Earlier harvesting of hearts stirs ethics debate

In an effort to increase the supply of organs available for transplants, some doctors are waiting just 75 seconds after a heart stops beating to begin harvesting the organs, but some ethicists worry about the practice.

The "dead donor rule" says an organ donor should be brain dead before any organs are removed for transplant. 

'It could easily encourage critical care physicians to consider the declaration of death potentially sooner than they normally would.' —Dr. Kerry Bowman

Under a fairly new and controversial approach, families are being asked to allow organs to be taken after cardiac death, meaning doctors would wait for the heart to stop beating after life support is removed — and ignoring the brain activity.

Time is crucial because the longer an oxygen-starved heart stays in a warm body, the lower the chances of a successful transplant.

Society needs to consider whether these patients are dead, said Dr. Kerry Bowman of the University of Toronto's Joint Centre for Bioethics. While Bowman is not opposed to donating after cardiac death, he is worried the definition of death is being massaged.

"I think the pull and the need for organs is so strong that it could easily encourage critical care physicians to consider the declaration of death potentially sooner than they normally would," said Bowman.

The issue was debated in Thursday's issue of the New England Journal of Medicine, which includes a report on three cases where doctors waited three minutes or less to remove the hearts of dying newborns who had severe brain damage, but were not brain dead.

In two of the cases, doctors waited only 75 seconds, given that there has never been a case reported of a heart restarting after waiting 60 seconds.

"As a result of their investigational protocol, three babies are now alive," the journal's executive editor Dr. Gregory Curfman and others wrote. "Had the procedures not been performed, it is virtually certain that all six babies would be dead."

Harvesting organs after cardiac death is much more common in the U.S. than it is in Canada.

In this country last year, 22 donors gave 61 organs after cardiac death.

Jenny Graham of Upper Stewiacke, N.S., is pleased that her family was approached to donate her daughter's organs. Kim Harnum-Graham was in a coma with a tiny amount of brain activity following a severe epileptic seizure just two weeks after giving birth.

Kim Harnum-Graham had signed her organ donor card and told her family that she did not want to be left on life support, but she did not meet the technical definition of brain death.

"We were ecstatic, and we were relieved that we could help somebody else," Jenny Graham recalled.

Canadian transplant teams see the potential for hundreds of more organs if hospitals get past the ethical issues.