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Dec. 17, 1998 - Mrs. Richards, the mother of a brain dead child, urges Dr. Carter to keep her child alive by the use of all possible heroic measures, including the use of mechanical procedures. After careful explanation that it would be medically futile to do so, and that only a do not resuscitate (DNR) order would be appropriate, the mother reluctantly agrees. While her child, Stephen, is kept technically alive in a persistent, vegetative state, the possibility of a liver transplant is suggested to her, with a 'match' having been found. This story raises a variety of ethical and legal issues.

An incapacitated patient is unable to make medical treatment or organ donation decisions based upon informed consent. Where, as in this case, the patient is also a minor, and, therefore, also lacking legal capacity, a parent can make such decisions as the childís natural guardian. Some states would require the appointment of a guardian (or surrogate) of the person through a formal, time consuming court procedure and the guardian chosen could be an 'independent', unrelated, third person. Court procedures could, therefore, tragically negate organ donor opportunities, and also wastes scarce medical resources.

A parent's initial response to being informed of a child's pending death may well be emotionally driven and be framed by a distrust of the brain-death diagnosis, or a sense of guilt if the parent 'lets go' of the child, or some responsibility for the causing impending death. The concept of 'brain death' defining death is accepted in most societies for both legal and medical purposes. While, useless or 'futile care' may be impossible to define in many medical cases, it is clearly applicable in this ER episode. Had the mother's insistence upon 'heroic measures' continued to conflict with the medical conclusion of care being futile, the latter should prevail, resulting in valuable health care resources not being wasted.

Voluntary organ donation and transplantation has become a way of life in the United States post World War II. There are approximately 62,000 people currently on waiting lists for transplants, with 11 people dying each day (4,000 per year) while awaiting transplants. Organs are donated annually from about 5,500 cadavers. The Federal government, through the Health and Human Services Department and state licensed transplant centers, regulates organ allocation. It is against public policy and illegal to buy or sell organs in the United States.

The 20th century concept of organ donation caused every religion to examine the process in the context of religious values and ethics. Ancient principles concerning 'respect for the dead', 'burying a decedent's entire body', and similar concepts, were analyzed. After debate, most organized religious organizations concluded that organ donation represented a 'gift of life' which trumped any other values relating to death or burial practices. ER has underscored the value in distributing scarce organs to the many patients who need them: true gifts of life. One life may end, but one or more lives continue.