What is brain death? How is it different from ‘coma’?

 What is brain death? How is it different from ‘coma’?

Brain death is the permanent and irreversible cessation of brain and brainstem function, after which a person is legally declared dead.

In Nepal, only 6 organ donations have been made after brain death so far, which is low.

Although Nepal has legally recognized brain death, lack of awareness and infrastructure hinders organ donation.

Brain death refers to the permanent and irreversible cessation of all brain and brainstem function. Once brain death is confirmed, the person is declared legally and medically dead, although the heart may continue to beat for some time on artificial life support.

Coma is a severe state of unconsciousness, where the brain remains partially active and the patient may have brainstem reflexes. There is a possibility of recovery from coma, but a person can never be revived after brain death.

Current Situation in Nepal

Given the current situation of hospitals and ICUs in Nepal, there may be 4-5 brain death cases per week, which is estimated to be around 240 to 250 brain death cases annually. If at least 50 percent of these patients’ organs are donated, 800 to 900 lives can be saved.

However, in reality, only 6 brain-dead patients have donated their organs in Nepal so far, which is a very low and sad fact.

Legal system of Nepal

The Government of Nepal has legalized brain death through the Transplantation of Human Organs (Regulation and Prohibition) Act, 2072. Accordingly, organs can be harvested after declaring brain death with appropriate medical evidence and consent of the family.

Brain death confirmation body

In Nepal, a special committee of doctors is required to confirm brain death, which consists of the following members:

-Neurosurgeon or neurologist

-Physician or intensive care specialist

-Anesthesiologist

-Hospital administration representative

These experts together have a provision to declare brain death according to the criteria.

Main obstacles to organ donation in Nepal

1. Lack of awareness: Many people and even hospital health workers do not have accurate information about brain death and organ donation.

2. Religious and cultural beliefs: Some religions/communities believe that one should not intervene in a dead body.

3. Lack of organ collection centers: Only a limited number of hospitals are capable of such work.

4. Lack of local hospital policy and training: There is a lack of trained transplant coordinators to communicate with families and proceed with organ donation.

5. Deceptive symptoms: Even after brain death, the patient may experience movements such as moving their arms and legs, finger flicking, head turning, and breathing-like movements for some time, which can also confuse doctors in their decisions.

6. Family disagreement and difficulty: Explaining brain death to the family, providing emotional support, and preparing them for organ donation is a challenging task.

Role of stakeholders in brain death

- Neurosurgeons and physicians: These doctors play a major role in timely recognition, confirmation, and communication with the family.

- Family members: Their understanding and willpower are decisive in organ donation.

- Hospital administration: Hospital policy should ensure the ease and coordination of the organ collection process.

- Government and organizations: The main responsibility is to spread public awareness, provide training, and develop necessary infrastructure.

Nepal in the global context

Today, more than 70 percent of the countries in the world have a practice of confirming brain death through legal recognition or medical guidelines. In countries including Spain, America, India, and others, organ donation after brain death has made significant progress. Although Nepal also prepared the legal basis in 2072, there is still a need for major improvements in implementation and practice.

Let's be aware, save lives

Organ donation after brain death is a humane, ethical, and life-saving act. Hundreds of patients are waiting in Nepal, while hundreds of organs are being wasted every year. Doctors, policymakers, media professionals, and the general public must work together to make this act a success.

Now we must move towards a new era, where it is time to accept brain death as death, respect the wishes of the deceased organ donor, and unite in the effort to save lives.

With a small effort from all of us, countless lives can be saved.