Brain death rules clarified to facilitate organ transplant in Dubai

The process of assessment for brain death starts six hours after an event that has led to a coma for an adult patient, according to the newly drafted brain death policy in Dubai.
However, in case of declaration of brain death and the subsequent decision to withdraw life-saving equipment, the consent of the guardian or custodian will not be taken as per UAE's Medical Liability Law of 2016 and cited in the policy.
Likewise, no consent is required from guardians to start the brain death assessment procedure which is done twice.
As the organ transplant programme actively takes shape, the Dubai Health Authority (DHA) has issued a policy that defines brain death clearly.
Launched on March 1, the policy applies to and works as a guideline for all hospitals and concerned physicians licensed by the authority.
As per the policy, the three essential findings in brain death are: Coma, absence of brainstem reflexes and apnea.
Dr Marwan Al Mulla, CEO, Health Regulation Sector, said that the policy was drafted to improve the diagnosis and reporting of brain death. "Also it is to ensure that the diagnosis of brain death has been carried out as per worldwide standards and international best practices," he told Khaleej Times.
He said that the policy would ensure all health facilities comply with the UAE federal laws and DHA policy for brain death.
"It will also facilitate diagnosis of brain death by neurologists, neurosurgeons, internists, intensivists, anesthesiologists and pediatricians as well as support the organ transplantation at the national level," he said.
As per the policy, determination of brain death shall be performed by a minimum of three DHA-licensed physicians. Organ transplant physicians and transplant surgeons are not permitted to perform this assessment.
Consequent to brain death and after the notification is duly signed, the guardian or custodian should be notified about the brain death and the consequences.
If the deceased meets the criteria for organ donation, then the transplant coordinator will be informed else the life sustaining equipment is withdrawn.
Pre-assessment conditions
Prior to requesting the assessment, the Most Responsible Physician (MRP) shall ensure that all of the pre-assessment conditions are met including:
>The patient is in a state of deep coma due to a known reason
>At least six hours have lapsed since the event leading to coma (for adults)
>Drug poisoning should be excluded in cases of motor vehicle accidents, suspicious drug poisoning, or coma due to unknown reason
>If such screening is not performed, then five days (120 hours) shall elapse from the time an agent was ingested/administered, before brain function assessment can be done
>The patient should not be under the influence of any sedatives, anxiolytics, hypnotics, narcotics, muscle relaxants, central nervous system depressants, or anti-depressants
>If the history is positive for ingestion/administration of any of above agents, then the influence of such agents should be excluded either by a laboratory test or awaiting five days (120 hours) from the last time an agent was ingested/administered, before brain function assessment can be done
>The patient does not exhibit any spontaneous motor activity
>The patient does not demonstrate any limb or facial response to applying significant pressure to the supra-orbital rim (central pain)
>The patient is not in a cardiovascular shock
>The patient's core temperature is more than 34 °C
>The patient is dependent on mechanical ventilation and can't trigger spontaneous ventilation.
>Biochemical tests do not indicate metabolic or hormonal derangements.
>Absence of any reflexes except for some simple spinal-cord mediated ones (e.g. plantar responses, muscle stretch reflexes, abdominal reflexes, and finger jerks)
asmaalizain@khaleejtimes.com
 
 

Asma Ali Zain

asmaalizain@khaleejtimes.com