The Newborn as Organ Donor

Abstract

From a medical perspective, organ donation from newborn infants is fraught with difficulty: the diagnosis of brain death is difficult to make in this age group and, by current definition, exceedingly rare. In addition, severely brain-injured newborns often retain sufficient respiratory ability to maintain circulation long past the time when organs may be suitable for donation after circulatory death (DCD) following the withdrawal of life-sustaining treatment. The issue of donor suitability in terms of organ size and the frequent absence of a clear diagnosis compound the complexity. These medical issues lead to ethical challenges for caregivers and the families of newborn infants when the potential for organ donation is raised. In this chapter, we will address the issues relating to the diagnosis of brain death in the newborn; with regard to DCD we will discuss the timing of death and how the dying and grieving process for families and the team may be altered by the prospect of donation. While organ donation may salvage some good for the family and broader society, caution is required not only for practical and medical reasons but also in view of the ethical uncertainty inherent in the concept of the newborn as an organ donor.