From village clinic to Supreme Court: A 78-year-old Kerala doctor’s decade-long fight for better brain death protocol

Dr Ganapathy moved the apex court after the Kerala High Court in 2017 closed his PIL, in which he had flagged a lack of transparency and alleged malpractices in declaring patients brain dead before their organs are used for transplantation.

Running SG Clinic at Sakthikulangara for the last 52 years, Ganapathy’s legal battle against the corporate healthcare world’s practices with regard to organ transplantation began a decade ago.

“My battle is half won. The present apnea test is not reliable. There is no evidence whether the test is even conducted or not. Doctors can write anything, can declare a person brain dead even without examining the patient. Videographing of the procedure is done only in government medical colleges. If tests like EEG and cerebral angiography are done before certifying brain death, there would be clear recorded evidence for such tests,” he said.

Ganapathy said that when he petitioned the High Court, Kerala’s health department initially agreed to his suggestion to make EEG and angiography, which he said were accepted across the world, mandatory. “But the government did not implement it under duress from big private hospitals,” he alleged.

Daughter’s word of caution

Recalling how he began the litigation to bring transparency into organ transplantation, Dr Ganapathy said, “I have been an admirer of organ donation as a noble gesture that transforms personal loss into a chance for others to live. In 2015, before I went in for heart surgery, I gave in writing to my doctor that if something were to happen to me before or after the surgery, my organs could be used for transplants for the poor. Opposing it, my daughter said if I gave consent in that manner, they (the hospital) would certify me brain dead and harvest my organs. I was shocked, but I still sent the mail.”

After that, he said, he began exploring the issue in Kerala, where he found that there were nine cases where brain death was declared in 2012, but the number rose sharply in later years.

“The figure rose to 79 in 2015. This nine-fold increase in three years made me suspicious,” he said, claiming that he learned from colleagues in corporate-run hospitals that “if a poor young person is admitted to the hospital with brain injury”, in many cases doctors would allegedly not attempt to save them, but would focus on convincing their relatives to agree to organ donation.

He also alleged that some doctors were paid to certify brain death in several cases. “After I moved the Kerala High Court, two neurologists in Ernakulam, involved in the process of declaring brain death, told me that they were forced to do so. They claimed that they only gave their signature or seal. If they do not sign, somebody else would have done so, and they would lose their jobs, I was told,” Ganapathy said.

He also questioned the survival rates in transplant patients in the state and claimed that the government was not revealing data on this.

Ganapathy said he has faced threats from various quarters during his legal battle. “Now, the hospitals in Kerala are worried and cautious. Had I not approached the court, the number of brain death cases in the state would have reached 400 by now,” he claimed.

His wife, Dr Jaya, had worked with the Railways, and their son, Gautham, is an IT professional in the UK. Their daughter, Geethanjali, runs a social enterprise in Bengaluru that seeks to help those who are neurodivergent.