Quick harvesting of hearts raises ethics questions
BOSTON (Reuters) - Doctors who waited just 75 seconds after the final heartbeat before removing the hearts of dying newborns for transplants said on Wednesday they improved their odds of success but have also raised ethical questions about organ harvesting.
The cases of two children who died between May 2004 and May 2007, and a third in which doctors waited three minutes, are detailed in a report and a series of commentaries in the New England Journal of Medicine.
The technique is controversial because the waiting time recommended by the Institute of Medicine has been five minutes, unless the patient is brain dead. The three babies were not, although all had severe brain damage.
But the doctors who performed the transplants said moving quickly helped save the lives of three infant recipients.
The matter is particularly critical for infants who desperately need a heart transplant. "Each year, as many as 50 infants are placed on the waiting list for cardiac transplantation but die while waiting, owing to the lack of a suitable donor heart," the journal's executive editor Dr. Gregory Curfman and others wrote.
Historically, death was defined by a stopped heart. But the longer an oxygen-starved heart sits in a warm chest cavity, the lower the likelihood it can be successfully transplanted.
So doctors are struggling to define "circulatory death," to determine when the heart has beaten for the last time once life support has been withdrawn.
WAITING FOR DEATH
In the first case, the Denver team waited three minutes after what appeared to be the last heartbeat. But because there has never been a case where the heart restarted itself after 60 seconds, they waited only 75 seconds for their next two cases.
Dr. Mark Boucek, who led the Denver team and who now is at the Joe DiMaggio Children's Hospital in Hollywood, Florida, said that when the decision is made to let a baby die, life support is removed and the heart quickly begins to deteriorate as it suffers from oxygen starvation, making it less viable for transplantation.
In the case of the three newborn infants, death took as long as 27.5 minutes.
"Adding an additional two, three or five minutes, or even 75 seconds, does add some additional injury. It could be 10 percent," he said in a telephone interview.
"The 6-month survival rate was 100 percent for the 3 transplant recipients and 84 percent for 17 control infants who received transplants procured through standard organ donation," Boucek's team wrote.
All three dying infants, each just a few days old, had severe brain damage, were given painkillers and an anti-anxiety drug before life support was removed.
"As a result of their investigational protocol, three babies are now alive; had the procedures not been performed, it is virtually certain that all six babies would be dead," Curfman and the other editors wrote.
Dr. James Bernat of Dartmouth Medical School in Hanover, N.H., predicted in one commentary that when leaders in relevant fields reach consensus, they will conclude that harvesting after just 75 seconds is too hasty.
"Removing organs from a patient whose heart not only can be restarted, but also has been or will be restarted in another body, is ending a life by organ removal," Dr. Robert Veatch of Georgetown University in Washington concurred.
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