Brain death explained: The hardest 'yes' and a window for organ donation

Brain death is the only moment when deceased organ donation can give others a second chance at life. Understanding it helps families say 'yes' when it matters most

Picture this: A young accident victim is rushed to the intensive care unit (ICU). Machines are keeping the heart beating, the chest rising and falling. The monitors beep rhythmically. But doctors say there’s no hope. The brain has permanently stopped working. In medical and legal terms, this is death.

 

At this moment, there is a rare, precious window to save up to eight other lives through organ donation. And yet, in many cases, families hesitate and walk away from that possibility, not because they don’t care, but because they can’t reconcile what they see with what they are told.

 

On this World Organ Donation Day, we speak with doctors to understand brain death and deceased organ donation.

   

What is brain death?

“Brain death is the irreversible loss of all brain functions, including the brainstem, which controls vital processes like breathing,” explained Dr Dibya Jyoti, consultant – Minimal Invasive Brain, Spine & Endovascular Neurosurgery, Yashoda Medicity.

 

It’s not a coma. A person in a coma may recover because some brain activity remains. In brain death, there is no activity, no reflexes, no breathing without machines, and no chance of coming back.

 

Here’s why this matters for organ donation: After brain death, the heart can still pump (with ventilator support) for hours, keeping organs alive and healthy. That makes brain death the only time when organ donation is possible with the heart still beating, allowing the transplant of heart, lungs, liver, and kidneys.

   

How do doctors make sure brain death is real?

To the untrained eye, someone who is brain-dead can look ‘alive’. That’s why the law demands strict safeguards before declaring it.

Dr Gaurav Kakkar, senior consultant & lead – Neuro-Anaesthesia & Neurocritical Care, Amrita Hospital, explained India’s process under the Transplantation of Human Organs and Tissues Act (THOTA):

 

• Two independent brain death tests in adults, at least six hours apart.
• Four doctors, none connected to the transplant team, must certify.
• All results recorded on a legal form (Form 10).

 

Tests include:

 

• Checking for no response to touch, pain, or voice.
• Absence of all brainstem reflexes (no blinking, no pupil reaction, no gag reflex).
• An apnea test to confirm the brain no longer controls breathing.
• If needed, scans like EEG or cerebral blood flow studies.

   

Why timing is everything

Once brain death is declared and certified, organ donation needs to happen quickly. The ventilator and ICU care keep blood and oxygen flowing to organs, but not forever. Prolonged delays can lead to inflammation, loss of circulation, and irreversible damage to organs.

 

That’s why hospitals have dedicated transplant coordinators to guide families through this emotional moment, answer questions, and ensure decisions are made with both clarity and compassion, both doctors explained.

 

If the hospital staff can clearly explain brain death when tragedy strikes, they might help your family see donation as a gift, not a loss. That awareness could mean the difference between letting eight people die on a waiting list… or giving them a second life.

   

World Organ Donation Day

Every year on August 13, World Organ Donation Day is observed to spread awareness about the life-saving potential of donation and to encourage people to pledge their organs.

The 2025 theme is ‘Answering the Call’ which aims to highlight the vital function that professionals play in the organ donation community and calls on them to strengthen their dedication and teamwork to save more lives.

Globally, the day is promoted by health ministries, NGOs, and organisations like the World Health Organization, with the aim of busting myths and normalising conversations about brain death and donation.    For more health updates, follow #HealthWithBS