NEW DELHI: Even as the Supreme Court has stepped in to examine how brain death is certified in India, asking for an expert committee from AIIMS to weigh in on whether additional tests such as electroencephalogram (EEG) and angiogram are needed, experts say these may not be necessary as existing protocols already have adequate checks and balances.Hearing a petition alleging malpractices in brain death certification, a two-judge bench said it would seek expert opinion from AIIMS on the safety and viability of such tests. The court asked the head of AIIMS’s neurology department to constitute a committee, which, according to sources, is yet to be formed.The plea, filed by Kerala-based medic and activist S Ganapathy, alleged that patients who may not be brain dead are sometimes declared so to facilitate organ donation. It also questioned the reliability of the apnea test—the standard method used to confirm brain death—calling it subjective and claiming that the legal requirement of videographing the procedure is often not followed.Under the existing legal framework, brain death certification follows a strictly defined protocol. Dr Manjari Tripathi, head of neurology at AIIMS, said the process is governed by Form 10 under the Transplantation of Human Organs and Tissues Act, 1994. “Brain stem death has to be certified by a panel of four independent doctors, including a neurologist or neurosurgeon, and confirmed twice with a minimum gap of six hours. The process is carried out with due diligence and seriousness,” she said.Experts said additional tests could add to the system burden. EEG is not routinely recommended for brainstem death certification, while angiogram is used only in select cases where the apnea test cannot be performed. Globally, the apnea test remains the gold standard. These criteria are clearly laid down and cannot be altered, said experts. Brain death is the irreversible loss of all brain function, including the brainstem; while the heart may continue to beat on life support, the person cannot breathe or regain consciousness and is medically considered dead, unlike in coma where some brain activity remains.The court’s move comes amid a persistent gap between potential and actual organ donation. Despite a large pool of potential donors, only about 1,100 deceased donations take place annually in India, or 0.77 per million population.A recent multi-institutional study, including researchers from AIIMS Delhi, Dr Deepak Gupta, found fewer than half of doctors had formal training in brain death certification and flagged inconsistencies in clinical practice, leading to under-recognition of eligible cases. These gaps often result in “silent brain deaths”, where patients meet criteria but are not formally declared, eliminating the possibility of organ donation.
