Goa Medical College plans policy review, to take brain dead off ventilators

GMC plans policy review, to take brain dead off ventilators
Preetu Nair | TNN

Panaji: Goa Medical College and Hospital may soon take patients who have been declared brain dead but are on ventilator off the apparatus so that the machine can be given to a patient with higher chances of survival. Doctors feel this could make the difference between life and death for critically ill patients.
Doctors at GMC admit that a review of the policy on ‘brain stem dead patients’ is in the offing. “At present, we keep such patients on ventilator till death is caused due to cardio respiratory failure. When a brain dead person is on ventilator, another patient who can definitely improve if put on ventilator in time is denied the facility,” said GMC dean Dr V N Jindal.
At any given point of time, there are at least seven critically ill patients admitted at GMC’s ICU, of which about a third go through the process of brain death. “Every week, we get at least one patient who stops responding during the course of treatment and becomes brain dead. But treatment is continued till the patient has a cardiac arrest so as to certify him or her dead,” said Dr Ponraj Sundaram, neurosurgeon at GMC.
“It is often difficult to convince the layman that a brain dead person is dead as people believe that a person is not dead as long as the heart keeps beating. A brain dead person on ventilator can register heartbeats for months together,” said Dr Jindal.
Even as doctors try to satisfy relatives of patients who are brain dead, they face the problem of denying admission into the ICU patients who are alive. Doctors say there are two accepted modes of death – cardio respiratory failure and brain stem death — in India as stated in the organ transplant act. A person is brain stem dead when there is an irreversible cessation of the functions of the brain.
Every year, GMC receives about 200 patients with head injuries who pass away from brain death, besides another 200 who die from massive strokes.
Explaining who can declare a patient to be brain dead, Dr Gopinath Shenoy, a medico-legal expert from Mumbai, said that according to the Organ Transplant Act, whenever an individual’s organs have to be harvested (for transplantation), a committee needs to examine the patient and certify the patient brain dead. “If the organs needn’t be harvested, then a single doctor can diagnose the patient as brain dead and a death certificate can be issued. This is acceptable in law,” he said.
There is, however, a moral and ethical dilemma involved. “Due to this we have decided to have a meeting with all medical consultants to review the situation and arrive at a policy decision,” added Dr Jindal.
Dr Shenoy added, “A brain stem dead patient is dead and even the law states this. By putting a brain stem dead person on ventilator, the doctor is actually doing a disservice to the patient and relatives as the hospital bill keeps mounting.”
A ventilator in a private hospital costs Rs 10,000 to 15,000 per day, while it’s free at GMC.
This decision comes in the wake of discussions on brain deaths and ventilators during the silver jubilee neurosurgery celebrations of GMC on Sunday.

November 10,2008, The Times of India, Goa edition