In a controversial new procedure, doctors removed the hearts from three severely brain damaged infants soon after the babies were removed from life support and transplanted the organs to three other infants, where the hearts were restarted. The news is raising complicated questions about when a patient can be declared dead, and whether doctors are
pushing an already controversial organ-retrieval strategy beyond acceptable legal, moral and ethical bounds [The Washington Post].
The hearts of the three donor babies stopped beating soon after their ventilators were removed.
In the first case, the Denver team waited three minutes after what appeared to be the last heartbeat. But because there has never been a case where the heart restarted itself after 60 seconds, they waited only 75 seconds for their next two cases [Reuters].
All three babies who received new hearts would have died without the transplants; six months after the operations, all three were doing fine. Doctors believe the swift organ removals from the donor babies increased the odds of survival for the recipient babies.
The experimental procedure, which was reported in the New England Journal of Medicine, pushed the limits of the so-called
dead donor rule, an ethical guideline stating that a donor must be dead before vital organs are prepared for transplantation. When the heart has stopped irreversibly, it is called cardiac death. Dead donor rule protocol, based on a 2005 consensus in the medical community, suggests waiting between two and five minutes after the pulse stops to declare death. But more time between circulation stoppage and transplantation causes more damage to the donor organs, especially the heart, [lead researcher Mark] Boucek says [Science News].
In all three cases, the parents of the donor babies decided to remove their infants from life support, and agreed to the organ donation. But medical ethicist Robert Veatch says the practice could still be considered illegal in light of the current rules.
"If a heart is restarted, the person from whom it was taken cannot have been dead according to cardiac criteria," he wrote. "Removing organs from a patient whose heart not only can be restarted, but also has been or will be restarted in another body, is ending a life by organ removal" [The Wall Street Journal].