THIRUVANANTHAPURAM: Despite a clear government directive to the contrary, hospitals are increasingly keeping brain-dead patients on ventilators in intensive care units (ICUs) longer than necessary, creating a heavy financial and emotional burden on families.
The 2020 directive made brain death certification mandatory and barred the treatment of such patients. However, in 2024, there were just 10 brain death certifications when nearly 4,000 people died in road accidents. This suggests that many patients who should have been declared brain-dead, in line with the World Health Organisation (WHO) definition ‘irreversible cessation of brain and brain stem function’, are being kept on life support unnecessarily, health experts point out.
The families of these patients are often the most affected by “futile care” — providing treatment when recovery is impossible — in both private and public hospitals. Some have spoken out against it, feeling that it leads to unnecessary financial strain and false hope from hospitals. Now, health experts are also raising concerns about how this practice harms not just the patients’ families but the organ donation process, which could save lives.
The Kerala State Organ and Tissue Transplantation Organization (K-SOTTO), responsible for managing organ donations, has seen a decline in donations from brain-dead patients. One reason for this is that doctors qualified to declare brain death are often hesitant, fearing legal repercussions.
“The process of certifying brain death has stalled even though road accident fatalities remain high,” K-SOTTO executive director Dr Noble Gracious told TNIE.
“Were the certification process improved, organs from at least 20-30% of these patients could have been used to save the lives of others with the consent of the victims’ families. It’s important to note that all organ donations last year were made with family consent.”
A recent ruling from the High Court, on February 10, may help address these concerns. The court dismissed a case filed by S Ganapathy, who challenged the validity of the concept of brain death.
“The verdict is likely to strengthen doctors’ confidence in declaring brain death,” says Dr Gracious.
“We submitted an affidavit to the court, affirming that we consider brain death to be death. This isn’t just about organ donation, but about a routine standard of care that should be followed in ICUs.”
The state government order mandated that brain death be declared if certain criteria are met, and that all treatment, including life support, must stop once brain death is confirmed. But futile care continues.
The practice of futile care not only misuses valuable resources but also deprives other patients of essential care in crowded tertiary hospitals. Dr Easwar H V, a professor of neurosurgery at the Sree Chitra Tirunal Institute of Medical Sciences in Thiruvananthapuram, raised this concern during his involvement in a case to defend the concept of brain death in India.
“If a patient who has irreversible brain damage is kept on life support indefinitely, it will prevent other patients from getting the necessary treatment they need,” he argued in court.
To support doctors, K-SOTTO has over the past year trained around 200 medical professionals in both government and private hospitals to become experts in brain death certification.
WHAT IS BRAIN DEATH?
Brain death is when a person’s brain stops working completely and cannot be fixed, even with treatment. This means the brain no longer controls any bodily functions, like breathing or heartbeat, and the person cannot recover. Although the body may still be kept alive for a while with machines, the person is considered dead because the brain is no longer functioning.
Highlights of Government Order, 2020
Brain stem death is also considered death under the Registration of Births and Deaths Act, 1969.
Issues with prolonging the lives of brain-dead persons on ventilators
Mistreatment of the dead, deprivation of dignity, provision of false hope with resultant distrust, prolongation of the grieving process, undermining the professional responsibility of the physician, harm arising from a negotiated standard of death determination.
Process
Panel of experts to conduct tests to assess brain stem reflexes twice, with a minimum interval of six hours between the tests
The expert committee must declare the patient dead if the criteria of brain stem death are met
The family members shall be provided the confirmation report signed by all four members of the certifying team
All treatment support must be discontinued after the declaration