Ethicist Question Infant Transplant Procedure

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In the New England Journal of Medicine, a detailed description of the transplant procedures in infants has created a heated debate (video of debate or pdf transcript) regarding whether the first-of-their-kind procedures are pushing an already controversial organ-retrieval strategy beyond acceptable legal, moral and ethical bounds.

The procedure itself is frightening in its complexities. In this procedure, doctors are removing the infant's hearts at a time when it is not clear whether the surgeons have waited long enough to see if the infants died according to accepted guidelines of death. The guidelines state that death is when there is: complete, irreversible cessation of brain function or of heart and lung function. There is a feeling by some that these operations are equal to murder.

Beginning in the 1970s, organs were harvested after a doctor declared a patient brain-dead. However, in the hopes of obtaining more organs, federal health officials, transplant surgeons and organ banks have been intensely promoting "donation after cardiac death," or DCD. DCD typically happens when a patient has severe, irreversible brain damage yet is not brain dead. In this case, their families consent to removing the patient from life support so that their organs can be harvested just minutes after the body has died.

DCD is still very controversial, although it has become a common practice. In a case brought against a California surgeon, he's facing charges from 2006 claiming that he hastened a patent's death to harvest the organs.

Hospital have strict guidelines which include making it clear that the doctor handling the patient can not be the doctor that removes and transplants the donor organs. As well, surgeons are required to wait at least two minutes -- and usually five -- after a heart stops to make sure it does not spontaneously start beating again on its own.

Between 2004 and 2007, three cases are detailed in the report which involved infants that experienced severe brain damage from oxygen deprivation during birth. Even though the parents consented to removing their babies from life support, the first baby's heart was removed just 3 minutes after the heart stopped and only 75 seconds for the second and third baby's hearts stopped! The ethics panel that monitored the research said that the was sufficient time to allow for a baby's heart to restart, if it was going to. The babies whose lives were saved, who were at that time between 1 to 4 months old, were alive six months after the transplants.

"We're very pleased with the lives we saved," said Mark M. Boucek, who led the team before moving to the Joe DiMaggio Children's Hospital in Hollywood, Fla. "We're trying to deal with a very difficult situation where children die waiting for transplant and parents of other children want to donate."

Critics aren't so accepting of the procedure, regardless. They are questioning whether these babies were truly dead when their hearts were removed. In these cases, the argument is that the hearts did restart in another infants body, so cessation wasn't irreversible.

"This practice cannot be ethically justified," said George J. Annas, a Boston University bioethicist. "The donors are not dead. I understand that they would like us to change the definition of death, but they can't do that by themselves. It's very problematic to start treating a baby as an organ donor before it's dead."

Robert M. Veatch, a Georgetown University bioethicist went on to say,

"The whole issue is whether the infants from whom the hearts were taken were dead. It seems very clear to me that they were not," he said. "I think it's illegal, and if it's illegal, what we're talking about is the physicians causing the death of the three patients, and that would be homicide. It's immoral. I think it should be stopped."

According to Dr. Mark M. Boucek, the cardiologist who lead the team, the hearts which were removed from the deceased infants were not able to continue functioning in those babies, which to him satisfied the question that the babies were indeed dead.

Despite the debate, Denver Children's Hospital plans to continue these procedures.