Use of anencephalic newborns as organ donors

Abstract

Organ transplantation for infants and children with lifethreatening illnesses has become very successful. However, this success is limited by a serious shortage of suitable donor organs. A variety of approaches to improve organ donation rates have been undertaken in adults but these approaches cannot be applied widely to paediatric patients because of physical limitations governing organ suitability and size. These limitations caused widespread discussion in the late 1980s and 1990s about considering the anencephalic infant as an organ donor, including the possibility of altering the standard brain death criteria to apply to the anencephalic in­ fant and of donation of anencephalic infant organs before death [1]-[5]. The potential to save the lives of infants dying from cardiac, renal and liver disease, and the desire to give meaning and benefit to the anencephalic infant’s family were presented as justification for changes in the medical standards and the law concerning death and organ donation from anen­ cephalic infants [6][7]. Official statements from the Canadian Paediatric Society (CPS) (1990) and the American Academy of Pediatrics (1992) affirmed that anencephalic infants were not appropriate organ donors and rejected arguments advo­ cating modification of the medical criteria of brain death and legal standards of pronouncement of death [8][9]. This updated CPS statement presents current information for clinicians supporting the previous CPS position that did not support the use of anencephalic infants as organ donors in the clini­ cal setting.