Infant Transplant Procedure Ignites Debate

[flashl]

Ethicists Question Strategy in Which Hearts Are Removed Minutes After They Stop Beating

By Rob Stein
Washington Post Staff Writer
Thursday, August 14, 2008; Page A01

Surgeons in Denver are publishing their first account of a procedure in which they remove the hearts of severely brain-damaged newborns less than two minutes after the babies are disconnected from life support, and their hearts stop beating, so the organs can be transplanted into infants who would otherwise die.

A detailed description of the transplants in today's issue of the New England Journal of Medicine has ignited an intense debate about whether the first-of-their-kind procedures are pushing an already controversial organ-retrieval strategy beyond acceptable legal, moral and ethical bounds.

The doctors who performed the operations as part of a federally funded research project defended the practice, and some advocates for organ donation praised the operations as offering the first clear evidence that the procedures could provide desperately needed hearts for terminally ill babies.

Critics, however, are questioning the propriety of removing hearts from patients, especially babies, who are not brain-dead and are asking whether the Denver doctors wait long enough to make sure the infants met either of the long-accepted definitions of death -- complete, irreversible cessation of brain function or of heart and lung function. Some even said the operations are tantamount to murder.

[madeline_con]

1. less than two minutes after the babies are disconnected from life support

It takes four minutes to die.

I'm just saying.

[RC]

2. The brain is already damaged beyond recovery.

The brain death is where the 4 minutes comes from.

[Warpy]

3. It is my understanding that this happens mostly in anencephalic

infants, meaning there is not enough brain stem present to keep respiration going. These infants are incapable of feeling distress because the organ that feels distress--the brain--is simply not there. The procedure is not nearly as cruel as it sounds.

Keeping them anoxic for the entire time it takes to stop the heart would irretrievably damage the heart. Add to that the ventilator is a temporary measure, only, to allow the parents to say goodbye to their damaged child, that there is not enough brainstem to regulate the heartbeat, either, and you begin to see just how grave the prognosis is for these infants. Even on a ventilator, they won't be kept technically alive for long.

In many ways, they were never truly alive. If the parents can find some peace and purpose in donating salvageable organs quickly, please let them do so. It serves no one to allow nature to take its course in these cases and allow other people's children to die as well for the want of a life saving organ that could have been harvested in time.

[madeline_con]

4. I didn't realize they were anencephalic infants. n/t

[chicagomd]

5. The "long-accepted definitions of death"

were generated for adults. The NICU is a much, much different place than the adult ICU. In a lot of ways it is a happier place, with more patients leaving alive, which makes it all the more difficult when a child dies.

If the parents have made a decision to remove their child from life support, for what ever reason, why should another infant not have the opportunity to live?

The immoral and unethical decision here is NOT to harvest those organs. Comparing these procedures to murder is beyond inflammatory.