Brain Death Certification in India & EEG and Angiogram

News: The Supreme Court of India is seeking expert opinion from AIIMS on using EEG and angiogram in brain death certification.

About Brain Death Certification in India

• Brain Stem Death:
  • Definition: Brain death or brain stem death is an irreversible condition where all brain activities, including automatic functions such as breathing, completely cease, even though the body is maintained on life support systems.
  • Cause: It is mainly caused by severe injuries such as road accidents and falls that cut off oxygen supply to the brain, leading to permanent loss of brain function.
  • This condition is crucial for organ donation as organs such as heart and lungs can be donated.
• Legality: Brain death certification in India is primarily governed by the Transplantation of Human Organs and Tissues Act, 1994.
• Guided by: The process of brain death certification is guided by the National Organ and Tissue Transplant Organisation (NOTTO).
• Protocol of Brain Death Certification:
  • The Medical Board: A four-member board including hospital in-charge, neurologist or neurosurgeon, and treating physician certifies brain death.
  • Mandatory Testing: Doctors must identify the cause and rule out reversible conditions like drug use, hypothermia, or metabolic imbalance.
  • The Apnea Test: It checks if the patient can breathe independently, though it is considered subjective and not always properly videographed.
  • Repetition: Brain death must be confirmed at least twice with a 12-hour interval.
  • Concerns: Lack of training among doctors and inconsistent protocols reduce proper certification and organ donation.
• Role of EEG and Angiogram:
  • EEG: Electroencephalogram (EEG) is a test that records electrical signals in the brain using small electrodes attached to the head, and in a brain dead patient, it shows absence of any electrical activity.
  • Angiogram: Angiogram is a test that uses contrast dyes and X-rays to examine blood flow in the brain, and in a brain dead patient, it shows that blood flow to the brain has completely stopped.