Infant Transplant Procedure Ignites Debate

Surgeons transplanted the hearts into three babies 1 to 4 months old who were dying of heart problems. Six months later, all three recipients were alive, compared with 84 percent of 17 babies who received hearts retrieved through standard organ-donation protocols.

"We're very pleased with the lives we saved," said Mark M. Boucek, who led the team before moving to the Joe DiMaggio Children's Hospital in Hollywood, Fla. "We're trying to deal with a very difficult situation where children die waiting for transplant and parents of other children want to donate."

James Burdick of the Department of Health and Human Services, which funded the study, agreed.

"In a very important way, it's a wonderful story. You had three situations with hopeless medical problems who would have otherwise died but got this gift of life," he said. "It's an important demonstration of what is possible."

But critics questioned whether the donor babies were truly dead when their hearts were removed. In those cases, the hearts were restarted in another child's body, meaning cessation was not irreversible, they argued.

"This practice cannot be ethically justified," said George J. Annas, a Boston University bioethicist. "The donors are not dead. I understand that they would like us to change the definition of death, but they can't do that by themselves. It's very problematic to start treating a baby as an organ donor before it's dead."

Robert M. Veatch, a Georgetown University bioethicist, went further, saying the deaths were equivalent to murder.

"The whole issue is whether the infants from whom the hearts were taken were dead. It seems very clear to me that they were not," he said. "I think it's illegal, and if it's illegal, what we're talking about is the physicians causing the death of the three patients, and that would be homicide. It's immoral. I think it should be stopped."

Boucek, the cardiologist, argued that the hearts were incapable of functioning in the newborns from whom they were removed, satisfying any question about pronouncing the babies dead.

"At the end of the day, we feel we are on very firm ground," he said. "There is no question these all met the criteria that one would establish for death."

Burdick called assertions that the babies were not dead "fussy semantics" that do not "really make common sense."

Because the procedures reopened so many contentious fault lines, two other ethicists proposed scrapping the fundamental ethical tenet that has guided organ transplantation for decades: the "dead donor rule," which states that organs should never be removed from a patient who is not dead. Robert D. Truog of Harvard Medical School and Franklin G. Miller of the National Institutes of Health argued that people with devastating brain injuries or terminal illness, or their family members, should be allowed to decide whether to consent to donate an organ, without needing to adhere to any specific method for declaring death.

"It's a much cleaner way to go, and avoids all of the crazy stuff that we're talking about here, in terms of how do we diagnose death," Truog said during the taped debate.

But a surgeon speaking on behalf of the United Network for Organ Sharing, which oversees the nation's organ-transplant system, rejected that approach, as did several bioethicists. Several experts worry that the Denver cases and such proposals will undermine public confidence in organ donation. They called for a national conference to establish a consensus before more procedures are done.

"The whole area of organ donation relies on the public trusting physicians, in that they believe they won't murder them or commit homicide. They won't hasten their deaths," said Arthur L. Caplan, a University of Pennsylvania bioethicist. "We ought not underestimate public unease."

Boucek welcomed such debate, but said that in the meantime, Denver Children's Hospital plans to continue the procedures and that other hospitals have begun seeking guidance about how to do them as well.

"It would be unfair to parents who are interested in donating and to the patients who would otherwise die if we stopped," he said.