HEART DONATION FOLLOWING “IRREVERSIBLE” CESSATION OF THE HEART

The donation of hearts following cardiac death appears contradictory but in August 2008 the New England Journal of Medicine published a report of a research protocol involving the transplantation of hearts from three babies who had been declared dead following cardiorespiratory failure.1 In recognition of the controversial nature of this research, the journal also provided three commentaries2^–4 and an editorial5 which highlighted fundamental questions about how death is diagnosed and how far it is appropriate to push the boundaries in order to expand the donor pool.

The research, undertaken by the Denver Children’s Paediatric Heart Transplant team, took place May 2004—May 2007. The mean age of the donors was 3.7 days and the cause of death of all three was birth asphyxia. Decisions to withdraw life-prolonging treatment were made by the intensive care team with the consent of the families. Treatment was withdrawn in the operating room where cardiac function was monitored. When cardiorespiratory function ceased, the first patient was observed for 3 minutes before the organ donation process was initiated. On the advice of the ethics committee the observation period was reduced to 75 seconds with the other two patients. The hearts were then removed and transplanted into other babies. All three recipients survived.

The paper’s authors presented the use of such donors as an opportunity to reduce mortality among children whose survival depends on a heart transplant. But while the use of other organs from these donors (usually called “non-heartbeating donors”) is widely accepted, the use of hearts remains highly controversial because of the implications of this for the diagnosis of death. Veatch crystallises this problem saying “one cannot say a heart is irreversibly stopped if, in fact, it will be restarted. He goes further to say that “removing organs from a patient …