When Does An Infant's Life End?

Doctors are locked in debate over a new approach to infant heart transplants, in which surgeons remove the organs of babies before they are declared brain dead.

Some say the approach saves lives by providing more viable organs to babies who have a chance at survival. But others say the practice devalues one life to try and save another.

The protocol, known as transplantation after declaration of cardiocirculatory death (DCD), allows for the transfer of organs following the stoppage of the heart, rather than brain death. In cases where the parents choose not to resuscitate, their infant's organs could be removed about a minute-and-a-half after the heart stops beating.

This type of organ transplant has previously been done with adult donors, and a new study looking at the use of the method in three infants determined that the transplants were just as successful as those taken from infant donors following brain death.

"There's potential to dramatically increase the opportunities for organ donation," said Dr. Mark Boucek, a pediatric heart surgeon at Joe DiMaggio Children's Hospital in Hollywood, Fla., who took part in the study while at Denver Children's Hospital.

"What we have shown… is that the organs are essentially equal between children who donated organs following brain death to children who donated organs following cardiocirculatory death," he said.

The results are published in this week's issue of the New England Journal of Medicine.

According to Boucek, applying the heart death standard to infants comes as a way of overcoming two problems he has faced over the years: the number of infants who die while awaiting a heart transplant and the number of infants who die with parents wanting to donate their infants' organs but cannot.

During the course of the study, Boucek said that 12 parents volunteered their child's organs, though in nine cases they could not be matched to an infant in need of a heart transplant.

Crossing the Line?

But what some doctors see as a lifesaving procedure is raising concern among other physicians who fear doctors will be more focused on preserving an infant's organs than doing everything possible to save its life.

"I understand the concerns people have... but this is a misguided endeavor," said Dr. Michael Grodin, a professor of health law, bioethics and human rights at the Boston University School of Public Health.

He said this procedure -- whether done in children or adults -- crosses a line in terms of when organs can be taken.

"That line is clear and bright, and I think it needs to stay that way," Grodin said.

Indeed, doctors disagree on the exact point when a patient can be declared dead, revealing that the question of when life ends is as debatable as when it begins.

One central concern is the heart itself. Though the organ could technically be restarted in the donor infant, it is not. But once the donor is declared dead, it is transplanted into the organ recipient and then restarted.

"The fact that the hearts could be restarted in other infants whose prognoses were better does not suggest that the hearts should have been kept going in the bodies of the original donors," said R. Alta Charo, a professor of law and bioethics at the University of Wisconsin Law School.

"In the donor bodies, the continued pumping of the heart was futile, given the scope of damage elsewhere. But in the recipients, the pumping hearts could lead to salvaged lives," she said.

But Grodin disagreed.

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