Infants as Organ Sources:
D. Alan Shewmon, Alexander M. Capron,
Warwick J. Peacock, and
Barbara L. Schulman
In July 1988, Loma Linda (California) University Medical Center suspended the controversial protocol under which it had been the only center in the United States with an active program for harvesting organs from anencephalic infants for transplantation ( Los Angeles Times, August 19, 1988:[pt I]3; Los Angeles Times, August 24, 1988:[pt I] 25). 1 In reaching this decision (following thirteen failed attempts to obtain organs from such babies during the preceding seven months), the protocol's principal author acknowledged that critics had been justified in worrying about such issues as the consequences for the anencephalic infant and the expansion of the category of potential donors to infants with less severe defects. The experience of the Loma Linda program clearly indicates that substantial ethical as well as practical issues remain to be resolved before any further effort is made to employ anencephalic infants as organ "donors."
The attempt to harvest organs from anencephalics itself reflects the difficulties physicians have faced in responding to the growing demand for suitable donors generated by recent progress in pediatric organ transplantation. The first difficulty is that death in organ donors is usually diagnosed through the use of brain-based criteria (typically referred to as "brain death"). 2,3 Yet, the sorts of injuries (such as highway accidents) that can destroy the brain, while leaving the other organs intact for transplantation, are much rarer in infants than in adults and older children. Aside from use of contrast angiography, diagnostic criteria for infant brain death have not been validated, and certainty of diagnosis is much less easily attained than in older patients, 4,5 recent guidelines 6,7,8 notwithstanding.
The difficulties in obtaining adequate numbers of infant cadavers with arti-____________________