MUMBAI: A panel of medical experts has drafted guidelines to tackle the ambiguity over declaring brain deaths in the paediatric age group, particularly 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 Organisation (Rotto), western India, has laid down protocols that address some of the complex issues in declaring brainstem deaths in neonates (0-28 days) or infants. Among others, it recommends two

tests to be carried at intervals of 24 hours, unlike adults or older children where it is done six hours apart, as well as a confirmatory test such as EEG, if the

declaration is likely to be 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

’s Directorate of Health Services.

The Transplantation of Human Organs and Tissues Act sanctions only deceased 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 procedural steps should be followed to declare babies brain dead.

Brain death certification in very young children remains a complex area across the world, 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 formulated the paediatric guidelines.

A study by Mohan Foundation had found that of all the organ donations in Tamil Nadu, Kerala and

in 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 brain death if it’s not trauma,” said Dr Sunil Shroff of Mohan Foundation.

For instance, he said, if the cause of brain death is drowning, doctors must wait and watch rather than hurriedly declaring brain death. “Framing guidelines is a step in the right direction,” he said, adding that in India, paediatric donations are mostly driven by parents.

In 2017, doctors in Maharashtra were faced with a dilemma when a doctor couple from Amravati wanted to donate the organs of their three-month-old daughter. Caught unaware about rules of declaring an infant brain dead, the local doctors took four days to certify it, by which time it was too late to retrieve the organs.

“Brain death certification in children above 2 years is well understood, the challenge is in younger babies,” said intensivist Dr Rahul Pandit.

“The guidelines will help to standardise procedures and reduce the loss of potential donors,” said Dr Astrid Gajiwala Lobo, director of Rotto. She added that guidelines, adopted from the Indian Society of Critical Care Medicine have also delved into the retrieval of all organs from adults too.