Seven years have come and gone since the then Union Minister for Health and Family Welfare, AR Antulay demanded revisions to the Human Organs Transplant Act, 1994 and appointed a committee to look into it.

One of the points of contention was the definition of brain death (after which human organs can be made available for transplant). But Antulay's committee has still not had its first meeting, even though several health ministers in the central government have come and gone.

This issue was the centre of the discussion between neurologists, neurosurgeons and physicians who were attending the two day Neurology Update on the 4th and 5th December 2003 at Hotel Taj, Mumbai.

Updating the surgeons on some of the mandatory aspects of brain dead patients, Dr Eelco Wijdicks, MD at Mayo Medical Centre, US presented before the gathering some of the necessary pre-requisites that were essential before detection of a brain dead patient.

According to Dr Eelco, some of the clinical diagnosis that had to be established included to look out whether the patient shows any signs of respiration, sweating, blushing, limb movements and hypertension.

The other relevant factor was whether there was any acute definitive catastrophic event involving the cortical hemispheres or brain stem, exclusion of any complicated medical condition and no documented evidence of intoxicity.

While all of the above was being followed, the confirmatory test and final judgment in case of brain dead patients must be made purely on clinical grounds, noted Dr Eelco. That is because the physician who would be permitting such a crucial decision made by a machine might be putting himself into a highly vulnerable position, noted Dr Eelco.

As per a survey that was done on 80 nations from around the globe it was observed that legal standards for brain dead patients existed in about 69 per cent countries, a further 88 per cent practice these guidelines, about 44 per cent required only one physician to certify the patient brain dead, 34 per cent required two physicians to certify the patient brain dead and in 59 per cent of the countries there existed no confirmatory test for declaring a patient brain dead.

While according to US FDA norms, presence of four physicians was mandatory while certifying the patient brain dead, worldwide, some of the approaches that was being followed include; In Bangladesh just one physician or at least an associate professor was required to certify; In India four physicians is the norm; In Iran three physicians were required to do the tests at an interval of 12, 24 and 36 hours while in Yugoslavia three physicians were required to do three tests.

According to Dr Eelco the future should see countries making a consensus in establishing detailed norms for brain dead patients and also establishing defined norms on the need for providing organs of brain dead patients to patients who are in dire need of a transplant.