Discussion

Abstract

At the 1997 Clinical Congress of the American College of Surgeons, the Board of Regents Committee on Ethics sponsored an Ethics Colloquium on endof-life issues. The 6-hour program addressed the care of the terminally ill, assisted suicide, and the possible use of anencephalic infants as organ donors. This article is derived from presentations on the issue of anencephalic infants as donors. Arguments for and against the practice were presented to an audience equipped with individual devices (Audience Interactive Response System) for immediate recording of personal views on relevant questions proposed by the moderator (Thomas J. Krizek, MD, FACS). The audience was involved not only through solicitation of opinion, but also by active participation in the discussion. We did not expect to reach consensus, but the “pro” and “con” format served to highlight important points such as the use of living donors, the definition of death, and the question of consciousness in brain-damaged individuals. These issues have important implications in an era when there is severe imbalance between the need for and supply of transplantable organs. It is estimated that only a few hundred anencephalic infants per year are born alive in the United States, and 90% of these die within 7 days. Survival beyond 2 weeks is rare even with neonatal intensive care, although one child, the subject of a court case, lived for 2.5 years. In contrast to these harsh statistics on supply, the annual number of children needing heart and liver transplants in the United States is estimated at 500 in each category. Because of the scarcity of donor organs, 30% to 50% of children under 2 years of age die while waiting for a suitable organ. Overall, the death rate of children on such waiting lists varies from 40% to 70%. As one step toward ameliorating this imbalance, it has been proposed that parents be allowed to donate organs from anencephalic neonates for transplantation before the infant reaches brain death as defined by today’s standards. To bring the issue into focus, the following brief case history was presented to the audience at the Ethics Colloquium: