Indian law on the determination of brain stem death is clear that the declaration of brain stem death means declaring a person to be dead, both clinically and legally. Now delves into the intricate topic of brain death in this insightful article, shedding light on its significance and implications.
What is Brain Death and How Do We Define It?
The definition of brain death is the cessation of all brain activity due to a lack of oxygen to the brain cells. Brain cells are the only cells in the body that cannot regenerate. So if there is a lack of oxygen due to any cause, the cells will die within 3 minutes. So any hypoxic event, which is also known as lack of oxygen, can lead to brain death.
Causes of Brain Death
Brain death can happen when the blood or oxygen supply to the brain is stopped.
This can be caused by:
- Cardiac Arrest – when the heart stops beating and the brain is starved of oxygen
- Heart Attack – when the blood supply to the heart is suddenly blocked
- Stroke – when the blood supply to the brain is blocked or interrupted
- Blood Clot – a blockage in a blood vessel that disturbs or blocks the flow of blood around your body
Brain Death Can Also Be Caused by
- Attempted hanging
- Head injuries
- Spinal injuries
- Other conditions require hospital stay, which leads to a decrease in the oxygen that is going to the brain.
Reasons People Go Into Brain Death.
We hear many stories that appear in the newspapers or on the TV regularly stating that there was a patient who was declared dead in the hospital and woke up in the mortuary or at the cremation ground, these are not untrue.
The reason is most of these patients had some metabolic or other reason that caused the heart to stop or become so faint that it was not detected and when that metabolic condition resolved, the patient became conscious again and started moving around. So do not confuse it with brain death, brain death if it occurs is irreversible, and the patient will never come back.
Now We Come to the Diagnosis. How Do We Diagnose a Patient With Brain Death?
The best thing is in India there was this law passed, which was also known as The Human Organs Act 1994, and in this act,
- The definition of brain death
- How to diagnose brain death
- What can be done legally in patients with brain death was properly defined.
We use only and only clinical acumen to diagnose brain death. The first thing is we assess the neurological condition whether the patient is conscious or unconscious and how deep the unconscious level is.
- There is a scoring system known as GCS, and it has to be at the absolute minimum of that score to even qualify for consideration for brain death testing.
- The second thing we test is the pupils of the eyes and we see whether they are fixed and dilated.
- The third thing we see is spontaneous respiration. Because most of these patients are on ventilators, it is important to see whether besides the ventilator, is the patient taking his breath or not.
- We see certain reflexes like the cough reflex, corneal reflex, and gag reflex to see if these are still present because these are the last things to go in a patient who is dying.
- Finally, we test for breathing in a different way, which is known as the apnea test, so that if we stop the ventilator, is it possible that after 5 minutes or 10 minutes, the patient again starts breathing or not?
These tests are done by a neurologist or a neurosurgeon and have to be done 6 hours apart.
And if both times it shows the same result, the patient can be declared brain dead. Now, a very important thing to know is the patient’s heart will still be beating normally and this is the enigma. So a patient’s heart is still beating, but the brain is dead. A neurosurgeon or a neurologist has said that the patient is brain dead. It is almost equivalent to seeing that the patient is dead. However, because of the limitation in Indian law, we obviously cannot just declare the patient dead and send him to the crematorium with a beating heart. So that is why we wait till the heart also stops beating.
A Lot of People Have Asked That If the Heart is Still Beating, Why Are You Declaring the Patient Dead?
It is very difficult to explain to all that heart beating is now not considered as important as the brain works. The brain is the most critical organ, and if it stops working, then other organs take some time before they stop. And especially in today’s age and date when we have life support equipment like ventilators, and cardiopulmonary bypass equipment, then we can keep the patient’s heart beating, and breathing continuing without the patient himself doing anything. This is why it is important to know the difference between brain death and cardiac death.
Why is It Important to Diagnose or Certify a Patient With Brain Death?
The most important thing is that then this patient can be eligible for organ donation. As we know, the most common causes of brain death are patients with head injury or spinal injury or from hanging most of these patient groups as they young males and some females between 18 years and 30 years. So these are the patients who are best suited for giving their organs to someone else.
India has the worst organ donation rate in the whole of the world, and that is because there are so many concepts around giving organs, including religious concepts, stigmas, including people who just do not believe that the heart is beating, but the brain is dead. So the patient is dead.
We try and educate, but the final education has to come from within because of the legal sanction to diagnose brain death and to confirm that this patient is dead from the brain side, what we do is if their relatives agree to organ donation, and that is an entirely different story altogether and we feel that the patient is ready to give his organs and we have the recipient ready also and then only is the time that the law allows a doctor to pronounce the patient dead. So the patient might still be alive in the sense that his heart is beating. But this time we can make a death certificate and pronounce him dead.
Having an arbitrary time when he is being shifted to the operation theater to have his organs taken out.Then the organ donation team, which consists of surgeons like the kidney surgeon, the lung surgeon, and the surgeons who remove other organs. They come together and take out the organs of the patient.
After that, the body is again stitched up and sent to the mortuary, and the organs are given to the recipients which are available at that time. I hope you understand a little bit more about brain death, its diagnosis, its implications, and how it helps us to have the organs donated to people who are waiting.
As we know, in India there are so many patients with kidney disease, lung disease, and cardiac problems who are waiting for organs from other patients to help them live longer. So we all have to think as a society, although I know anybody having a brain death is not a good thing, certain things are not in our hands.
Only thinking out of hand is to prevent. Prevent what? Prevent head injuries by wearing helmets, even driving, so that you do not end up in an accident in a hospital in a state like brain death.