Transcript Slide 1

Law and Ethical Issues in Harvesting
Solid Organs for Transplantation
from Deceased Infants and Children
by
William J Keough, BA, LLB, Dip.Crim,
M.Hlth & Med.Law
Barrister & Solicitor,
Melbourne Australia
Paper presented to the 6th World Congress on
Family Law & Children’s Rights,
Sydney, Australia, March 2013
“New technologies like transplantation
force society to continually re-examine
the values and boundaries of life and
death”
A Caplan & D Coelho, eds, The Ethics of Organ Transplantation,
Prometheus Books, NY, 1998 @ p.13.
A Short Précis of Transplantation
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Dogged by problems surrounding rejection;
First successful Kidney Tx in 1954 – twins
with same antigens;
First Heart Tx in South Africa in December
1967 – died 18 days;
American Heart Tx in 1968 – lived >8 years.
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Live Organ Donation: an organ taken
from a living person and given to another,
eg: a kidney;
Cadaver Organ Donation: an organ
taken from a person shortly after death and
transplanted into another;
Xenotransplantation: an organ taken
from an animal and used in humans;
Genetically Created Organs: arising
from advances in undifferentiated stem cell
research; and
Artificial Organs.
Staunton identifies the wide range of tissue currently being
transplanted as follows:
Regenerative Tissue
Blood;
Bone Marrow;
Skin.
Non-Regenerative Tissue
Blood Vessels;
Bone;
Corneas;
Heart;
Intestines;
Kidneys;
Liver;
Lung; and
Pancreatic Tissue.
P Staunton, Law For Nurses & Midwives, 7th Edition, Elsevier, Sydney, 2013, @ p.303.
The Paediatric Context
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This is Canadian Dylan Stork who weighed 5.5 lbs, or 2.5 kilos at the time of transplant.
Donation Statistics for Paediatric
Population
For the period 2003-2005 there were only 9 deceased
donors in the age group of 0-4 years, and 25 donors in
the age group of 5-14 years;
For the period 2006-2008 there were 5 donors in the
0-4 year age group and 21 donors in the 5-14 year
age group; and
For the period 2009-2011 there were 8 donors in the
0-4 age group and 20 donors in the 5-14 age group.
ANZOD 2012 Report @ p.7
Parental Willingness to Donate
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Prior Exposure to Organ Donation
information;
Their own beliefs; and
Who First Mentions Donation.
Emotional Issues Dominate
Refusal to Consent
The process of ”decoupling” (ie: separating
the death declaration from the donation
request) has been shown to increase
consent rates.
E Tsia, et al, “Organ Donation in Children: The Role of the Pediatric Intensive
Care Unit”, 2000, Vol 1, No 2, Pediatric Critical Care Medicine, 156.
Definitions of Death
There are essentially three definitions of
death from a theoretical perspective:
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Traditional heart-lung [cardiac] definition;
Whole-Brain Death; and
Higher Brain Death.
B Ott, “Defining & Redefining Death” in A Caplan, ed, The Ethics of
Organ Transplants, Prometheus Books, NY, 1998, p.16 @ p.17
Cardiac Death
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Cessation of Heart and/or Lung Functioning
“Clinically Recognisably Dead”
Not Pink, Warm and No Reflexes
Brain Death
“Coma Dépassé”, literally a state beyond coma, just before
death.
P Mollaret and M Goulon, “Le Coma Dépassé (Mémoire Préliminaire)”, 1959, 101, Review
of Neurology, 3. See also D Lamb, Death, Brain Death & Ethics, 1985, Croomhelm,
London, p.4.
“Harvard Criteria”
(i) Unreceptive & Unresponsive – patient shows total unawareness to
externally applied stimuli, even painful stimuli;
(ii) No Movement or Breathing – all spontaneous muscular movement is
absent; and
(iii) No Reflexes – no response to external stimuli and no tendon reflex.
Higher Brain Death
“Loss of higher brain functions robs us of all
that makes us human in any sense beyond
that defined by our genetic endowment”
J Botkin, “Anencephalis Infants as Organ Donors”, 1988, Vol 82, No 2,
Pediatrics 250, @ p.252.
Anencephalic Infants
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Cerebrum and Cerebellum (“Higher Brain”) is absent
Brain Stem (“Lower Brain”) is present
Never Experiences Consciousness
Very Short Life Span – less than half survive >1 day
Remainder of Organs fully functioning
Neither “Cardiac Dead”, nor “Whole Brain Dead”
Violation of “Dead Donor Rule”
“brain absence” be given the same medico-legal
significance as brain death. M Harrison, “Organ Procurement for
Children: The Anencephalic Fetus as Donor”, 1986, 2 Lancet, 1383-1385.
The Law
Australian Law favours “Whole Brain Death”
in the alternative to Cardiac Death”
Section 41 Human Tissue Act 1982 (Vic)
Section 33 Human Tissue Act 1983 (NSW)
Law Sitting on the Fence
So What Does This All Mean in Practice?
The Moral Imperative: The Utmost
Adherence to Sensitivity and Respect
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Caregivers of deceased infants/children be
approached about organ donation
Decoupling
Best Practice
The Moral Imperative: The Utmost
Adherence to Sensitivity and Respect