Enclosures
FORM  8 Board of Medical Expert certificate for Brain Death
We the following members of the Board of medical experts after carefulpersonal examination hereby certify that Shri/Smt/Km.................................................. aged about........................son of/wife of/ daughter of.............................................. resident of........................................................ is dead onaccount of permanent and irreversible cessation of all function of thebrain stem. The tests carried out by us and the findings therein arerecorded in the brain stem death Certificates annexed hereto.
Dated ..............................		Signatures. ...............................
		1.
		2.
		3.
		4.
1. R.M.P. Incharge of the Hospital which brain  stem death has occurred.		2. R.M.P. nominated from the panel of Names approved by the Appropriate Authority.
3. Neurologist / Neuro Surgeon nominated from the panel of names approved by Appropriate Authority.		4. R.M.P. treating the aforesaid deceased person.
BRAIN STEM DEATH CERTIFICATE
(A) PATIENT DETAILS :
1.	Name of the Patient -	Mr/Ms......................................................
	S/O,D/O,W/O
		Mr.....................................................
		Sex ....................... Age..........................
2.	Home Address	.....................................................
		.....................................................
		.....................................................
3.	Hospital Number	.....................................................
4.	Name and Address of next of kin or	.....................................................
	person responsible for the patient (if none exists, this must be specified)	.....................................................
		.....................................................
		.....................................................
5.	Has the patient or next of kin agreed  to any transplant?	.....................................................
		.....................................................
6.	In this a police Case?	Yes-......................No..........................
		.....................................................

(C) PRE-CONDITIONS:
1. Diagnosis : Did the patient suffer from any illness or accident that led to
irreversible brain damage? Specify details ....................................................
.................................................................................................
.................................................................................................
Date and time of accident/onset of illness .............................................
Date and onset on non-responsive coma ...................................................
2. Findings of Board of Medical Experts:
The following reversible causes of coma have been excluded:
Intoxication (Alcohol)
Depressant Drugs
Relaxants (Neuromuscular blocking agents)
Primary hypothermia
Hypovolemic shock
Metabolic or endocrine disorders
Tests for absent of brain stem functions
2) Coma

First Medical Examination		Second Medical Examination
........................	........................	.........................	........................
1st	2nd	1st	2nd

3) Cessation of spontaneous breathing.
4) Pupillary Size
5) Pupillary light reflexes
6) Dolls head eye movement
7) Corneal reflexes (Both Sides)
8) Motor response in any cranial nerve
distribution, any responses to stimulation
of face, limb or trunk
9) Gag reflex,
10) Cough (Tracheal)
11) Eye movements on caloric testing bilaterally
12) Apnoea tests as specified
13) Were any respiratory movements seen?
Date and Time of first testing ..........................................
Date and Time of second testing .........................................
This to certify that the patient has been carefully examined twiceafter an  interval of  about six hours and on the basis of findingsrecorded above,  Mr/Ms ....................................... isdeclared brain-stem dead.

Signatures of -

           1. Medical Administrator Incharge of the hospital
           2. Authorised Specialist
           3. Neurologist/Neuro Surgeon
           4. Medical officer treating patient.
NB.I. The minimum time interval between the first testing and second testing will be six hours.
II. No.2 and No.3 will co-opted by the administrator in charge of thehospital from the panel of experts approved by the Appropriate Authority.