certify brain stem death could help bridge this gap.
The successful implementation of deceased organ donation requires the timely and accurate identification of potential donors. Certification should be conducted through a transparent and medically rigorous process, officials have said. Standardised procedures can also help establish more confidence for families at a very difficult time, and ensure clinical assessments are conducted in line with established legal and ethical safeguards.
Brain stem death (or brain death) is when the brain stem stops functioning completely and irreversibly. Unlike in some cases where the patient can remain unconscious and have some brain activity, brain stem death is irreversible. Once a person has been declared brain stem dead under the legal and medical framework, there is no way for them to recover.
The new national guidelines outline the process that medical professionals have to follow when certifying brain stem death. The board of four doctors, as defined in the Transplantation of Human Organs and Tissues Act, can certify brain stem death after performing the necessary clinical exams.
In adults, the prescribed clinical tests are conducted twice, with a minimum of six hours of time between the two sets of tests. This repeated assessment is intended to ensure that the diagnosis is made carefully and consistently before brain stem death is formally certified.
The guidelines are also important because deceased organ donation can potentially help several patients awaiting life-saving transplants. A single deceased donor can save up to eight lives through organ donation while donated tissues can improve the quality of life for many more recipients. Some organs—such as the heart and lungs and even tissues, like the cornea—can only be provided by deceased donors.
India continues to experience a huge gap between the demand for organs and their availability. Living donation is important for transplantation, but it is not enough to cover all the organs. Increasing deceased donation is considered to be an important part of the country's transplant capacity.
The Centre is also asking states to ensure that hospitals follow the national brain stem death certification protocols, which is to say that it wants more consistency in medical practice across the country.
Increasing awareness, early identification of potential donors, and adherence to recognized certification procedures for organ donation will help build public confidence in the organ donation system, officials say.
The implementation of the guidelines will ultimately depend on collaboration between state health authorities, hospitals, transplant professionals and organ donation organisations. With more adherence to the standardised framework, authorities expect more hospitals to participate in deceased organ donation and help make more organs available to patients waiting for transplants.
