The Use of Anencephalic Neonates as Organ Donors JAMA 1995

1
The Use of Anencephalic Neonates as Organ
DonorsJAMA 1995

• James G. Anderson, Ph.D.
• Professor of Sociology
• Purdue University

2
Current Law

• Requires persons to be dead before organs may be
  removed for transplantation.

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Shortage of Organs for Infants and Children

• Each year 500 children need a heart, 500 children
  need a liver, 4-500 children need a kidney in the
  U.S.
• 30-50 of children under 2 years die while
  waiting for a transplant
• Overall 40-70 children die while waiting for a
  transplant

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Anencephaly

• Each year in the US 2000-3000 infants are born
  with only a brain stem that supports the bodies
  autonomic functions
• These infants do not experience consciousness
• The infantas have a short life span -
  less than 50 survive one day or more
  less than 10 survive more than one week

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Benefits of Parental Donation

• Many children will be saved
• Parents find psychological stress alleviated
  somewhat

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Objections

• Prohibition against removal from living persons
• Inaccuracy of diagnosis
• Slippery slope concerns
• Few useable organs are obtained
• Public trust will be reduced in the organ
  procurement system

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AMA OpinionIt is ethically permissible to use
anencephalic neonates as organ donors if

• The diagnosis is certain and is confirmed by two
  persons with special expertise.
• The parents of the neonate initiate any
  discussion about organ donation and indicate
  their desire in writing.
• There is compliance with the Councils Guidelines
  for the Transplantation of Organs

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Case A

• While Theresa Ann Campo Pearson was in the womb,
  the tube around her embryonic central nervous
  system failed to close at one end. Consequently,
  she never developed a brain. When her parents
  learned at the eighth month of pregnancy that
  their baby would die within days of birth, they
  petitioned the Florida courts to declare Theresa
  brain dead. If Theresas organs could be taken
  while her brain stem kept her heart and lungs
  functioning, her parents could offer her kidneys,
  lungs, liver and heart to infants awaiting
  transplants.

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Questions

• Should Theresas parents request be granted
  since most infants needing a transplant will die
  before one becomes available?
• If the courts rule in favor of the parents
  request, will this allow some good to come from
  this tragedy?
• Would granting the parents request result in the
  devaluation of human life where terminally ill
  patients will come to be viewed as collection of
  spare parts?

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Question

• Would declaring the baby brain dead in order to
  take her organs amount to killing a dying baby so
  that its organs could be used by someone else?
• Should there be an exception to the brain death
  rule in the case of anencephalic neonates?

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Case B

• Baby Gabrielle was born in London, Ontario
  without most of her brain. In a radical
  departure from routine medical practice, the
  infant was placed on a respirator so that her
  heart could be salvaged for a transplant
  operation. Gabrielles parents stated that
  They wanted to see that their baby would touch
  others and contribute to life in some way. The
  baby, while still connected to a respirator, was
  flown to California. After 48 hours, doctors
  turned off the respirator every 6 hours to test
  her breathing. When it was determined that
  Gabrielle could no longer breathe without the
  respirator, she was declared legally brain dead .
  Her heart was transplanted into a newborn boy.

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Questions

• Did placing Gabrielle on a respirator prolong her
  life and suffering beyond normal expectations?
• Was it ethical to keep baby Gabrielle alive just
  for the purpose of preserving her organs for
  transplantation?
• Does this case establish a precedent whereby the
  life of other terminally ill patients could be
  prolonged in order to preserve their organs for
  donation to others?

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Case C

• Ms. F, a woman in 32nd week of her pregnancy, is
  seen by her physician for a routine prenatal
  exam. During the exam, it is noted that the
  fetuss growth is less than expected and the
  patient is sent for an ultrasound exam.. The
  ultrasound shows that the fetuss head is grossly
  malformed consistent with the diagnosis of
  anencephaly. Ms.Fs physician explains that, if
  born alive, the child will die within days. There
  are three choices abortion, continuing the
  pregnancy and allowing the child to die, or
  continuing the pregnancy with the hope of
  donating the childs organs. Ms. F chooses the
  third option. At 38 weeks there is decreased
  fetal movement, a sign that the fetus may be
  dying. Ms. F requests a C-section so that the
  childs organs could be used for transplantation.

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Questions

• Should her physician accede to Ms. Fs request?
• Are the risks to Ms. F of a cesarean section
  justified in this case?