Kerala on Saturday claimed to have become the first state to have a standard operating procedure to certify instances of brain death, The Indian Express reported. In 2017, the Kerala High Court had asked the government to ensure that hospitals have the highest standards and take extra care in certifying brain deaths.

All government and private hospitals in the state need to follow the guidelines before declaring a patient brain dead and accepting donations of his or her organs. Registered organ transplant centres in Kerala follow such guidelines, but this is the first time they have been documented officially as standard norms, according to The Hindu.

“The SOP [standard operating procedure] was brought out as per the High Court directive and to mitigate public fear about the process involved in declaring a person as brain dead,” Kerala Health Minister KK Shailaja said. “The government wanted to ensure that a person who is declared as brain dead has no chance to return to life.”

The procedure requires a medical board comprising four doctors – at least one government doctor – to declare a patient brain dead, the Hindustan Times reported. The procedure also says that a patient cannot be declared brain dead without being completely out of reversible causes of coma. The guidelines also give detailed definitions of brain death and the state of coma.

S Ganapathy, a physician, had challenged the existing practices in the High Court, arguing for more foolproof measures to rule out possibilities that the certification is manipulated to use the patient’s organs for transplant.

In its judgment in June 2017, the Kerala High Court observed that patients and their wards can “easily be misled into believing things which may not be correct”, and the government must protect them and avoid medical fraud and malpractice.