Pledging of Organs Following Brain Death Has Risen Markedly

by Medindia Content Team on Oct 8 2007 5:37 PM

Delhi is finally accepting that brain death is irreversible. Official figures of AIIMS’s Organ Retrieval Banking Organisation (ORBO) reveal that in the past five years, more than 7,000 people have pledged to donate their entire body if they ever become brain dead.

The number of such donors is steadily rising in the city. While only 671 made the pledge in 2005, the number stood at 1,681 in 2006. This year, 2,323 people have so far made the ‘brain-dead-whole-body’ pledge, vowing to give away all organs that can be donated if they are brain dead.

According to Dr Ashish Suri, neurosurgeon at AIIMS, the increasing trend of brain death donation is vital for India, which is facing a severe shortage of organs needed for transplants. After natural death, only a few tissues like cornea, bone, skin and blood vessels can be donated whereas almost 37 different organs and tissues can be donated after brain death, Suri said. These include vital organs like heart, kidneys, liver, lungs, pancreas and lungs.

Brain death usually results from a severe brain injury or haemorrhage that causes all brain activities to stop although other vital organs continue to function, some with the help of machines. Medically and legally, a brain dead person is dead but the state can be confusing for his family members.

Since a brain dead person on a ventilator seems alive with the heart still beating, the family harbours hope that the patient’s condition will improve.

Even though India legalised the concept of brain death way back in 1994 through the Transplantation of Human Organs Act, which facilitated organ procurement from brain-dead donors whose heart was still beating, the concept failed to appeal to people for want of awareness.

Suri said: ‘‘One whole-body donation can help over 40 needy patients. Indians were slow to accept brain death as the end of human life. They think the patient has hopes of recovery till his heart beats. But the idea of brain death is now picking up.’’ He added that some organs can only be saved for transplant while blood circulates through them. ‘‘The moment blood circulation stops, except for kidney and cornea, no other organ can be used.’’

Dr Aarti Vij, associate professor at AIIMS and in-charge of ORBO, said: ‘‘Religious belief — a notion that the patient will be born without the donated organs in his next life, lack of awareness, fear of disfigurement, apprehension of organ trade and family objections have been the main cause for the low rate of organ donation.’’ According to the brain death registry maintained by ORBO, while some have pledged their organs for medical research, most have agreed to donate them for use on other patients who need transplant of vital organs to survive.

Patients who are brain dead suffer from complete and irreversible loss of all brain functions and are clinically and legally dead. Mechanical ventilation and medications keep their heart beating and blood flowing to their organs. ‘‘There is respiration, body warmth and heart movement because the ventilator pushes oxygen and air into the lungs, making the person’s chest rise and fall. Families must realise there is no recovery from brain death,’’ Dr Vij said.

According to experts, the defibrillator used to shock a heart may get it functioning again within the first several minutes after it stops. But there is no such method to jump-start or revive a brain that has been deprived of blood and whose cells have died.

Modern medicine and technology can maintain bodily functions (except brain function) for painfully long periods of time with one recorded case of brain death lasting 45 days before the heart and kidneys failed to respond to artificial life support measures.

Two French physicians in 1959 first recognised brain death on patients being ventilated in ICUs and called it coma depasse (a state beyond coma). In 1968, an ad hoc committee of Harvard Medical School defined brain death as irreversible coma. India has 3 million patients with end-stage renal disease requiring a renal replacement. Only 2,500 get it. Nearly 50,000 individuals require cornea and more than 2.5 lakh die of liver disease annually. Living donors satisfy only a fraction of the demand, experts say.

Kiss Of Life

In 2005, 671 people pledged to donate entire body in case of brain death.

The number rose to 1,681 in 2006. So far, 2,323 people have made the pledge in 2007.

After natural death, a few tissues like cornea, bone, skin and blood vessels can be donated.

37 different organs — including heart, kidneys, liver, lungs, pancreas and lungs — and tissues can be donated after brain death.