When Does An Infant's Life End?

"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.

"To my standard, the person is not dead," he said. "Taking the heart of somebody [when there's a] question of whether they're dead or not is a serious concern."

In this case, he said, the patient clearly does not meet the necessary criteria of having the heart irreversibly stopped.

"If you're going to take out the heart, obviously the heart starts up again or you couldn't do the transplant, so it's clearly not irreversible," he said.

Grodin also raised the issue of public perception.

"I think that we need to be very concerned about the public's sensibility and sensitivity," he said.

But Boucek said that those concerns can be eliminated by transparency in the process of deciding when and how to donate a dying infant's organs.

He said the parents' prerogative would determine whether the organs can be donated, and only after death was declared by one medical team would another come to transfer the donated organs.

"I think the public knows when death occurs," he said.

'Bending the Rules' a Concern

One concern, raised by Dr. John Lantos, a bioethicist and pediatrician at the University of Chicago, was the lack of a clear protocol to determine when further treatment is futile.

Although he does not find this method of declaring an infant dead before preparing for organ donation ethically problematic, "the problem will arise, as it creates a temptation to bend the standards of futility in order to increase the supply of donors," he said.

Those concerns were echoed by Dr. Steven LeFrak, director of the humanities program in medicine at the Washington University School of Medicine.

"While it sounds very erudite for the authors to refer to withdrawing 'futile' care in their population, what exactly this means is neither defined by them nor is there a generally accepted meaning of this term in medical or medical ethics circles," he said.

"As a result of these problems, this paper is more disturbing than groundbreaking. Perhaps that is because in fact the ground it breaks, the elephant in the room if you will, is the elephant of taking vital organs from living patients so that others may live."

But others counter that not taking steps to preserve organs that would otherwise perish is taking away lives.

"Once it is determined that it will be acceptable for a family to have artificial life support discontinued, not using viable organs wastes precious life-saving resources," said Rosamond Rhodes, director of bioethics education at Mount Sinai School of Medicine. "Using the organs to preserve life has to be ethically better than wasting them, particularly when it costs the lives of other babies."

And as Dr. Vivian Tellis, former director of the transplant program at Montefiore Medical Center in New York, explains, donating the organs might help relieve some of the mental burden from an unfortunate situation, when the family is faced with the death of a child.

"At this painful time for a family, when they make a decision to halt artificial means of support in a child, it can often be an act of kindness to offer the family a chance of helping another child, and so get some solace in an otherwise unbearable circumstance."

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