MUMBAI: A panel of medical experts has drafted guidelines to tackle the ambiguity over the death of the children, especially among neonates and infants. The proposed rules state that a baby born after 37 weeks of gestation can be declared brain dead and considered for organ donation.
The panel brought together by the Regional Organ and Tissue Transplantation Organization (Rotto), Western India, has laid down protocols in some of the critical issues in the issue of declaration brainstem deaths in neonates (0-28 days) or infants. Among others, it recommended twoapneatests to be carried at intervals of 24 hours, unlike adults or older children where it was done six hours apart, as well as a confirmatory test such as EEG, ifbrain deathdeclaration followed by an organ donation.
The guidelines have been drawn from practices the world over, said the experts, adding that it is awaiting approval from Maharashtra’s Directorate of Health Services.
The Transplantation of Human Organs and Tissues Act sanctions only dead and no live organ donations in people aged less than 18 years, but it is ambiguous on how young a deceased donor can be or what are the procedural steps to follow.
Brain death certification in very young children remains a complex area, doctors said “The rules are only to give the medical fraternity some clarity on how to go about declaring brain death when it’s a newborn or a small baby,” said Dr. Soonu Udani, Director, Critical Care at SRCC Children’s Hospital, who created the paediatric guidelines.
A study by Mohan Foundation had found that all the organ donations in Tamil Nadu, Kerala andRajasthanin 2016, around 7% were from the paediatric age group (0-12 years). “Paediatric organ donation is untapped, but also tricky. In very young babies, unlike adults, their brains can recover dramatically So it is extremely crucial to establish the cause of death if it is not trauma, “said Dr. Sunil Shroff of Mohan Foundation.
For example, he said, if the cause of brain death is drowning, doctors must wait and watch rather than hurriedly “Framing guidelines are a step in the right direction,” he said, adding that in India, paediatric donations are mostly driven by parents.
In 2017, doctors inMaharashtrawere faced with a dilemma when a doctor couple from Amravati wanted to donate the three-month-old daughter. Caught unaware about the children of declaring an infant brain dead, the local doctors took four days to certify it, by which time the organs were retrieved.
“Brain death certification in children above 2 years is well understood, the challenge is in young children,” said intensivist Dr Rahul Pandit.
“The guidelines will help to standardize procedures and reduce the loss of potential donors,” said Dr Astrid Gajiwala Lobo, Director of Rotto. She added that the guidelines from the Indian Society of Critical Care Medicine have also been delved in all the organs from adults too.