`Brain Dead` Technicality Thwarts Infant Donors

October 12, 1986|By New York Times News Service.

LOS ANGELES — A 26-year-old woman, pregnant with twins, has been told that one of her infants will die at birth because he is anencephalic--his brain has completely failed to develop.

The woman wants to donate the organs of her doomed child when the twins are delivered 16 weeks from now, but she cannot. Using such infants as organ donors is illegal in the United States.

The case illustrates how medical, legal and ethical aspects of organ transplantation are colliding as the pace of such operations accelerates. It illustrates in particular the quandry posed by anencephalic infants, a potentially valuable source of organs.

The demand for infant-sized organs is potentially large, but the supply is virtually nil. Each year an estimated 400 to 500 infants need new kidneys, 400 to 500 need hearts and 500 to 1,000 need livers, according to Dr. Michael Harrison a pediatric surgeon at the University of California at San Francisco. About 3,500 anencephalics are born in the United States each year, according to Dr. Mitchell Golbus of the University of California at San Francisco. Infants with the defect, whose cause is unknown, constitute a potentially large supply of newborn organs. Yet they cannot be used as donors, even when their parents insist.

Anencephaly technically does not meet the requirements for brain death under United States law. Brain death requires ``irreversible cessation of all functions of the entire brain, including the brain stem,`` according to a uniform legal definition used by almost all states. The remaining states have similar laws.

Since the anencephalic infant`s brain stem is functioning at birth, the infant is not legally brain dead.

It is particularly tricky to ascertain brain death in most babies, said Art Caplan, a bioethicist at the Hastings Center in Hastings-on-Hudson in New York.

While anencephalics clearly have no chance for life, he said, most infants are notoriously resilient, and ``there are cases of kids popping awake`` after brain wave instruments indicted they were dead. Physicians are thus reluctant to declare infants brain dead without extensive new tests that are not yet available at most hospitals.

Many pediatric neurologists, however, point out that anencephalics are entirely different. Their brains consist of a tiny portion of brain stem perched on top of the spine. They are doomed to die within hours or days of their birth, Harrison said.