infants, heart transplant, brain death, organ donation
Luis Romero/AP

Heart Transplant Cases Create Debate

August 15, 2008 12:08 PM
by Emily Coakley
Transplanting hearts after they’ve stopped beating has raised ethical questions.

‘A Ray of Hope’

A new report published in the New England Journal of Medicine has become controversial because it involves declaring someone dead once his heart has stopped beating, not because he is brain dead, as is usually the case for transplantation. The three donors and their recipients in this case were infants at Denver’s Children’s Hospital.

The babies had been deprived of oxygen during birth and had brain damage. The families agreed to take them off life support, and they were removed an average of four days after birth.
Though the Institute of Medicine says a heart, when removed from life support, should be given a five-minute window to make sure it doesn’t start beating again, doctors waited three minutes for the first child, and 75 seconds for the other two, according to the Associated Press. There are no cases of a heart restarting more than 60 seconds after life support stopped, and the team was concerned about the hearts getting damaged without blood.

One mother whose daughter was one of the three donors spoke to the AP.

“The reality was Addison was not going to live,” said Jill Airington-Grooms. “As difficult as that was to hear, this opportunity provided us with a ray of hope.”

Pushing the Boundaries of Organ Transplants

Even with family consent, some object to cardiac death transplants.

“I don’t know how you can ever have a patient that meets the criteria for irreversible loss of function, and then reverse that function in someone else,” said Robert Veatch, a professor of medical ethics at Georgetown University, in a commentary that accompanied the report.
Veatch, according to HealthDay, sees nothing wrong with transplanting most organs after death. But if a person died because his heart stopped beating, that heart shouldn’t be used again

Harvard Medical School’s director of clinical ethics, Robert Troug, asked this: “If death means irreversible loss of cardiac function and that heart beats in someone else’s chest, it’s not irreversible, is it?”

Wesley J. Smith, an attorney and author who has written about bioethics issues, calls the report “disturbing.”

“If organ professionals and bioethicists want to destroy all public faith in organ transplant medicine, I can’t think of a better way than taking organs before true irreversible cardiac arrest and pushing for procurement rights before actual death,” Smith said on his blog, Secondhand Smoke.

An editorial in the journal acknowledges the report’s controversial nature, but says: “As a result of their investigational protocol, three babies are now alive; had the procedures not been performed, it is virtually certain that all six babies would be dead.”

Reference: NEJM Report


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