Ethical and medical management of a pregnant woman with brain stem death resulting in delivery of a healthy child and organ donation

Guidelines for the management of the social and ethical challenges in brain death during pregnancy

“…Even in cases where the protection of the legal interests of the fetus exists, there is no legal imperative to continue maternal corporeal support if there is little likelihood of successful fetal outcome . The differences (discrepancies) within the international legislation with regard to protection of the legal interests of the fetus and attribution of legal rights to the fetus leave an ethical grey area which must be negotiated by clinicians, where, starting from the medical and ethical standpoint, the interests of the fetus must be the primary consideration . The prolongation of corporeal support could be misunderstood by the public as using a cadaver as an incubator, but this line of thinking could be seen to underestimate the mother's invested months of pregnancy, and that continuation would also mean biologic continuity of her life and symbolic continuity of her being .…”

“…Furthermore, the mother's consent to organ donation could be seen to justify the prolongation of corporeal support, as the fetus would be the first one to benefit from the donation and, even after delivery, organs could still be donated, depending on their condition . While, from the legal perspective, this might contribute to the justification for continuing with the prolongation of corporeal support even when the father, next of kin, or family member disagrees with the decision to continue with corporeal support, in these cases it would perhaps be better not to observe them from the organ donation perspective because of the different nature of problems involved …”

“…Leaving aside publication bias, some insights into how to manage these cases have been already cited in the literature, with successful corporeal support for 110 days as the most extended period published as a case study, and, more recently reported in the media in Brazil, 123 days . Long‐term follow up of the surviving children has been performed for 24 months in six cases, the longest being in Croatia for 36 months; however, longer follow‐ups are also needed to draw firm conclusions about the effects of such a delivery on the child. Some technical understanding has been gained as a result of these successful cases and published literature and, from the management perspective, practical guidelines have been developed, especially in relation to medical management, corporeal (somatic) support and care, fetal nutrition, and hemodynamic provision, and even a care management algorithm …”

“…Some authors argue that the mother's interests, such as protection of her inheritance, disposition of remains, right to autonomy, and bodily integrity should not be underestimated and need to be balanced against the concerns that center on the fetus . Also, the interests of the newly deceased mother should be respected, but, after being declared legally dead, these cannot overcome the needs and interests of the fetus, which justifies sustaining the biological functions of the mother and her body in order to achieve fetal gestational viability . This fact does not imply that there is always a moral obligation to perform corporeal support in BDP, but from an ethical standpoint it might only be morally justifiable if there is even a small hope of success, depending not on the gestational age but on the fetus's viability—i.e.…”

Challenges of Cardiopulmonary Resuscitation during Pregnancy

“…However, in pregnancy, the issues of brain death are more complex. 40 The issue of the appropriateness of continuing maternal somatic support to prolong gestation until delivery is debatable. The expected physiologic changes after brain death also pose challenges to successful organ system support and fetal well-being.…”