Gaps in brain death certification contribute to low deceased organ donation rates in India: experts

A majority of brain deaths in intensive care units (ICUs) across the country continue to remain ‘silent deaths’, without being certified as brain deaths, and thereby are missed opportunities for organ donation, said experts, addressing members of the press via a Zoom call on October 4, 2025.

Highlighting the findings of a national survey, conducted over three months among physicians involved in organ donations, Deepak Gupta, professor of neurosurgery at AIIMS, Delhi, who led the team conducting the survey, said that fewer than half of surveyed doctors had received formal training in brain death certification during medical school. Also, only 10% reported that they routinely trained their residents in brain death certification. “This is a critical gap in the organ donation programme in India. Without awareness and training on brain death certification, the deceased organ donation rates cannot go up,” he said.

The survey findings were published as a research paper, ‘Disparities in Brain Death Certification Knowledge among Indian Physicians Involved in Organ Donation’ in the September-October edition of Neurology India. The survey also found that of 177 doctors, while 96% were aware of the apnea test, nearly half failed to screen for drugs or toxins — an essential step in ruling out reversible causes of coma.

Sunil Shroff, trustee of MOHAN Foundation, an NGO that works towards promoting deceased organ donation in India, pointed out that India had around 1,60,000 road traffic deaths every year, and yet, the number of organ donations remained at between 1,000 and 1,200 per year. Even when families were willing, the lack of trained counsellors and trained intensivists could impede potential donations. Just as green corridors were being set up in cities to transport organs, hospitals too, needed green corridors to make their processes easier, he said.

Mathew Joseph, neurosurgeon at CMC, Vellore, noted that lack of familiarity with brain death was a big problem. He also noted that there was a learning curve to the process but even though awareness about brain deaths had increased, practical learning had not kept pace.

Panellists stressed the urgent need to build awareness and strengthen brain certification training programmes for doctors starting at the medical college level, to frequently conduct such trainings and to set out uniform protocols for brain death certification, a currently-neglected area.