New Technique For Infant Heart Transplant Successful, But Controversial

In what could be considered as a breakthrough in medical science, surgeons at Children's Hospital in Denver have performed the first transplants of hearts - whose donors are infants who died a controversial cardiacdefine-related death, rather than being declared brain-dead.

Through controversial, the new approach may reduce the number of infants who die each year awaiting a new heart, doctor’s claim.

Contrary to medical procedures followed until now where only those hearts were selected for transplants whose donors were declared brain-dead and their hearts were still functioning, the new approach is picking up hearts for transplant from infants who died a cardiacdefine-related death.

The Denver surgeons performed medical procedures to retrieve hearts for transplant on three donor babies who suffered from severe neurological injuries but were not considered to be brain dead. In all 3 cases, a decision was made by the families of the babies to withdraw life support.

While the average age the donors were just less than four days, the average age of the babies receiving a new heart was, however, over two months.
The three Denver transplants were performed over a three-year period beginning in May 2004. All organ recipients are alive today.

However, while the Institute of Medicine in 1997 recommended a minimum of 5 minutes between the time the heart stops and the organ retrieval procedure begins, the doctors at Children's Hospital in Denver altered the standards – narrowing it to as little as 75 seconds - to make the donors' hearts more viable for transplant and to increase the transplants’ success rate, thereafter.

While, the critics argue that the call fro waiting up to 5 minutes ensures that the heart does not start beating again on its own – as it can be possible in cardiac-death patients, the enthusiasts for the new approach maintain that by removing the heart earlier, it increases the odds of a successful transplant since it limits the damage caused by a lack of oxygen to the organ.

"Donors who died from cardiocirculatory causes offer an opportunity to reduce waiting time and waiting-list mortality among children whose survival depends on a heart transplant," the Denver doctors wrote in the August 14 issue of the New England Journal of Medicine.

Meanwhile, the move has provoked serious concern among medical groups, with some even judging the operations as tantamount to murder.

Questioning whether the procedure was legal when the event is declared a cardiac death, Georgetown University medical ethicist Robert argues, "If a heart is restarted, the person from whom it was taken cannot have been dead according to cardiac criteria."

"Under the current definition of cardiac death, cardiac function must be irreversible, and by definition, if cardiac function is irreversible, how can such a heart then be placed in another person where it starts beating again?" he questions.

However, the enthusiasts advocate that the new strategy is a way to bridge the gap between the number of available organs and the number of Americans on the waiting list for transplants. In the US, an estimated 50 infants die while on a waiting list for a heart transplant, annually.

Details of the 3 cardiac-death transplants at Denver Children's Hospital are reported in Thursday's issue of the journal ‘New England Journal of Medicine’.