Loma Linda Will Delay Respirator Use : Center Modifies Baby-Organ Harvesting
Despite a string of seven failed attempts, Loma Linda University Medical Center is continuing a controversial program to harvest organs from anencephalic infants, but with a “minor” change designed to improve the likelihood of success.
Dr. Joyce L. Peabody, the Loma Linda neonatologist in charge of caring for the infants, said Friday that medical center physicians will change their practice of placing the babies--who are born without parts of the brain and skull--on respirators as soon as they are born.
Instead, the physicians will wait until the infants experience breathing or circulatory difficulties before employing artificial life support systems. Without such measures, anencephalic babies are usually either stillborn or die within days of birth.
Peabody said the “minor modification” was made in the hope that more babies can be declared brain dead so that organs such as the heart and liver can be transplanted. The future of the program will be assessed again after “five to seven” babies have gone through the modified procedure, she said.
“Supporting the baby artificially from birth may delay the natural dying process and interrupt the development of brain death,” Peabody said in a telephone interview.
On the other hand, Peabody said the change makes it more likely that an anencephalic’s body would be irreversibly damaged from lack of oxygen during the dying process. Such damage might render the organs useless for transplant.
One outside expert in medical ethics said that the change is potentially disturbing because it appears to have been undertaken primarily to “maximize” the number of harvested organs.
“The modification reveals that we don’t know what the proper management approach is,” said Art Caplan, director of the Center for Biomedical Ethics at the University of Minnesota. “It is a subtle difference between managing these infants to maximize the likelihood of successful organ procurement versus managing the dying of the infants to minimize their suffering.”
Parents must consent for their infants to enter the program, which has been controversial because the anencephalics are kept alive not for their own benefit but in the hopes of providing benefit to other children.
In addition, medical experts are uncertain whether it is possible to accurately diagnose brain death within the first week of life.
Loma Linda has had seven anencephalic cases since it began its program last December. One baby was stillborn. Five did not meet brain death criteria within seven days of birth, a time limit set by Loma Linda on how long they would be considered eligible organ donors; four of them died shortly after being taken off the respirator. The fifth is still alive. And no recipient could be found for the organs of the single baby that was declared brain dead.
In a related development, Peabody said Loma Linda expects to begin a research project “to add to our scientific knowledge about how anencephalic infants die.” The project will involve additional blood tests and ultrasound examinations of the anencephalic’s vital organs.
Parents would have to give a separate consent for their brain-defective infants to be entered into the research program, Peabody said. Participation, however, would not be a “necessity” for the infants to be considered as organ donors. The proposal, which is still being drafted, is expected to be considered by Loma Linda’s Institutional Review Board within the next several weeks.
