Infant Heart Transplant Controversy Continues

Yahoo News ^ | 8/13/08 | Serena Gordon/Health Day

[wagglebee]

WEDNESDAY, Aug. 13 (HealthDay News) -- Three new reports challenge current guidelines on how long after cardiac death doctors must wait before taking a heart from an infant organ donor.

There's no question that organ donation saves lives, and there's also no question that there aren't enough donor organs to save everyone on the transplant list. However, deciding who is a suitable organ donor, particularly when the potential donor is an infant, is not so clear-cut.

Most people are familiar with the concept of organ donation after brain death, but organ donation is also permissible after cardiac death. Cardiac death occurs after life support is withdrawn, and the heart stops on its own. Because the heart can sometimes restart, the Institute of Medicine recommended in 1997 that 5 minutes should elapse between the time the heart stops and the organ retrieval begins. More recently, however, it's been suggested that cardiac death becomes irreversible after just one minute.

Now, in the Aug. 14 issue of the New England Journal of Medicine, surgeons from Denver Children's Hospital report on three cases in infant heart donors where surgeons reduced the time between when the heart stopped and when organ retrieval began. In one case, the time was shortened to three minutes, and in the other two to just 75 seconds.

The reason doctors might want to shorten this interval is to reduce the time that transplantable organs are deprived of oxygen, which likely increases the success of transplants. Doing so might also help increase the number of available organs for donations, which is important because as many as one in four babies awaiting a heart transplant dies while on the waiting list, according to the study.

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"I don't know how you can ever have a patient that meets the criteria for irreversible loss of function, and then reverse that function in someone else," said Veatch. Using other organs after cardiac death is possible, he said, but if surgeons are declaring someone dead because their heart has stopped, then under the current law, that heart shouldn't able to be used in someone else, no matter how long surgeons wait.

They see these babies as spare parts, NOT human beings.

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[Mrs. Don-o]

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[wintertime]

because as many as one in four babies awaiting a heart transplant dies while on the waiting list, according to the study.
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I wonder how many babies who receive a heart transplant live five years? How many make it this far even if the donor baby did not have cardiac death.

I wonder how many make it to one year after they receive the transplant?

By the way, a dear friend of mine had a baby with serious heart defects. The little boy died at 2 months before he could get a heart transplant. The couple then had 2 more children. One needed heart surgery at the age of 5 and is doing well.

[gracesdad]

I didn’t find a five-year number, but pediatric (under age 18) survival at three years is 80 percent.

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Veatch said, ideally, people would have a choice when they decide to become organ donors, and that choice would include organ donation after whole brain death, organ donation if you've suffered a permanent loss of consciousness, and cardiac death. Currently, organs are only harvested after whole brain death or cardiac death, according to Veatch, and he added that only New Jersey offers organ donors a choice with these options. But, he said he believes that many people, if offered the choice, would choose to have their organs donated if it was determined that they were in a persistive vegetative state.

This doctor would have "harvested" Terri Shiavo without going to all the bother of dehydrating her to death.

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I didn’t find a five-year number, but pediatric (under age 18) survival at three years is 80 percent.
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That's better than I would have thought.

[wagglebee]

I didn’t find a five-year number, but pediatric (under age 18) survival at three years is 80 percent.

However, that statistic really doesn't give much insight.

It's logical that an otherwise healthy 16 or 17 year old who receives an adult heart from perfectly healthy person who dies in a car crash is going to fare better than a frail infant who receives a heart from another frail infant.

[gracesdad]

There’s also this about heart transplants overall:

As of June 15, 2007, the one-year survival rate was 87.4 percent for males and 85.5 percent for females; the three-year survival rate was about 78.7 percent for males and 75.9 percent for females. The five-year survival rate was 72.3 percent for males and 67.6 percent for females.

Higher than I would have thought.

[gracesdad]

“It’s logical that an otherwise healthy 16 or 17 year old who receives an adult heart from perfectly healthy person who dies in a car crash is going to fare better than a frail infant who receives a heart from another frail infant.”

I don’t think they divide the statistics into the “frail infant to frail infant” category.

Anybody who gets a heart transplant is extremely frail. They wouldn’t be getting a transplant otherwise.

[wagglebee]

I don’t think they divide the statistics into the “frail infant to frail infant” category.

I understand. However, I would think that they would at least have statistics for children under three.

Anybody who gets a heart transplant is extremely frail. They wouldn’t be getting a transplant otherwise.

Yes and no. With an older child or adult, it is often just the heart. With infants there are often problems with the lungs as well. Additionally, with an infant they are usually getting a heart from another unhealthy infant who doctors believe has a healthy heart. Older children and adults are often receiving hearts from perfectly healthy adults who died in accidents.

[gracesdad]

“I understand. However, I would think that they would at least have statistics for children under three.”

Those stats are probably out there somewhere, but the fed numbers I found were divided only into 18 and older and under 18. I didn’t spend long looking.

[gracesdad]

“With an older child or adult, it is often just the heart.”

I’m not a physician, but I have seen adults where it was “just the heart.” They were unable to do anything other than lie in bed and the heart problem was severely compromising other functions. They were frail.

In fact, some people are eventually unable to get a transplant because they’re simply TOO ill. Doing the transplant would kill them so the organ goes to somebody with a better chance.

[wagglebee]

You’re right. I am just trying to point out that with an infant there are nearly always other serious problems that will still be present even with a new heart.

[gracesdad]

BTW, we’re not talking about tons of cases:

According to the latest statistics from The United Network for Organ Sharing (UNOS), 247 children were waiting for a heart transplant in the United States on June 1, 2007 including:

28 in the under 1 year age group
78 in the 1 to 5 years age group
63 in the 6 to 10 years age group
78 in the 11 to 17 years age group

I also just looked at one hospital in Virginia (U.Va.) and their survival rate for children aged 1-5 is 80 percent at 5 years. At three years it was 90 percent. The 3-year rate for those under 1 was 77 percent.

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Those stats are much better than I would have thought.

[verga]

Yes and no. With an older child or adult, it is often just the heart. With infants there are often problems with the lungs as well. Additionally, with an infant they are usually getting a heart from another unhealthy infant who doctors believe has a healthy heart. Older children and adults are often receiving hearts from perfectly healthy adults who died in accidents.

I have to question this. To me it does not make logical sense that they would take a heart for a sickly child and give to another. Logically I thought they were more likely to take one from a child that died from an accident (Auto, fall, drowning, etc...) I am not saying you are wrong, but to me there is a gap in logic. I realize that there is a tremendous shortage and they are willing to use any that might be viable, it just seems off a bit.

[wagglebee]

The babies in question here WERE NOT in accidents, they had just been born.

http://www.sanluisobispo.com/health/story/438479.html