Friday, August 22, 2008

Infant Heart Transplant Controversy

Last week the New England Journal of Medicine published articles on Organ Transplants that challenged the current dead donor rule and challenged the limits to cardiac death donation.

One of the articles by Boucek et al, entitled: Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death reported on 3 cases from the Denver Children's Hospital Pediatric Heart Transplant Team.

Link to the article:
http://content.nejm.org/cgi/content/full/359/7/709

The Boucek et al article was followed by a commentary by Robert Veatch, a long-time supporter of Organ Donation who questionned the ethics within the Boucek et al article.

Link to the article:
http://content.nejm.org/cgi/content/full/359/7/672

The Boucek et al, article in the New England Journal of Medicine, reports on the decision from the Denver Children's Hospital to remove the heart from an infant at 3 minutes after cardiac death and two infants at 75 seconds after cardiac death. The accepted limit for removing a heart after cardiac death is 5 minutes to ensure that the donor's heart cannot spontaneously restart.

It is likely that the reason the doctors shortened the time interval before removing the heart was to reduce the time that transplantable organs are deprived of oxygen, which would likely increase the success of transplant.

The ethical question is: Are the organ donations done after three minutes or less after cardiac death done on donors who are actually dead or is the removal of their organs the cause of death.

Veatch explains that a heart could be restarted after a period of 5 minutes by means of external stimulation.

The organs in the Boucek et al article may have been taken from infants who were not actually dead. This is a very big concern because the organ transplant may be the cause of death.

Once it becomes acceptable to remove organs from people who may not be dead, or as the Troug and Miller article suggest, from people who are not dead but have consented to the act. How will our system be capable of protecting the most vulnerable in society if we are able to remove organs from people who are not dead?

Link to Troug and Miller article:
http://content.nejm.org/cgi/content/full/359/7/674

Will pushing the boundaries on organ donation result in a society that removes organs from people who are cognitively disabled but not otherwise dying?

Link to the article in the US News and World Report:
http://health.usnews.com/articles/health/healthday/2008/08/13/infant-heart-transplant-controversy-continues.html

2 comments:

Ironsides said...

That really is an area which needs to be monitored. That leaves babies who are known to be mentally deficient in a dangerous situation.

Yesterday, I was reorganizing the clutter on my computer and website bookmarks from rss feeds on my Microsoft, Yahoo and Google pages when I stumbled across the CMA 2008 Report Card:

http://www.newswire.ca/en/releases/archive/August2008/18/c4794.html

Doctor Brian Day says: ""In some ways, mental illness is the final frontier
of socially-acceptable discrimination. Can you imagine the public uproar if
mental health was replaced with race, gender or religion?""

This is a pretty strong statement coming from a doctor, and it's a statement I think Disability Rights and Living With Dignity activists need to educate the public with.

Alex Schadenberg said...

Dear Ironsides:

You and I know that the acceptance of transplanting organs from infants who might not be dead is from the fact that these children are viewed as not worth living.

Instead of giving them a chance at life we will simply remove their organs to give another baby who does not have a disability, a chance at life.

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