The difference between an accepted medical practice and allegations of immorality, even homicide, can be measured in minutes or turn on a word.
Between 2004 and 2007, a medical team at Children’s Hospital in Aurora removed the hearts of two dying newborns less than two minutes after those hearts stopped beating. The hearts were transplanted into two other infants. In a third case, the doctors waited three minutes.
Children’s Hospital’s transplant procedure, part of a federally funded study first described in Thursday’s New England Journal of Medicine, pushed the boundaries of what is considered ethical organ retrieval, critics say, by so quickly removing and restarting hearts.
The dead-donor rule requires that an organ donor be dead before taking vital organs.
Federal and Colorado law — the law in most states — holds that death is the irreversible cessation of the brain, heart or respiratory system.
The previously accepted definition of death had been complete and irreversible loss of brain function. In the past 15 years, donor programs, hospitals and federal officials have accepted a more quickly discernible end to life — cardiac death — to make more organs available for transplant.
A widely accepted donor-program protocol is to wait five minutes before removing organs from a patient whose heart has “irreversibly” stopped because the heart sometimes, though rarely, spontaneously begins beating again. A few programs use a period of only two minutes.
The Children’s Hospital study involved three cases of severely brain-damaged newborns whose families consented to disconnecting them from life-support systems. Critics say the procedures violated ethical standards and perhaps the law by waiting as little as 75 seconds after a heart stopped and then restarting that heart in another infant.
“There is a gray zone. These fellows are not in the gray zone,” said Robert Veatch, a bioethicist at Georgetown University.
The team was aggressive in waiting only 75 seconds, Veatch said, but “the key issue is that a heart that can be restarted in another infant wasn’t irreversibly stopped.”
Dr. Stefan Mokrohisky, chairman of Children’s Hospital’s ethics committee, said the objections are misguided.
“There are no reports of a stopped heart spontaneously starting up beyond one minute,” Mokrohisky said. “We could see no moral difference for the donors of the hearts or for society between waiting 75 seconds and waiting 120 seconds. We saw a physiological difference.”
The shorter interval provided a better medical outcome, he said.
Any heart can always be mechanically restarted, Mokrohisky said, and the real test of viability is whether there was any chance that heart would be restarted in the donor.
There was no intent by the families to restart the hearts in the donor infants after ending life support because of their terminal brain damage, Mokrohisky said.
“In terms of the donor, it was an irreversible cessation of heartbeat and cardiac function,” Mokrohisky said.
Electa Draper: 303-954-1276 or edraper@denverpost.com
