Should Anencephalic Infants be Used as Organ Donors?

Abstract

The frontiers of organ transplantation and its scientific and ethical-legal aspects have advanced to the arena of pediatrics. The technical advances bring with them the problem of organ procurement, with estimates that the discrepancy between supply and demand for pediatric organs will be even more pronounced than in adults. In partial response to this anticipated shortage, it has been proposed that newborns with anencephaly be used as organ donors. 1 In this article the essential elements of this proposal will be briefly described and some of the underlying ethical and legal controversies will be highlighted in the hope that pediatricians will be stimulated to participate with health lawyers, policymakers, and transplantation surgeons in the debate. MEDICAL ASPECTS Significant progress has been made in the transplantation of small organs and the use of immunosuppressive agents in growing children. 2 The prospect now exists that annually in the United States 300 to 450 children with end stage renal disease, 400 to 800 children with liver failure, and 400 to 600 children with complex congenital heart disease may be helped with organ transplantation. 1,3 The supply of usable organs may be limited by asphyxial damage related to the common causes of death in infants, however. Each year, approximately 1,800 babies are born in the United States with anencephaly. 4 Available data suggest that 25% to 45% are live born and at least 95% die within the first week. 5 Apart from their fatal neurologic malformation, their organs are presumed suitable for transplantation. 4 Moreover, prenatal α-fetoprotein and ultrasonographic screening can identify almost all anencephalics with a high level of certainty. 6