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08/14/2008

Harvesting Hearts As Fast as One Can: Is It Ethical?

The controversy surrounding the New England Journal of Medicine article about using cardiac death as the criterion for death in pediatric heart transplant has sparked significant discussion among ethicists. Bioethicists have been asked to consider whether it is ethical that precious organs were harvested within literally seconds (75 to be exact) of cardiac death to preserve the integrity of the hearts prior to transplantation into their recipients.

One has to wonder: were the parents’ decisions rushed in order to harvest organs, or if not in these cases, could they be in the future if this became standard practice? Does preserving the integrity of the organ justify whatever sacrifices of considered judgment might be made?

Personally, this policy seems to make sense for children who have experienced cardiac death and whose parents clearly have made up their minds that they wish to donate their child’s organs to another needy recipient. However, for those parents whose child’s death is sudden, which would be the case for many children whose hearts are healthy in the first place, and/or who may not have considered judgments about when they would consider their child dead (a horrible thing to even think about) and under which circumstances they would wish to donate organs, I am concerned that these parents may not be able to make adequately informed and rational choices about organ donation. These three cases presented by the NEJM article clearly did not suffer from these problems–but could other less carefully thought out protocols? No doubt.

Moreover, I question the NEJM authors’ assertion that using cardiac death as the definition would increase substantially the number of donors available for pediatric heart transplantation. Certainly, it would make more persons and families POTENTIAL donors, but unless the majority of those parents choose to donate their child’s organs one has to wonder if embracing this policy, even just for heart transplantation, would be justifiable in virtue of the number of actual donations gained.

Stay tuned to the blog for more updates as comments and commentaries come in about this issue. There no doubt it is bound to be a conversation starter among ethicists, doctors, and policy-makers all around.

Summer Johnson, PhD

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