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The anencephalic organ donor: A challenge to existing moral and statutory laws

Objectives:To inform physicians of the critical shortage of neonatal heart donors and to provide arguments for and against selecting brain-absent anencephalics as heart donors for brain-normal infants who are dying of hypoplastic left heart syndrome. Data Sources:International scientific journals of medicine, genetics, epidemiology, bioethics, and public health; adjudicated U.S. civil court cases; and state regulations and statutes. Study Selection:Worldwide experience with anencephalics as homologous organ donors. Data Extraction:Demographic and epidemiologic data on anencephalic births and natural histories; U.S. civil, district, and appellate court case decisions directing or prohibiting organ donation; state determination-of-death acts; state uniform-anatomical-gift acts. Data Synthesis:Organization of all data into either moral challenges or legal challenges to anencephalic organ donation. Conclusions:Statutory laws pose a greater challenge to anencephalic organ donation than moral laws. Case law reviews eliminate substituted judgment rulings in directing anencephalic organ donation. A redefinition of brain death applying only to human beings born without a brain would make more donor hearts available to brain-normal infants dying of hypoplastic left heart syndrome. (Crit Care Med 1993; 21:1781–1786)