Death is Not the End of Life

Things I know about heart transplants:

• Hospitals don’t decide which organs are suitable for donation. The Organ Procurement and Transplant Network makes that decision.

• When death is imminent, the hospital is required to contact the Organ Procurement and Transplant Network before:
  • Withdrawing ventilation

  • Speaking with the family regarding options
• Once a ventilator is removed, a body must be in an operating room within (maximum) 5 minutes to remove a heart for donating (though some experts say that irreversible damage starts occurring within as little as 60 seconds). Once removed, that heart must be placed in another body within (maximum) 4 hours.

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Regarding heart transplants, every second counts. But there are still rules that must be followed. One of those rules is that a person must be declared dead before a donation can occur. There are 2 different kinds of death, cardiac death and brain death. This is, I suppose, how this controversy developed.

Three infants suffered irreparable brain damage due to a lack of oxygen when they were born. Three infants’ families consented to removal of ventilation, and organ donation. The infants were declared dead (cardiac, not brain death) and their hearts were donated to three other infants (who as far as I know are still doing fine).

With the first of the infants, doctors waited 3 minutes after the heart stopped beating to declare cardiac death. With the other two, only 75 seconds had passed before death was confirmed. This is where the controversy comes into play. Did these doctors wait long enough to make the call? At what point of time can death be declared?

In the first case, doctors waited for three minutes after the heart stopped before death was declared. Then the waiting time was reduced to 75 seconds on the recommendation of the ethics committee to reduce the chances of damage to the heart.

The authors said 75 seconds was chosen because there had been no known cases of hearts restarting after 60 seconds.

Some people think that death should not have been declared because damage to the heart was not, at the time of "the call" irreversible (since the hearts restarted fine after transplantations), or because the infants weren’t brain dead. People argue that those infants were not actually dead and the doctors declaring them so is nearly equivalent to homicide.

Maybe those people are right. I don’t know. I suppose that’s why I’m not on an ethics committee at a hospital. I don’t know if I could make those decisions.

Here’s what I do know:

The doctors involved knew they couldn’t make that decision either. That’s why they went to the ethics committee. Ethics committees exist so that tough, unbiased decisions can be made in a health care setting.

Organ and tissue donating situations are not, at all, taken lightly or rushed through at a hospital. Every detail is thought through, right down to the person who asks the parents if their child can be a donor. That person has to go through special training to be able to even ask the question. I highly doubt the doctors involved purposely didn’t wait a certain amount of time before declaring a death just so another infant could have a new heart.

Those three infants were not going to survive. Their brains were functioning, which is why they could not be declared brain dead. However, their brains were not functioning well enough to keep their hearts beating. This is why they were on ventilators—to provide oxygen needed for the heart to continue beating. The infants’ families had accepted the deaths, had agreed to donation, had found some kind of closure ("A ray of hope," one mother said).

Each year, about 50 infants are placed on a waiting list for a new heart, and die waiting. Infants are 10 times more likely to die than adults while waiting for a heart. Three other infants are alive now because they have new hearts—because doctors declared a cardiac death rather than waiting for an inevitable brain death.

Maybe the doctors, the ethics committees, and the parents of the deceased infants all made the wrong decision. I don’t know. But I don’t think they did.




To read the full article regarding this in the New England Journal of Medicine click here.


**Arizona State University lectures (Organ Donation Overview and Brain Death, Transplant, and More!), April 2005, prepared by Shirley Miller RN (Donor Program Manager), Tracey Knotts RN (Organ Recovery Coordinator), and Susan Stillwell MSN, RN, CNE (Clinical Associate Professor)