Pediatric Brain Death and Organ/Tissue Retrieval : Medical, Ethical, and Legal Aspects

Based On A March 1987 Conference, Discusses Criteria For Determining When A Child Can Be Ethically, Medically, And Legally Considered Dead, And Needed Organs Or Tissue Be Transplanted To Other Children. Many Contributors Recount The Experience With This Emotion-charged Issue At Particular Institutio Front Matter....Pages i-xvi Front Matter....Pages xvii-xvii Death-Defining Acts Historical and Cultural Observations on the End of Life ....Pages 1-30 A Jewish Approach to Ethical Issues in Brain Death and Organ Transplantation....Pages 31-34 Catholic Considerations of Brain Death and Organ Retrieval....Pages 35-43 Protestant Perspectives on Organ Donation....Pages 45-53 The Legal Status of Brain-Based Determinations of Death....Pages 55-63 Brain Death Historical Perspectives and Current Concerns ....Pages 65-72 Front Matter....Pages 73-73 Brain Death in Children Guidelines and Experience at the Massachusetts General Hospital ....Pages 75-81 Brain Death in Children The Philadelphia Experience ....Pages 83-87 Pediatric Brain Death and Organ Transplantation....Pages 89-99 Pediatric Brain Death and Organ Transplantation The Los Angeles Experience ....Pages 101-106 Clinical Criteria for Pediatric Brain Death The Washington Experience ....Pages 107-111 Brain Death in Infants and Children The Atlanta Experience ....Pages 113-119 Brain Death in Children The Loma Linda Experience ....Pages 121-128 Brain Death in Children Task Force Guidelines ....Pages 129-133 Validity of Radionuclide Cerebral Angiography for Diagnosing Brain Death in Infants....Pages 135-148 Detection of Blood Flow to the Brain by Radionuclide Cerebral Imaging....Pages 149-156 The EEG in the Determination of Brain Death in Pediatric Patients The NIH Study ....Pages 157-163 Role of EEG in Brain Death Determination in Children The Bronx Experience ....Pages 165-175 Front Matter....Pages 177-177 Estimation of Organ and Tissue Donor Pool from Multiple Cause of Death Statistics....Pages 179-190 Use of Anencephalic Infants as Organ Donors Crossing a Threshold ....Pages 191-197 Front Matter....Pages 177-177 Relaxing the Death Standard for Organ Donation in Pediatric Situations....Pages 199-205 The Definition of Death Unresolved Controversies ....Pages 207-218 Front Matter....Pages 219-219 Developments in Immunosuppression The Secret to the Success of Organ Transplantation ....Pages 221-232 Pediatric Transplantation Needs and Potential Donors ....Pages 233-235 Developments in Tissue Transplantation....Pages 237-248 Front Matter....Pages 249-249 Organ and Tissue Retrieval and Donation The Ethical Imperative ....Pages 251-257 Attitudes Toward Clinical and Social Issues in Organ Procurement....Pages 259-266 Effect of Organ Donation on Families of Brain-Dead Patients....Pages 267-281 Legal Aspects of Organ Transfer....Pages 283-289 Anatomical Gifts Effective at Death....Pages 291-297 Fragile Trust The Success and Failure of Required Request Laws, and the Procurement of Organs and Tissues from Children and Adults ....Pages 299-307 Reconsidering the Ban on Financial Incentives....Pages 309-315 Front Matter....Pages 317-317 Funding of Transplantation The Health Care Financing Administration ....Pages 319-323 Medical Technology Evaluation and Coverage....Pages 325-330 The Private Insurer Response to Advanced Health Care Technology The Case of Organ Transplants ....Pages 331-343 Federal Efforts to Improve the Organ Procurement System....Pages 345-350 Back Matter....Pages 351-365 The death 'Of a child, 'One wh'Ose vulnerability and unfilled promise c'Omp'Ounds the tragedy 'Of any death, t'Ouches us deeply. When that death 'Occurs due t'O the generally unexpected and sudden loss 'Of brain functi'On, it is particularly P'Oignant. And yet, when death c'Omes, it sh'Ould be diag nosed expediti'Ously. The professi'Onal resP'Onsibilities 'Of the physician require that he b'Oth rec 'Ognize brain death and inf'Orm the family 'Of its occurrence. In additi'On, since recent advances in transplantati'On provide the P'Ossibility 'Of using the 'Organs 'Of a brain-dead child t'O save the lives 'Of 'Other children, the c'Oncepts 'Of beneficence an~ charity further c'Ompel physicians t'O facilitate such transplantati'Ons by inf'Orming the family about this P'Ossibility. Criteria 'Of brain death have been refined 'Over about 30 years since the term coma depasse (bey'Ond c'Oma) was coined by M'Ollaret and G'Oulon in 1957 (Kaufman and Lynn, 1986). The last maj'Or criteria ev'Olved 'On a nati'Onal level were th'Ose 'Of the President's C'Ommissi'On in 1981. H'Owever, studies t'O date have c'Oncentrated 'On adults, and relatively little work has been rep'Orted ab'Out devel'Oping brain death criteria f'Or the y'Oung. Indeed, the advis'Ors t'O the President's Com missi'On suggested that there are significant-although n'Ot well defined~ifferences in the ability of the brains 'Of th'Ose under five years 'Of age t'O rec'Over from clinical states that W'Ould be accepted as indicative 'Of c'Omplete and irreversible l'OSS of brain functi'On in adults