Doctors who waited just 75 seconds after the final heartbeat before removing the hearts of dying newborns for transplants said on Wednesday they improved their odds of success but have also raised ethical questions about organ harvesting.
The cases of two children who died between May 2004 and May 2007, and a third in which doctors waited three minutes, are detailed in a report and a series of commentaries in the New England Journal of Medicine.
The technique is controversial because the waiting time recommended by the Institute of Medicine has been five minutes, unless the patient is brain dead. The three babies were not, although all had severe brain damage.
But the doctors who performed the transplants said moving quickly helped save the lives of three infant recipients.
The matter is particularly critical for infants who desperately need a heart transplant. "Each year, as many as 50 infants are placed on the waiting list for cardiac transplantation but die while waiting, owing to the lack of a suitable donor heart," the journal's executive editor Dr. Gregory Curfman and others wrote.
Historically, death was defined by a stopped heart. But the longer an oxygen-starved heart sits in a warm chest cavity, the lower the likelihood it can be successfully transplanted.
So doctors are struggling to define "circulatory death," to determine when the heart has beaten for the last time once life support has been withdrawn.
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