It seems fitting that I would be writing this on the Easter holiday with the symbolism of death followed by resurrection being the principal path for an organ to live on in another after departing their host. This topic came across my radar this week after I caught the following article on NBC news that I would encourage you to take a look at as it really captures the state of this practice in the US at the moment.
This may surprise you but there really is nothing in the literature about this. There was a flurry of articles about neonatal transplantation in the late 1980s as debate raged about the ethics of using anencephalic newborns as donors but since then very little. I could find one article in pubmed which is a basic science article showing that mid trimester fetuses lung tissue can be used to regenerate cells in a recipient lung scaffold many hours after the stillbirth had occurred with the longest duration being 41 hours in this study. It would seem based on this study that the capacity for stillborn tissue to survive outside the deceased in theory then could provide a window for obtaining consent although how long such whole organs would last is uncertain.
The Big Questions?
How as a medical society we could manage this is a challenging one. Consent would only be possible after the recognition of fetal loss and who knows how long a window there would be from the time of death until the baby was delivered. Approaching families to ask about organ donation after they have just suffered a fetal loss is a difficult task to say the least. On the other hand the opportunity for some families to have some good come out of their tragedy as the NBC article points out may be therapeutic in some way.
Lastly, there is no question that there is a need for small organs. Having worked previously in a centre that offered cardiac transplantation I recall waiting for available hearts that never came or came too late. The challenge is that the thorax is only so big in a newborn and can’t accommodate a heart from a child or adult. Add to this that certain conditions preclude a baby or child from donating depending on the cause of death and having access to a larger pool of potential organs could indeed change the landscape of organ transplantation.
I should also stress that I am not talking about Planned Parenthood who has been accused of selling aborted fetuses tissue (having said that I can find little hard evidence for these claims out there). These are all babies who have been stillborn and not intentionally born to harvest organs.
I doubt this is the last you will hear of this but as the topic becomes more mainstream I can see ethicists and legal teams coming to the forefront to tackle this at each hospital and across many countries. It will be intriguing to follow this story and see how it unfolds.