A detailed description of the transplants in Wednesday's issue of the New England Journal of Medicine says the surgeons removed the hearts of severely brain-damaged newborns less than two minutes after the babies were disconnected from life support and their hearts stopped beating. The organs of the babies were transplanted into infants who would otherwise die.
The organ-retrieval procedures that were carried out as part of a federally funded research project have been highly praised by many advocates for organ donation, saying the method was a life boon to many terminally ill babies who received heart transplants.
Infant donor hearts are usually removed only after the child is declared brain dead, which has limited the number of hearts available for infant transplant. The U.S. now has 44 infants awaiting heart transplants and about one fourth of babies needing heart transplants die before an organ become available.
However, critics argue that it is ethically and morally wrong for doctors to remove hearts from patients, especially babies who are not brain-dead, and suggested that the Denver doctors should wait long enough to make sure the infants met either of the long-accepted definitions of death.
The time between cardiac death and pronouncement of death for one infant was three minutes. For two other donors, it was 1.25 minutes. With the consent of the babies' parents, the physicians decided to end mechanical life support that had been keeping the infants alive, the article said.
Critics say that the procedure endangers the care of dying patients as the doctors can hasten the death of a potential donor. Death in medical terms is defined as complete, irreversible cessation of brain function or of heart and lung function.
The three transplants were done at the Denver Children's Hospital from 2004 to 2007. All three recipients are still alive, according to the study.
The highly controversial procedure, known as donation after cardiac death, has been intensely promoted by federal health officials, transplant surgeons and organ banks. It involves patients who have devastating and irreversible brain damage but are not actually brain-dead. Their families consent to removing life support, and their organs are removed minutes after the patients' hearts stop beating.
The authors of the report have called for review of current transplant rules. They are also urging lawmakers to issue guidelines on the exact time death can be pronounced on the basis of loss of heart function.
