Moderator: Anencephalic neonates as organ donors?

Thanks to everyone who responded!  Feel free to continue discussing the topic.  Many of members of the VCOM community who commented on this case evoked the utilitarian argument that harvesting organs from our anencephalic neonate is acceptable because it could save the lives of numerous other infants.  However, we did not reach consensus, as various arguments were presented from the legal, clinical, emotional, biologic, and slippery slope stances.

We raised a lot of important questions: What state of a brain is considered adequate for life, and is there a difference between an anencephalic infant and an adult in a permanent vegetative state? Does the law respect the parents’ right to choose what’s best for their child? What are the parents going through, and how can we help them cope? Will there even be an organ donation team willing to harvest the organs of an anencephalic neonate?

Law makers and clinicians have struggled with these same questions for many years. The first successful infant heart transplant in the US occurred at Loma Linda University Medical Center in 1987. The donor was an anencephalic infant from Canada. In the following nine months, the medical center placed a dozen anencephalic infants on ventilators to await their brain death (which could be prolonged because of the intervention) so that their organs could be donated. All 12 infants failed either to arrive at brain death within one week or to be matched with a recipient infant within one week. As a result, the hospital suspended its anencephalic organ donor program under the current legal definitions of brain death.

For those of you interested in further reading, here are two excellent reviews:

Meinke, SA: Anencephalic infants as potential organ sources: Ethical and legal issues. National Reference Center for Bioethics Literature. 1989. Full article

Bard, JS: The diagnosis is anencephaly and the parents ask about organ donation: Now what? A guide for hospital counsel and ethics committees. Western New England Law Review. 1999. Full Article

Sources: 
Goldsmith, MF: Anencephalic organ donor program suspended; Loma Linda Report expected to detail findings. The Journal of the American Medical Association. 1988.
Annas, GJ: From Canada with love: Anencephalic newborns as organ donors? Hastings Center Report. 1987.