Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Commentary
  • Published:

Anencephalic organ donation after cardiac death: a case report on practicalities and ethics

Journal of Perinatology volume 35, pages 785–787 (2015)Cite this article

Subjects

By waiting for circulatory death before retrieval of organs for transplantation (‘Donation after Circulatory Death’, or DCD), anencephalic newborns are being considered as suitable candidates for organ donation. Although this practice may meet ethical standards for organ transplantation, there remain additional factors that influence its widespread adoption. This case illustrates some of these factors as they relate to the feasibility of DCD in anencephalic infants, and to whether the ethical principles surrounding this practice require further debate.

With the growing success of organ transplantation in the early 1980s, organ donation from anencephalic infants became a topic for practical and ethical consideration. Criteria for brain death guided decisions regarding the suitability of various potential organ donors, but because anencephalic infants rarely met criteria for brain death, they were not considered suitable donors.1 In more recent years advances in transplantation medicine have made it possible to successfully retrieve organs from terminal patients, including neonates, who don’t meet brain death criteria. This process, referred to as Donation after Circulatory Death (DCD) involves donation of organs from terminally ill patients who are removed from life support and then, as a result, sustain a circulatory death.2 This approach satisfies (1) the need for providing organs for transplantation in addition to those procured after brain death and (2) fulfilling the wish of family members that relatives with severe brain pathology serve as organ donors after removal of life-sustaining therapy and subsequent death. Indeed, DCD now is generally accepted as an ethical opportunity for anencephalic infant organ donation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Peabody JL, Emery JR, Ashwal S . Experience with anencephalic infants as prospective organ donors. N Engl J Med 1989; 321: 344–350.

    Article  CAS  Google Scholar 

  2. Wolman R . Ethical issues in organ donation after cardiac death. In: Van Norman G, Jackson S, Rosenbaum S, Palmer S (eds). Clinical Ethics in Anesthesiology. Cambridge University Press: Cambridge, UK, 2011; 114–122.

    Google Scholar 

  3. Stumpf DA . The infant with anencephaly. The medical task force on anencephaly. N Engl J Med 1990; 322: 669–674.

    Article  Google Scholar 

  4. American Academy of Pediatrics Committee on Bioethics: infants with anencephaly as organ sources: ethical considerations. Pediatrics 1992; 89: 1116–1119.

  5. Glasson J, Tenery RM, Wilkins GT, Orentlicher D, Harwood KA, Leslie JE et al. The use of anencephalic neonates as organ donors. Council on Ethical and Judicial Affairs, American Medical Association. JAMA 1995; 273: 1614–1618.

    Article  Google Scholar 

  6. Nakagawa TA, Ashwal S, Mathur M, Mysore M . Clinical report-Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Pediatrics 2011; 128: e720–e740.

    Article  Google Scholar 

  7. Powers R . California Transplant Donor Network, personal communication 2013.

  8. Committee on Hospital Care, Section on Surgery, and Section on Critical Care. Policy statement—pediatric organ donation and transplantation. Pediatrics 2010; 125: 822–828.

    Article  Google Scholar 

  9. Baird PA, Sadovnick AD . Survival in infants with anencephaly. Clin Pediatr 1984; 23: 268–271.

    Article  CAS  Google Scholar 

  10. Meinke SA . Anencephalic Infants as Potential Organ Sources: Ethical and Legal Issues. National Reference Center for Bioethics Literature; Scope Note 12.

  11. Shewmon DA, Capron AM, Peacock WJ, Schulman BL . The use of anencephalic infants as organ sources. A critique. JAMA 1989; 261: 1773–1781.

    Article  CAS  Google Scholar 

  12. Anand KJ, Hall RW . Controversies in neonatal pain: an introduction. Semin Perinatol 2007; 31: 273–274.

    Article  CAS  Google Scholar 

  13. Fletcher AB . Pain in the neonate. N Engl J Med 1987; 317: 1347–1348.

    Article  CAS  Google Scholar 

  14. Stevens B, Franck L, Gibbins S, McGrath PJ, Dupuis A, Yamada J et al. Determining the structure of acute pain responses in vulnerable neonates. Can J Nurs Res 2007; 39: 32–47.

    PubMed  Google Scholar 

  15. Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C et al. Determining behavioural and physiological responses to pain in infants at risk for neurological impairment. Pain 2007; 127: 94–102.

    Article  Google Scholar 

  16. Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE et al. Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Res A Clin Mol Teratol 2010; 88: 1008–1016.

    Article  CAS  Google Scholar 

  17. Williams LJ, Rasmussen SA, Flores A, Kirby RS, Edmonds LD . Decline in the prevalence of spina bifida and anencephaly by race/ethnicity: 1995-2002. Pediatrics 2005; 116: 580–586.

    Article  Google Scholar 

  18. Hanley H, Kim S, Willey E, Castleberry D, Mathur M . Identifying potential kidney donors among newborns undergoing circulatory determination of death. Pediatrics 2014; 133: e82–e87.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Mark Mercurio MD, Professor of Pediatrics (Neonatology); Director, Program for Biomedical Ethics, Yale School of Medicine, for his thoughtful counsel during the management of this case and for his kind review of this manuscript.

Author information

Authors and Affiliations

  1. Department of Neonatology, Mednax Medical Group, Good Samaritan Hospital, San Jose, CA, USA,

    R J Powers

  2. University of California, Santa Cruz, Santa Cruz, CA, USA,

    D Schultz

  3. Department of Anesthesiology, Good Samaritan Hospital, San Jose, CA, USA,

    S Jackson

Authors
  1. R J Powers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R J Powers.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Powers, R., Schultz, D. & Jackson, S. Anencephalic organ donation after cardiac death: a case report on practicalities and ethics. J Perinatol 35, 785–787 (2015). https://doi.org/10.1038/jp.2015.72

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2015.72

Search

Advanced search

Quick links