Brain Death Certification Under Supreme Court Review

Context

Brain death is the irreversible cessation of all brain activity, including the brainstem, rendering a person legally dead despite artificial support maintaining heartbeat and respiration. The Supreme Court is considering certification procedures under the accusation of malpractice, namely that patients are proclaimed dead in the brain to receive an organ transplant without undergoing the required, videotaped tests, which raises questions about the effectiveness of existing apnea tests. 

What is Brain Death?

• Definition: The complete and irreversible loss of all brain functions is known as brain death. It is regarded as synonymous to legal death in India and most of the other nations, even when the heart of the individual is still beating through a ventilator. 
• Irreversibility: It is essential to determine the difference between this and a coma or a persistent vegetative state (PVS), where a patient can recover. In brain death, the brainstem, which controls vital functions such as breathing, can no longer function. 
• Diagnosis (The Apnea Test): A team of physicians examines a deep coma, lack of brainstem reflexes, and failure to breathe autonomously. This test is supposed to be performed twice, separated by a duration of six hours and the process must be videotaped as required by the law.

Reasons Supreme Court Review

The protocols are under review by the Supreme Court after a petition by a doctor-activist alleging manipulation in the process. 

• Challenging Existing Procedures: The petitioner claimed that the apnea test, which concludes that brain death is the inability to breathe without a ventilator, is subjective and not foolproof. 
• Malpractice charges: Malpractice charges were filed, alleging that videography of the mandatory apnea test is often disregarded. 
• Organ Donation Pressure: It is feared that brain dead patients are not necessarily those who are brain dead but are improperly tested to have organs extracted. 
• Reliable Tests required: The Supreme Court is asking the AIIMS to give expert opinion to evaluate more solid, objective tests, say a brain angiography or EEG, to verify that the blood flow and brain electrical activity have stopped. 

Regulatory Framework and Concerns

• Transplantation of Human Organs Act (THOA), 1994: The act stipulates that brain stem death has to be certified by a board of four doctors, including specialists.
• Non-Compliance: The petitioner asserted that the certification form, Form 10 is usually signed in the doctor rooms without a bedside examination, and the cases of possible brain deaths are on the increase. 

Way Forward

The action by the Supreme Court to include an expert committee of AIIMS is to bolster the certification procedure to make it scientifically sound and transparent. This is paramount in ensuring that the system of organ donation is not exploited by people who have no trust in it, as it is against medical ethics. 

Source: The Indian Express

UPSC Prelims Practice Question 

Q. Consider the following statements regarding ‘Brain Death’ certification in India:

1. Under the Transplantation of Human Organs and Tissues Act (THOTA), 1994, brain death is defined as the irreversible cessation of all brain activity, including the brain stem.
2. The certification of brain death requires a panel of four doctors, and the apnea test must be mandatory videographed.
3. According to current mandated protocols, a EEG or cerebral angiogram must be conducted to certify a patient as brain dead. 

Which of the statements given above is/are correct?

A) 1 and 2 only
B) 2 and 3 only
C) 1 and 3 only
D) 1, 2, and 3

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