Anencephalic Newborn Will Be Kept Alive for Transplanting Organs

LOMA LINDA, Calif. — Loma Linda University Medical Center has agreed to deliver an infant expected to be born with most of its brain missing, and then to keep the baby alive artificially so that its organs can be donated to other infants, it was announced here Monday.

The center also said it plans to accept other such anencephalic babies, with the goal of harvesting their organs for donation either at Loma Linda or elsewhere. A Loma Linda official said she does not know of another hospital in the nation that sustains the lives of anencephalic infants in order to use their organs. Most of these babies die within a month of birth.

The decision is expected to bring new controversy to Loma Linda, where surgeons in recent years have performed many infant heart transplants as well as one such operation involving the use of a baboon's heart.

Loma Linda's announcement Monday was prompted by the pending birth of an anencephalic baby to Brenda and Michael Winner of Arcadia. The infant may be born as early as Saturday. Dr. Joyce Peabody, chief of the neonatology division at Loma Linda, said at a press conference that Loma Linda's decision to accept anencephalic babies as a matter of policy was prompted by more than 50 requests in the last year from parents of anencephalic babies who wanted their infants to be born so that their organs could be donated to other needy infants.

"Our bed capacity is 40, and we would attempt to accommodate them," Peabody said. "But I can't picture having any more than two babies of this kind at any one time."

After they learned that their child was destined to be anencephalic, the Winners longed to have their baby's organs donated. And when informed on Monday of Loma Linda's decision, Brenda Winner expressed delight.

"That is fantastic!" she said. "I'm willing to work with them . . . but I try not to get my hopes up anymore."

Peabody stressed that the hospital would keep the Winner baby alive on a respirator only "if another institution cannot be found willing to accept the responsibility."

Moments later, Peabody informed Winner by telephone: " . . . If no other institutions are available, we will work with you."

Winner, who intends to deliver her baby naturally, said her own physician has not yet found another hospital willing to handle her case. "I'm really pleased to hear about this," she said. "This is a first step toward what we want. . . . All I wanted was for doctors to use the baby. But none of them would do it, not because they didn't want to, but because they couldn't under current brain-death criteria."

By law, a doctor must declare a donor brain-dead before removing organs for transplant. Anencephalics, however, die slowly, and by the time brain death occurs, their vital organs deteriorate to the point that they are useless for transplant.

Some medical ethicists and critics contend that it may be ethically wrong to prolong a life not for the benefit of the patient but solely for the purpose of harvesting organs.

Sustaining the life of an anencephalic, these critics say, may also make it difficult to determine when they actually die, creating the prospect that organs could be removed from a living patient.

Peabody said Loma Linda's organ transplant program, which had been limited by organ availability, would be expanded under a new "protocol" established last week by hospital officials for dealing with these babies and their parents' desires.

'A New Commitment'

"It is a new commitment to the whole issue, and we have dealt with the ethical, medical and legal concerns," Peabody said. "My hope, frankly, is that we will be working with other institutions . . . giving them the financial and moral support that they need to allow them to address the parents' needs."

The protocol, expected to become formalized within two weeks, would involve confirming a fetal diagnosis of anencephaly, obtaining an informed consent from the parents to artificially support the infant for a period of time set by the parents--"with a strong recommendation on our part that it be limited to seven days," Peabody said.

If a recipient is not found within that time, the hospital would take the baby off the respirator and provide "standard care--keep them warm and give them fluids, if they will take it," Peabody said. Most of the estimated 3,500 anencephalics born each year in the United States die within a month, she said.

The limitation of seven days was established, in part, because doctors "don't want the donor parents to agonize over this for days on end when they know their child has got a fatal problem," said Loma Linda spokeswoman Anita Rockwell.