Ethical debate erupts over organ donation

CHICAGO (AP) — The number of suitable juvenile organ donors could rise 42 percent if organs are taken from patients before they are declared brain-dead, a study found.
The study in the June issue of the journal Pediatrics contributes to the ethical debate over the use of donors who are “heart-dead” but still have minimal brain activity.
Arthur Caplan, a medical ethicist at the University of Pennsylvania, said the study underscores the need for a national consensus on how to deal with such patients.
Currently, only a few hospitals across the country use such patients as donors, he said.
“There’s a concern that it’s hastening the death just to get the organs,” said Dr. Tracy Koogler, a critical-case physician who co-wrote the study at Children’s Hospital of Philadelphia. “There are also some concerns of some right-to-life people that it may be killing for organs.”
But the study’s authors argue that neither is true and that their study shows “benefits exist for individuals and society” from such transplants.
The study was part of the hospital’s efforts to evaluate the practice; it doesn’t currently remove organs from patients who still have brain activity.
These patients typically have suffered catastrophic brain injury that leaves them in a vegetative state. Once life support is withdrawn and their hearts stop beating, organs could be removed within minutes.
Experts disagree on how long surgeons should wait to make sure the heart doesn’t spontaneously restart. The authors suggest waiting two to four minutes, though some have recommended 10 minutes. Waiting longer would allow the organs to begin deteriorating.
The authors note that in rare cases, some patients may still have enough brain activity to perceive pain when life support is removed and should be given pain medication.
Last year, the private Institute of Medicine studied the controversy at the government’s request and called such transplants an important and “ethically acceptable” approach.
The authors of the latest study reviewed records of all 6,307 critical-care patients at the hospital from 1992 through June 1996. Of the 111 patients taken off life support, they found that more than 25 percent could have been “non-heartbeating donors.”
If they had donated at the same rate as patients who already were brain-dead, 60 percent would have been donors, resulting in a 42 percent increase in total juvenile organ donors. Koogler said similar results could be expected elsewhere.
That translates into about 300 more donors and thousands more organs available each year for the more than 50,000 patients on transplant waiting lists nationwide. There were 688 pediatric organ donors in 1997, according to the United Network for Organ Sharing, which runs the nation’s transplant system.
Dr. Mark Fox, an ethics committee member at the network, called the procedure “a legitimate course to pursue” once the ethical issues are thoroughly examined.