Infant Heart Transplant Controversy Continues

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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.

"I don't know how you can ever have a patient that meets the criteria for irreversible loss of function, and then reverse that function in someone else," said Veatch. Using other organs after cardiac death is possible, he said, but if surgeons are declaring someone dead because their heart has stopped, then under the current law, that heart shouldn't able to be used in someone else, no matter how long surgeons wait.

Truog also thinks the debate over how many seconds to wait before declaring cardiac death misses the point. "If death means irreversible loss of cardiac function and that heart beats in someone else's chest, it's not irreversible, is it?"

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He said the debate over whether transplant surgeons are hastening death is similar to the debate over whether or not withdrawing mechanical ventilation was killing a patient or not from 30 years ago. Today, he said, many deaths occur in intensive care units when mechanical ventilation is withdrawn.

If a patient, or in the case of an infant or a child, the patient's surrogate, provides consent for organ donation prior to cardiac death, Truog said in his perspective, "With such consent, there is no harm or wrong done in retrieving vital organs before death, providing that anesthesia is administered. With proper safeguards, no patient will die from vital organ donation who would not otherwise die as a result of the withdrawal of life support."

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