Anencephalic newborns Flashcards
What are the ethical principles required for organ donation?
- brain death or somatically dead before organ donation using standard cardiorespiratory criteria
- Fully informed parents - of the risks to themselves, potential infant donor and recipient
How can you avoid coercion?
Physicians involved in organ transplantation should not be involved in consent discussions with the parents of potential organ donors.
What is anencephaly
A central nervous system abnormality that is characterised by congenital absence of the forebrain, skill and scalp. Some rudimentary forebrain may exist and there is usually a functioning brainstem
When do most anencephalic newborns die?
Within the first days or weeks
When can an anencephalic newborn donate organs
If the satisfy the criteria for brain death or somatic death
What are the specific physical problems, as identified int he Loma Linda study, for anencephalic babies to donate organs?
- They will not usually satisfy the criteria for brain death or somatic death
- By the time brain death or somatic death have occurred, the end organs have usually undergone ischemic damage, making them unsuitable for donation. This occurs because there is gradual decline in cardiorespiratory function
- Life support does not improve the likelihood of successful organ donation. There is gradual organ deterioration prior to death
What are the ethical concerns regarding donation in anencephalic babies?
Application of similar arguments in favour of organ donation from other serious brain damaged living patients
Serious risk of loss of public trust in transplantation programs
Serious deleterious effects on families and staff involved
Risk of loss of public respect for the intrinsic value of all human life
Why is this becoming less of an important problem
- improved prenatal diagnosis +/- termination
- improved folate supplementation = decreased incidence
- improved treatment of HLHS with norwood (less need for heart transplant)
What is the CPS’s viewpoint? Is there anyone who opposes this?
Organ donation from anencephalic infants should not be undertaken. We should not use life-sustaining measures such as medical therapy and mechanical ventilation to maintain organ donation while awaiting death.
The american medical association previously said that you can use these babies. Currently they are saying that you can use life-sustaining treatment and await brain death or somatic death
According to the CPS, should we change the brain death requirements to allow use of anencephalic infants?
No. There should be no alteration or modification of standard infant brain death criteria
What do you do if families want to donate the organs of their anencephalic infant?
Provide education regarding why this practice is not done. The option of guess and stem cell donation should be discussed using the ethical principles and medical practices applied to other donors.
