Baby Called Brain-Dead; Organs OK for Donation

The first anencephalic baby to be kept alive in the United States solely for the purpose of preserving his organs for donation has been declared brain-dead, clearing the way for his liver and perhaps heart to be transplanted into another infant.

Officials at Loma Linda Medical Center described the baby’s quiet death as vindication of the controversial procedure, saying they had succeeded in preserving the infant’s organs without causing him pain or inordinately prolonging his life.

“My staff have said they feel very, very good,” Dr. Joyce Peabody, chief of neonatology at Loma Linda, said in a press conference. “They do not feel that in any way the dignity or respect of this baby was compromised.”

The seven-pound baby, born Tuesday with a condition called anencephaly, in which most of the brain is missing, was first declared brain-dead at about 9 p.m. Wednesday. He had been put on a respirator since his birth 25 hours earlier in an Anaheim hospital. The infant remained on a respirator after the declaration of brain death so that his organs could continue to receive oxygen, which is necessary if they are to be suitable for transplanting.

The baby, identified only as Baby John, was entered into the national organ donation system to be matched with other babies needing his organs. System officials have located four potential recipients with the same blood type in need of a liver, Peabody said.

She said transplant system officials would decide within a day or two which infant would receive the liver. Then a team of surgeons probably will fly here to “harvest” the organ and take it away for transplantation.

Although such procedures have been used at Loma Linda on an anencephalic newborn from Canada, they have never been used previously on such a child born in the United States.

The entire procedure, being pioneered at Loma Linda under guidelines drawn up late last year, has been attacked by ethicists and others who say it is morally wrong to keep a person alive on a respirator solely for the benefit of someone else.

Some have also argued that there are no proven standards for determining brain death in infants under 7 days old or in anencephalic infants. For that reason, they say there is a risk that organs might be removed from a living human being.

“What they are doing here, I think, is an indication of the danger--that these babies are being regarded as another species,” Alexander Capron, a prominent specialist in determination of brain death, commented Thursday. “They’re not regarded as human beings.”

Peabody, however, said she was encouraged by the case.

She said the hospital had accomplished its aim of maintaining the baby’s organs “without rendering any apparent discomfort or distress to the baby.” That is, the baby was lying comfortably and showing no signs that the breathing tube was bothering him, she said.

Second, Peabody said, brain death occurred “in a reasonable period of time” and was “clear and certain” to three neurologists and two neonatologists who examined the baby. Critics have said that the respirator could inappropriately prolong the process of dying.

Third, Peabody said, her staff felt satisfied with the conduct and outcome of the case and the way the baby had been treated. The baby’s mother also said she was “heartened” by the outcome of an event that “would otherwise have been a tragedy,” Peabody said.

Finally, Peabody pointed to the four potential recipients.

“There is, in fact, a need in the country at this time for four livers matching this baby’s blood type,” she said in an interview after the press conference. “So clearly something good came from the effort.”

As for the controversial question of brain death, Peabody said determination was based on the absence of any brain stem reflexes, gag reflexes, blinking and other response to stimuli, and the absence of any spontaneous breathing in response to a stimulus.

Under questioning, she said the baby did receive Demerol, a painkiller, twice during and shortly after being transported from Martin Luther Hospital in Anaheim, where he was born, to Loma Linda. She denied the suggestion of some critics that painkillers might prompt a response that could be misinterpreted as brain death.

“We are quite convinced that there was no Demerol in the baby’s body at the time of death,” she said, noting that the last dose was administered 11 hours before the first determination of brain death.

However, Capron, a professor of law, medicine and public policy at USC who helped draft the law on brain death in California, Thursday questioned the hospital’s ability to diagnose brain death in newborns.

Capron said criteria for determining brain death in older children were recently developed and remain controversial. But he said no such criteria have been established for infants under 7 days old.

“They don’t have the standards for knowing what they claim to know,” Capron said of the doctors at Loma Linda. He suggested that they are willing to risk a mistake because they know that almost all anencephalic babies die naturally within seven days.

Also critical of the procedure Thursday were officials of the National Right to Life Committee. They called for a moratorium on the use of body parts from anencephalic babies until questions concerning the definition of brain death are resolved.

“Our main concern is the very real possibility that body parts would be taken from children who are not yet dead,” said Brian Johnston, western director of the national organization.

Anencephalic babies are born with neither the tops of their skulls nor the higher brain centers that control thought and feelings. With only a small brain stem to power their lungs and heart, such infants usually die within days, or even hours, of their birth.

Some 3,500 anencephalic babies are born in this country each year. About half are born dead. Ordinarily, the others are given warmth, hydration and nourishment and die within a week. Because they die slowly, their organs deteriorate and are unsuitable for transplantation.

In hopes of salvaging those babies’ hearts and livers for other newborns needing transplants, Loma Linda officials late last year drew up guidelines under which brain-dead anencephalic babies would be used as organ donors.

Arthur Caplan, an ethicist who has specialized in the area of transplantation and who supports the use of anencephalics as sources of organs, said Thursday that the events at Loma Linda represent a significant step in the selection of organ donors.

“I think the significance is that we are moving away from those who can in a sense exercise choice (over whether to donate their organs) to those who can’t,” said Caplan, director of the Center for Biomedical Ethics at the University of Minnesota in Minneapolis.

“People will look back and say, ‘This was the time when American medicine decided to use as sources human beings not in a position to choose,’ ” he said. “I think that is significant ethically.”

Janny Scott reported from Los Angeles and Louis Sahagun from Loma Linda.