Infants’ organs removed before meeting criteria for brain death

Aug 21, 2008 / 18:53 pm

A new report reveals that doctors in Colorado removed dying infants’ hearts from their bodies just minutes after the hearts stopped beating so the organs could be transplanted. While the doctors, who carried out the procedures with familial consent, argue that the legal and ethical definition of death is flawed, the infants did not meet criteria for brain death. One critic claimed it is an “open-and-shut case” to decide that the doctors violated medical ethics.

In typical practice, organs have been removed only after doctors determine that a donor’s brain has completely stopped working.

The Denver cases, detailed in a recent edition of the New England Journal of Medicine (NEJM), were examples of a procedure called donation after cardiac death, the Associated Press says.

All three infants were on life support after suffering brain damage from lack of oxygen when they were born. They reportedly showed little brain function, but they did not meet the criteria for brain death.

Having obtained the families’ consent, medical staff removed the newborns from ventilators and surgeons removed their hearts for transplant soon after they stopped beating.

One surgery took place in 2004 while two took place in 2007. The infants were on average about four days old when taken off life support.

In two of the cases, doctors waited only 75 seconds after the infants’ heartbeats stopped. The authors of the NEJM study said the period of 75 seconds was chosen because there had been no known cases of hearts restarting after 60 seconds.

Other surgeons in organ donation surgeries wait two minutes after the donor’s heart stops, while the Institute of Medicine has suggested five minutes.

The infants’ hearts were donated to three babies born with heart defects or heart disease. All three recipients survived and their conditions were indistinguishable from 17 other pediatric heart transplants done at the same time using hearts from donors who were declared brain dead.

"It seemed like there was an unmet need in two situations," said Dr. Mark Boucek, who led the study at Children's Hospital in Denver. "Recipients were dying while awaiting donor organs. And we had children dying whose family wanted to donate, and we weren't able to do it."

State laws require that an organ donor must be declared dead before organ donation, based either upon irreversible, total loss of brain function or heart function.

Critics of the study say the Denver cases violate the requirements because it was possible for doctors to restart the transplanted hearts in the organ recipients’ bodies.

"In my opinion, it's an open-and-shut case. They don't have irreversibility, and they don't have death," said Robert Veatch, a professor of medical ethics at Georgetown University.

Drs. Robert D. Truog and Franklin G. Miller, writing recently in the New England Journal of Medicine, questioned the idea of cardiac death and brain death as the standard of ethical organ donation, writing “although it may be perfectly ethical to remove vital organs for transplantation from patients who satisfy the diagnostic criteria of brain death, the reason it is ethical cannot be that we are convinced they are really dead.”

Most moral ethicists, agreeing with the generally accepted Catholic view, consider the death of the donor as the event making it ethical to remove vital organs for transplant. They argue that removing vital organs from a living donor would constitute actively killing a person