Child Heart Transplant Cases Raise Ethical Issues

Armen Hareyan's picture
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Three child heart transplant surgeries have been successfully conducted by Denver doctors and have saved lives of all transplant recipients. However, the cases have raised ethical issues among health professionals because the hearts were removed a very short time after stopping.

The first case of child heart transplant took place in May 2004, when the transplant heart was removed 3 minutes after the last beat. The second case took place in May 2007 and recently this year, when heart was removed 75 seconds after stopping. Since there has never been reported cases when heart starts working 60 seconds once it stops, physicians decided that 75 seconds is quite enough to wait and to make sure that the heart has stopped forever.

However, according to Institute of Medicine estimates, the waiting time should be 5 minutes and a person can be considered as dead only after the patient's brain is totally damaged. In these 3 transplant cases brains were only damaged partially, but the damages were considered fatal. This is why the issue is raised questioning when a person can be considered dead and when an organ can be removed from the body.

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From an ethical point of view it is better to wait until there is no hope at all that the the heart will beat again and to make sure that the brain is totally damaged. But from a scientific point of view a very short period of time can damage transplant organs, which experience oxygen starvation, and transplant recipient will not really benefit from the surgery. Quickly removed and transplanted organs provide with 100% success rate for recipients, while other cases provide with only 84% success, which is a significant difference.

In these child heart transplant cases doctors gave painkillers and anti-anxiety drugs to the dying babies before cutting life-support system off. Thanks to quick and effective surgeries, all three transplant recipient babies are now alive and totally healthy. If transplant hearts were not removed quickly, all 6 babies would die.

Moreover, each year there are 50 infants placed on waiting list to receive donor organs, but almost all of them die because of organ shortage.

The procedure, when donor organ can be removed soon after heart stops, is called donation after cardiac death and is encouraged by the federal government, organ banks, giving an opportunity to donate. After the procedure was legally approved, the number of cardiac death donor cases increased to 793, which accounts for 10% of all donor cases.

However, critics insist that the dying patients should be officially and legally declared as dead before removing organs, especially in cases where children are involved.

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