I know some things they may say.
Things like “The baby would have died eventually.”
Or, “Think about how many babies are being saved.”
Or, “This puts the parents through fewer traumas.”
Here is the question…
A heart stops beating in one baby. It is transplanted and restarted in another baby. But was the baby that the heart was taken from really dead?
It’s a harsh question. It shouldn’t have to be asked. But doctors are in a hurry. Medical technology and all…and someone has a baby waiting.
“Dead Donor Rule”…that comes in to play here…an ethical guideline stating that an organ donor must be declared dead before vital organs are prepared for transplantation. In past research, a heart has not restarted on its own more that 65 seconds after a person was taken off of a ventilator. Coroners are asked to wait between two and five minutes after the pulse stops to declare death. That is the general practice protocol of the dead donor rule.
A team of doctors at Joe DiMaggio Children’s Hospital in Hollywood, Fla. preformed three heart transplants on babies. In the first transplant, the donor baby’s heart stopped 11.5 minutes after the baby was taken off of life support, with death being declared three minutes later and the transplant immediately following.
The next two transplants began 75 seconds after the donor’s pulse ceased. Each of the babies hearts stopped 27.5 and 16 minutes after each was taken off of life support. Because the team began the transplants after the shorter time period, and less time than the dead donor rule, it raised the question of whether the babies were in fact dead. Why did they do this? Because, as more time elapses between when circulation and the heart stop, and when transplantation begins, there can be more damage to the organ that is going to be donated.
I guess death is the vision of the physician...or should I say life....
"In another NEJM commentary, Robert Veatch, Ph.D., a biomedical ethicist at Georgetown University in Washington, opposed definitions of death that hinge on the impossibility of autoresuscitation.
"Anyone who had had a cardiac arrest lasting beyond the time at which autoresuscitation was possible would be legally deceased, even if the heart had been successfully restarted through external stimulation," he argued.
The third commentary, by two other medical ethicists, countered that the dead-donor rule should be reconsidered.
Robert D. Truog, M.D., of Children's Hospital Boston, and Franklin G. Miller, Ph.D., of the National Institutes of Health, contended that death definitions based on brain function were also flawed.
"There have been persistent questions about whether patients with massive brain injury, apnea, and loss of brain-stem reflexes are really dead," they said.
Drs. Truog and Miller suggested replacing the dead-donor rule with a system that would allow some donations of hearts and other vital organs prior to a declaration of death, subject to clear criteria including informed consent.
"Whether death occurs as a result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate," they wrote. "With such consent, there is no harm or wrong done in retrieving vital organs before death."
In an editorial, Dr. Drazen acknowledged the criticisms of the Denver transplant protocol and said the journal was publishing the paper "to foster discussion of donation after cardiocirculatory death in general and its application to infant heart transplantation in particular."
But they also appeared to side with Dr. Boucek and colleagues. "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," Dr. Drazen and colleagues wrote.
Dr. Boucek and colleagues said they had not undertaken their protocol lightly.
"Before the trial was begun, an extensive period of education, discussion, and preparation was undertaken within our hospital and in programs already using donors who died from cardiocirculatory causes," they wrote. "After each transplantation involving these donors, there was extensive institutional debriefing and review by the ethics committee and the data and safety monitoring board."
Read the entire article HERE
