An Organ Donation and Medicolegal Workshop was organised by Indian Society of Critical Care Medicine (ISCCM) Rajkot Branch in association with MOHAN Foundationon 28^th September 2018 at the 6^th Gujarat Criticon 2018 in Ahmedabad. The venue of the workshop was CIMS Hospital and a total of 47 delegates attended the workshop.

The workshop started off with an overview of organ transplantation in India by Dr. Sunil Shroff, Managing Trustee, MOHAN Foundation followed by Dr. Sumana Navin, Course Director, MOHAN Foundation talking about the Transplantation of Human Organs and Tissues Act, 2011 and the Rules 2014. She emphasised that a uniform determination of death was the need of the hour in India to remove any ambiguity about the protocol regarding ventilation when brainstem death has occurred and the family has said ‘no’ to organ donation.

Films on identification and brainstem death as well as the good and poor approaches to approaching a family for organ donation were screened. Dr. Prashant Kumar, Senior Consultant Critical Care, Medanta – The Medicity, Gurugram gave a comprehensive  presentation on the pathophysiology of brainstem death and the management of a potential brain-dead donor. Three very interesting real-life case studies on identification and certification of brainstem death were presented. The first one on spinal reflexes was presented by Dr. Digvijaysinh Jadeja, the second one on confounding factors was by Dr. Bhumi Dave, and the third one was on the role of ancillary testing by Dr. Milap Mashru. All of them are from ISCCM, Rajkot Branch.

The first panel discussion was an interactive case-based session on various issues relating to brain death maintenance. The panelists included Dr. Dhiren Shah, Dr. Tushar Patel, Dr. Sankalp Vanzara, Dr. Digvijaysinh Jadeja, and Dr. Prashant Kumar. Dr. Sunil Shroff presented different case scenarios for the panelists and audience to deliberate on and give inputs on how to optimise the potential donor.

Post-lunch group activities were conducted. The role plays on breaking bad news to families saw enthusiastic participation from members of the audience. Some of the takeaways were to prepare a case summary instead of a death summary if the family wants a second opinion. Also, do not refuse to give investigation reports to the family, it can cause distrust. An organ donation pathway activity on how to proceed when there is a potential deceased donor in the hospital gave the participants an insight into the steps to be followed.

The last panel discussion was on ‘Medicolegal Issues in Practice of Critical Care Medicine.’ The moderator was Dr. Sankalp Vanzara, ISCCM Rajkot Branch and the panelists were Dr. Hitesh Bhatt, Dr. Milap Mashru, Dr. Prashant Kumar, and Dr. Sunil Shroff. Some of the issues that were discussed were:

• When there is brainstem death, but the family says ‘no’ to organ donation – can the ventilator be withdrawn?
• What is the time limit for registering a medicolegal case (MLC)?
• Can a doctor refuse to attend medicolegal cases?
• In which scenario can medicolegal case be skipped?
• What is the legal value of different types of ‘abstract’ consent?

-  GC (General condition) poor consent

-  DNR (Do not resuscitate) consent

-  Non-MLC consent

-  LAMA/DAMA (Leave against medical advice/Discharge against medical advice) consent

One of the key messages from Dr. Hitesh Bhatt for handling a medicolegal case was – “Communication, documentation, communication of documentation, and documentation of communication.”