25 February 2011
The family of a 36–year–old brain dead patient, Radhakrishnan, who works in a lathe, was keen on donating his organs. The hospital where he was admitted sent the request to the state cadaver organ registry. But since he sustained head injuries during a tussle with his friend, the registry insisted on a no–objection letter from the police. The Triplicane police, which is probing the case, turned down the request.
The question they posed was: "Is a patient who is clinically dead really dead?" If the organs are retrieved before he is dead, should the case be one of murder or of attempt to murder? Also, should the person responsible for the victim’s injury be charged with murder because the victim is braindead or attempt to murder because brain–death has not been overtly covered by Section 302 of the IPC.
"We will not be able to allow doctors to harvest the organs until we have all the papers," said Dr J Amalorpavanathan, convenor, state organ transplant registry.
According to the police, Radhakrishnan sustained head injuries after one of his friends pushed him down after a fight on Tuesday. He was taken to the Government General Hospital the same day, but was moved to a private hospital on Wednesday. On Thursday, doctors attending to him declared him brain–dead.
The patient’s wife told the doctors that the family was keen on organ donation. Not aware of the legal recourse available to them, a relative of the family even landed in the Madras high court to meet the Chief Justice and place a special request before him. But he could not meet Chief Justice M Yusuf Eqbal, who had left his office by then.
When the patient’s brain loses functional ability, doctors declare brain death. The organs, however, are kept functional with life–support systems. The patient, according to the Transplant of Human Organs Act, is eligible to donate vital organs if his family agrees. The Tamil Nadu government in its order also said that if the investigating officer agrees and if the forensic experts record the postmortem, the organ donation can be carried out.
"We have sustained the functioning of the organs with ventilator. But we are losing time," said a senior doctor at Global Hospital.
Need more awareness on donation of organs: Doctors
Most doctors working for promoting cadaver organ donation said that the state needs to create more awareness. "Police should be convinced that donation will not come in the way of investigation. They will be able to conclude this only if they consult with forensic experts," said Dr Sunil Shroff, who runs MOHAN foundation.
He also pointed out that in the US, definition of death comes under the Uniform Determination of Death Act (UDDA). This includes both natural and brain death; hence switching off the ventilator does not become an issue. "In India too, we should pitch for this," he said.
The Uniform Determination of Death Act (UDDA) in the US says: An individual who has sustained either 1) irreversible cessation of circulatory and respiratory functions, or 2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.
A determination of death must be made with accepted medical standards. Most US states have adopted the UDDA. Several states have added amendments regarding physician qualifications, confirmation by a second physician, or religious exemption.