Infant Heart Transplant Controversy Continues

By Serena Gordon
HealthDay Reporter
Wednesday, August 13, 2008; 6:00 PM

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WEDNESDAY, Aug. 13 (HealthDay News) -- Three new reports challenge current guidelines on how long after cardiac death doctors must wait before taking a heart from an infant organ donor.

There's no question that organ donation saves lives, and there's also no question that there aren't enough donor organs to save everyone on the transplant list. However, deciding who is a suitable organ donor, particularly when the potential donor is an infant, is not so clear-cut.

Most people are familiar with the concept of organ donation after brain death, but organ donation is also permissible after cardiac death. Cardiac death occurs after life support is withdrawn, and the heart stops on its own. Because the heart can sometimes restart, the Institute of Medicine recommended in 1997 that 5 minutes should elapse between the time the heart stops and the organ retrieval begins. More recently, however, it's been suggested that cardiac death becomes irreversible after just one minute.

Now, in the Aug. 14 issue of the New England Journal of Medicine, surgeons from Denver Children's Hospital report on three cases in infant heart donors where surgeons reduced the time between when the heart stopped and when organ retrieval began. In one case, the time was shortened to three minutes, and in the other two to just 75 seconds.

The reason doctors might want to shorten this interval is to reduce the time that transplantable organs are deprived of oxygen, which likely increases the success of transplants. Doing so might also help increase the number of available organs for donations, which is important because as many as one in four babies awaiting a heart transplant dies while on the waiting list, according to the study.

"Donors who died from cardiocirculatory causes offer an opportunity to reduce waiting time and waiting-list mortality among children whose survival depends on a heart transplant," wrote the Denver doctors.

In two of the four accompanying perspective pieces in the same issue of the journal, two experts with normally divergent viewpoints on this issue, agreed on one thing: Under the current definition of cardiac death, cardiac function must be irreversible, and by definition, if cardiac function is irreversible, how can such a heart then be placed in another person where it starts beating again? Clearly, the loss of cardiac function was not irreversible, according to Dr. Robert Truog, director of clinical ethics from Harvard Medical School, and Robert Veatch, a professor of medical ethics from Georgetown University.