Brain Death and Family Consent

Brain Death & the deceleration:

According to THOA, 1994 “deceased person” is someone who lost all evidence of life because:

a) all functions of brain stem have permanently and irreversibly ceased;

b) or in case of cardiac arrests at any time after live birth has taken place.

Even though is a concept of the declaration of death, the idea in India is only used regarding organ donations. The idea comes more from the UK system than the one followed in most of the States in the US. The US supports the concept of whole-brain death to declare someone dead and giving the deceased a potential donor tag.

In India, legal processes guard these death declarations, which are to be fulfilled by specific doctors (neurologists, neurosurgeons, intensivists, anaesthetists and physicians of MD Level approved by the Government of India). Two different doctors are supposed to perform two different tests at intervals of 6 hours, individually and independently. After the second test, one has to approach the family of the deceased regarding organ donation. Rahul Pandit et al. tried to demystify the concept of brain death and legal procedure according to Indian legislation in their research. An NGO working in the southern part of India has also tried educating intensive care personals and the general public about the concept and exact procedure and checklist to be followed to declare someone brain dead and tag as the potential organ donor.

Brain death is commonly caused by:

1. Spontaneous intracranial haemorrhage

2. Head injuries due to motor vehicle accidents, recreational and industrial accidents, gunshot assaults.

3. Cerebral anoxia/ischemic injury (cardiac arrest due to asthma, asphyxiation, drug overdose, hanging, drowning, meningitis, carbon monoxide, poisoning or primary cardiac arrest)

4. Primary cerebral tumour

Once the brain death is declared, the next step within the organ donation process is the family consent in case the deceased has already been registered in the organ registry. Family consent is the most important aspect of the process and plays a major role in low organ retrieval rates in various countries (also India)

Regulations concerning the consent process

Explicit Consent

If the deceased at any point in his/her life has pledged his organs, to recover his/her organs consultation is required from his/her near relative.

Presumed Consent

If the deceased has never opted against donating his/her organs then to recover his/her organs affirmative consent from his/her near relative is a must.

Relatives right to veto

In the absence of explicit consent from the deceased, relatives have full power to give or revoke the organ donation consent.

The hierarchy of close family is as follows:

a nominated representative;

spouse/partner;

parent/child;

brother/sister;

grandparent/grandchild;

niece/nephew;

step-parent;

half-brother/half-sister;

friend of long standing.

This is the third article of Organ donation knowledge sharing series, the next article will focus on the impacting factors for negative family consent rates in countries like India.