What is Brain Stem Death and how is it related to organ donation?

A brain stem death results from a severe irreversible injury to the brain or haemorrhage which causes all the brain activity to stop. All areas of the brain are damaged and no longer function, due to which a person cannot sustain his/her own life, but vital body functions may be maintained by an artificial support system. This maintains circulation to vital organs long enough to facilitate organ donation. Patients classified as brain stem dead can have their organs surgically removed for organ donation.

A Brain stem Dead person has absolutely no chance of recovering. Brain stem death is a form of death and is irreversible. To know more about Brain Stem Death, please visit the following link to a short clip and an easy to understand movie giving insights on what is brain stem death https://www.youtube.com/watch?v=i8kz_ONWHUE

Once brain stem death has been declared, the person is dead but their organs are still alive because they have been kept alive through artificial means. This means that if a person dies at home or anywhere else, and their heart stops beating, they cannot donate their vital organs, because the organs of a person who has died a cardiac death will die within minutes of the heart stopping. Therefore, the only time you can donate your vital organs is if you are in hospital and have been declared brain stem dead.

In case of a cardiac death it is possible to donate your corneas and tissues such as bones, skin, veins, blood stem cells, blood and platelets, tendons, ligaments, heart valves, cartilage and even your body.

While the incidence of brain stem death is obviously less common than cardiac death, it is important to remember that organ donations will take place only if everyone is aware about when and how they can donate organs.

Procedures for Brain Stem Death Declaration in India

According to the provisions of the Transplantation of Human Organs & Tissues Act, THOTA 1994 the protocol for declaration of brain stem death has been defined. Any organ donation process must involve the following steps before the actual transplant can occur:

Panel of 4 doctors need to declare the brain stem death twice in a span of 6 hours. Two of these doctors must be from a panel approved by the government. This panel includes:

1. Registered Medical Practitioner in charge of the Hospital where brain stem death has occurred.
2. Registered Medical Practitioner nominated from the panel of names sent by the hospitals and approved by the Appropriate Authority.
3. Neurologist/Neuro-Surgeon (where Neurologist/Neurosurgeon is not available, any Surgeon or Physician and Anaesthetist or Intensivist, nominated by Medical Administrator In-charge from the panel of names sent by the hospital and approved by the Appropriate Authority shall be included).
4. Registered medical practitioner treating the aforesaid deceased person. The same is recorded on Form 10 of the THO Act 2014. The family’s consent is obtained on Form 8. Healthy organs are transplanted from the body of the patient as soon as possible.

The certifying clinicians must have no interest or benefit in any way from transplantation of cadaver donor organs. The legal time of death in these circumstances is taken as the second set of brain stem death tests. The certification should be done on laid out forms as per the act. The medical director or medical superintendent of the hospital should finally countercheck and sign the form. It is only after these formalities have been completed, should organs be retrieved.