Thiruvananthapuram: Kerala has become the first state in the country to bring out specific government guidelines for brain death certification. The guidelines have been framed as per the High Court direction to remove doubts and apprehensions among people about declaring a person as brain-dead. Health Minister K.K. Shailaja said the guidelines were aimed at declaring a person as brain-dead after confirming through scientific and medical tests that there is no possibility of the patient returning to life. The guidelines adhere to all international standards which will be mandatory for all government and private hospitals in the state.
Three steps mandatory for brain death testing:
Step 1: The most important step before subjecting a patient for stem death testing is to rule out any reversible causes of coma. Establish irreversible and proximate cause of coma, exclusion of reversible cause of coma.
Step 2: Assessment of brain stem reflexes. Two sets of tests are required to be done, the minimum time interval between the first and second testing will be six hours in adults. In case of children between age 6-12 year, 1-5 years and infants’ time interval shall increase depending on the opinion of brain stem death certifying experts.
Step 3: Apnea test, the process for testing the respiratory system to hypercarbia (apnea test) should be the last brain stem reflex to be tested and should not be performed, if any, if the preceding test confirms the presence of brain stem reflex. Informed written consent is to be obtained by treating doctor. Preparation for apnea test: First apnea test should be performed only after 4 hours of coma associated with absence of brain stem reflexes, in case of anoxic brain damage, this period should be extended to 12 hours. The physician involved in certifying brain death shall be present during ventilator removal to attest the presence of apnea if found .
Apnea test should be aborted if the patient develops hypotension or significant cardiac arrhythmias. When to abandon the certification process: Rather than ordering ancillary tests, physicians may decide not to proceed with the declaration of brain death if clinical findings are unreliable. Documentation of brain stem death; ensure the all data is entered in Form10, ensure signatures of all four doctors and the date, time of brain stem death is documented in medical records, including Electronic Medical Records. The presence of a government doctor is mandatory for brain death certification. After the second apnea test and certification of brain death, the relatives of the patient should be briefed about all the test results.
