Infant Heart Transplantation after Cardiac Death: Ethical and Legal Problems

Michael Potts, Paul A. Byrne, and David W. Evans

The Journal of Clinical Ethics 21, no. 3 (Fall 2010): 224-8.

The removal of hearts from infants who have been declared dead after very brief periods of apparent circulatory arrest, as reported by Boucek and his colleagues, brings into sharp focus the questionable propriety of non-heart-beating organ donation (NHBOD) — or donation after cardio-circulatory death (DCD) — in general. "Controlled DCD," in which there is "planned withdrawal of life-sustaining treatment," and "uncontrolled DCD," in which "DCD occurs after unanticipated cardiac arrest," raise the issues of violation of the dead-donor rule and "treatment" that is oriented toward the end of preserving donor organs, rather than toward helping the donor. These procedures have acquired a measure of acceptance, seemingly on the grounds of their potential for increasing the supply of donor organs. We believe that this acceptance, in the face of the ethical and legal problems widely represented in the medical literature, suggests that the transplant community has moved too quickly to adopt a morally problematic procedure. We hold that these problems are of such fundamental importance that there is urgent need for a fully informed consideration of their consequences for the community and profession.