Experience with Anencephalic Infants as Prospective Organ Donors

Abstract

Recent advances have made organ transplantation in newborns feasible, but the paucity of organs small enough for this age group remains a major limitation. Because anencephalic infants can survive for no more than a few weeks, they have been considered as possible organ donors for other infants. Under current law, however, they cannot be used as donors until their brain-stem activity ceases and the criteria for total brain death are thereby met. If anencephalic infants receive customary care, their solid organs usually undergo irreversible hypoxic injury during the process of dying and become unsuitable for donation by the time of death. We modified the medical care of 12 live-born anencephalic infants for one week to determine whether organ viability could be maintained and whether the criteria of total brain death could be met. Six received intensive care from birth, and six only when signs of imminent death developed. Only two infants met the criteria for total brain death within one week, and no solid organs were procured. Most organs were suitable for transplantation at birth. When intensive care was provided from birth, organ function was maintained; however, brain-stem activity ceased in only one infant within the first week. When intensive care was delayed until death was imminent, most organs were damaged to an extent that made them no longer suitable for transplantation. Our findings suggest that it is usually not feasible, with the restrictions of current law, to procure solid organs for transplantation from anencephalic infants.

Stereological Evaluation of the Kidneys of Anencephalic and Normal Fetuses

“…[25][26][27] On the other hand, some of them mentioned some disadvantages, such as effect of anencephaly on other organs, 28 arterial thrombosis, vascular rejection, 8 the size of the recipient (age and sex), 29 and ethical problems, 30 due to no more than a few weeks of life expectancy for anencephalic infants. 14 In this study, it was attempted to detect the glomerular and other quantitative parameters of kidneys of anencephalic and normal fetuses.…”

“…[7][8][9][10] New organ sources for transplantation, in spite of some limitations such as the paucity of organs, tissue rejection, technical problems, and current law, compelled the researcher to investigate new sources for organ donation that can help meet the demand for transplantation. [11][12][13][14] Stereology is a series of techniques that are based on well-defined mathematical and statistical background. The data accumulated through these methods are based on two-dimensional images of three-dimensional structures.…”

Anencephalic organ donation after cardiac death: a case report on practicalities and ethics

“…It was estimated that the tissue typing would occupy 6-8 h, and on completion, the neonate would be extubated. On the basis of the literature and personal communication, 1 it was predicted with some degree of certainty that the neonate would expire within a relatively brief time, following extubation. The understanding was that the window for viable kidney and hepatocyte retrieval would be~120 min.…”

“…Criteria for brain death guided decisions regarding the suitability of various potential organ donors, but because anencephalic infants rarely met criteria for brain death, they were not considered suitable donors. 1 In more recent years advances in transplantation medicine have made it possible to successfully retrieve organs from terminal patients, including neonates, who don't meet brain death criteria. This process, referred to as Donation after Circulatory Death (DCD) involves donation of organs from terminally ill patients who are removed from life support and then, as a result, sustain a circulatory death.…”

Anencefalia: conhecimento e opinião dos médicos ginecologistas-obstetras e pediatras de Goiânia

“…Live-born anencephalous babies show functions of the brainstem, with spontaneous breathing and, frequently, some reflex responses, such as suction 24,36 . Therefore, there is an evident difference between the anencephalous and the patient in brain death: the functioning of the brainstem.…”