India Loses Thousands of Organ Donors Due to Brain Death Oversight

A recent study reveals that India is losing thousands of potential organ donors each year due to inconsistencies in the certification of brain death. Conducted by Prof Deepak Gupta from the All India Institute of Medical Sciences (AIIMS), the research highlights critical gaps in the training of medical professionals responsible for declaring brain death, a vital first step in the organ donation process.

The findings, published in Neurology India, surveyed 177 doctors, primarily neurosurgeons from teaching hospitals. Alarmingly, less than half of the respondents (41.8%) reported receiving training in brain death certification during their Bachelor of Medicine, Bachelor of Surgery (MBBS) studies, and only 10% of them regularly trained residents in this crucial area. The study found significant inconsistencies in screening protocols, the use of ancillary tests, and consent procedures across different hospitals.

Despite existing guidelines in certain states, such as Kerala, which mandate the video recording of brain death tests, only 20% of the surveyed hospitals implemented such measures. This lack of standardization poses serious implications for organ donation in the country.

Many doctors reported witnessing what they referred to as “silent brain deaths,” where patients meet the criteria for brain death but are never formally declared. Approximately 41% of the respondents indicated that they had seen more than 20 such cases in a year, with nearly a quarter suggesting that the number could exceed 50. The situation is even more concerning for children, where one in five doctors stated they had not seen any declarations of brain death in the past year.

The emotional toll on families is profound. A senior transplant surgeon emphasized, “Every silent brain death means eight lives that could have been saved.” Patients often face long waits in hospitals, deteriorating over time and often dying before receiving the necessary transplants.

The study identified several barriers to organ donation. Family refusal and lack of public awareness were cited by 62% of doctors as the most significant obstacles. Other challenges included the absence of transplant facilities (43.5%), religious beliefs (50.2%), indifference among clinicians (43.5%), and a lack of confidence in declaring brain death (36.7%).

These findings come during a time when India has recorded its highest number of organ transplants in 2024, with nearly 19,000 procedures, including over 13,000 kidney transplants and 4,900 liver surgeries. Despite this progress, the organ donation rate remains below one per million population, lagging significantly behind countries like Spain and the United States, where rates are in double digits.

Prof Gupta and his research team concluded that enhancing training in brain death certification at both the MBBS and residency levels, enforcing consistent standards, and increasing transparency are crucial steps needed to foster public trust in the organ donation system. Without these improvements, India risks losing not only potential organ donations but also countless lives that could be saved.