K-SOTTO develops course on brain death, 60 doctors receive certification

Determination of brain stem death as per the standard protocol is the first crucial step which has to be completed by critical care specialists manning intensive care units in hospitals, even before the prospect of organ harvesting can be considered.

Kerala State Organ and Tissue Transplant Organisation (K-SOTTO), the apex body in Kerala which oversees organ harvesting and transplantation, has developed a structured course on brain death certification, to aid critical care specialists in determining brain death among patients with catastrophic brain injuries

The course, which has been drawn up in collaboration with the Departments of Neurology and Neuro-Anaesthesia at the Sree Chitra Tirunal Institute for Medical Sciences and Technology, is perhaps the first structured course on brain death certification in the country, which focuses on neurological criteria as a matter of standard practice in death determination in ICUs.

The course module of this one-day certification course is designed to train doctors in the accurate evaluation of cessation of brain stem activity so that brain death certification can be done in all clarity.

“World over both circulatory and neurological criteria are utilised in death determination so that there is no unnecessary prolonging of life in ICUs. Our idea is to empower the critical care specialists to take charge of ICUs, identify those patients who are brain-dead so that they need not be maintained on ventilators, prolonging the financial burden, grief and uncertainty of families,” says Noble Gracious, the Executive Director of K-SOTTO.

Brain death certification has to be an accurate and consistent standard of clinical practice in ICUs so that expensive medical resources are well-spent on patients who are salvageable. For this to happen, more doctors need to be put through brain stem death certification training programmes, Dr. Gracious says.

‘Linked’ to organ donation

In India, brain death has been defined only in connection with organ donation, in the Transplantation of Human Organs Act, 1994. Because of this, the public as well as many clinicians perceive brain death certification as a procedure that has to be done only if there is a possibility of organ donation happening. Doctors have no clarity whether brain stem death certification should be done as a matter of routine in ICUs, when it comes to patients who have suffered catastrophic neurological damage.

In 2019, the Kerala government put an end to the ethical dilemma faced by doctors by issuing a GO, which de-linked the process of brain stem death declaration and organ donation. The GO set forth the guidelines for brain death certification in ICUs and made it clear that once a patient has been pronounced brain-dead as per the protocol, all treatment, including cardio-respiratory support be discontinued. The prospect of organ donation comes only later, depending on the wish of the family.

Inaugurating the workshop on the brain death certification course here on Thursday, the Additional Chief Secretary (Health), Rajan Khobragade, said that the course was intended to empower ICU doctors so that brain death certification becomes a standard clinical practice in ICUs, regardless of whether organ donation takes place or not .

The first batch had 60 doctors from all across the country.

The one-day brain death certification course workshop was organised by K-SOTTO on the sidelines of the 26th annual conference of the Indian Society of Neuroanaesthesia and Critical Care (ISNACC) being held here from January 24 to 26.