Laws Blamed for Dearth of Infant Organs

It is “not feasible” to harvest organs from brain-defective babies within the restrictions of current laws requiring that the infants be declared brain dead before organ procurement, according to a report by Loma Linda University Medical Center researchers in Wednesday’s New England Journal of Medicine.

Dr. Joyce L. Peabody, Loma Linda’s chief of neonatology, Dr. Janet R. Emery and Dr. Stephen Ashwal said that “some other mechanism” for increasing the supply of organs must be sought, such as procuring organs from animals or changing current laws so that organs could be harvested from anencephalic infants who do not meet brain death criteria.

Anencephalics are born missing parts of the brain and skull. Untreated, they usually die at birth or within several days.

The researchers found that they could maintain the function of the anencephalic’s organs by providing intensive care from birth, but that the dying process was prolonged as well. But when intensive care was delayed until death was imminent, the organs were damaged and no longer suitable for transplantation.

The report is the first account in a medical journal of Loma Linda’s controversial anencephalic organ donor program. The program started in December, 1987, two months after the medical center’s Dr. Leonard Bailey performed the first successful heart transplant from an anencephalic infant. Paul Holc, the Canadian infant who received the heart, is now living with his parents in Vancouver.

But the next 13 attempts to harvest organs from anencephalic babies failed. As a result, Loma Linda officials halted the program in July, 1988. Currently, there are no active programs for harvesting organs from anencephalic donors in the United States.

The Loma Linda report was published along with two commentaries, one supporting and one opposing a change in current laws so that organs could be harvested from anencephalics before they were declared brain dead.

Brain death, the legally accepted standard for death, means a complete loss of brain function, even though the heart may continue to beat. While anencephalics are born missing much of the brain, the brain stem, which controls breathing and other reflex activities, may continue to function.

At a press conference Wednesday, Peabody said that changing the law “would save the greatest number of infants.” But she cautioned that the law should not be changed unless a consensus supporting it developed within society. “I personally don’t think we have a consensus right now,” she said.

Medical advances have made transplants in newborns feasible, but the shortage of small organs sharply limits the number of infants who might benefit from this therapy.

Loma Linda physicians had hoped that the anencephalic babies could be declared brain dead while their heart, liver and kidneys remained undamaged and suitable for transplantation.

But critics contend that placing such newborns on life support raises ethical concerns, because life was being prolonged not for the benefit of the patient but for the sole purpose of harvesting organs. They also calculate that few infants might benefit. For example, Dr. D. Alan Shewmon, a child neurologist at UCLA Medical Center, has estimated that the annual number of infants in the country who might benefit 10 years from now is “at most” 25 kidney recipients, 12 heart recipients and 7 liver recipients.

The new Loma Linda report describes attempts to harvest organs from 12 live-born anencephalic infants. At birth, their hearts, livers and kidneys appeared to be normal.

Two of the 12 infants met the criteria for total brain death within one week of birth, an arbitrary time limit set by the medical center on how long the newborns would be eligible to be considered as organ donors. But no organs were procured.

The report attributed the failure to harvest organs to a number of factors, such as a lack of suitable recipients and “the fear of transplantation centers that they would become involved in the controversy over donation of anencephalic organs, potentially jeopardizing their transplantation programs.”

Six of the 12 infants were given intensive care from birth and six received intensive care when signs of imminent death developed. The researchers found that when life support was provided from birth, the function of the heart, liver and other organs was maintained but brain death was less likely to occur. When life support was delayed until death was imminent, brain death was more likely to occur but the organs deteriorated and were no longer suitable for transplantation.