Anencephalics as organs donors : an analysis and application of the original intent of the ad hoc committee on brain death

216 Pages·1992·8.3 MB·English

by  Egan, Neely Anne Towe

YALE
MEDICAL LIBRAW
Digitized by the Internet Archive
in 2017 with funding from
Arcadia Fund
https://archive.org/details/anencephalicsasoOOegan

ANENCEPHALICS AS ORGAN DONORS:
AN ANALYSIS AND APPLICATION OF THE ORIGINAL INTENT
OF THE AD HOC COMMITTEE ON BRAIN DEATH
A Thesis Submitted to the Yale University
School of Medicine in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Medicine
by
Neely Anne Towe Egan

TABLE OF CONTENTS
Acknowledgements. iv
Abstract. v
I. INTRODUCTION. 1
II. THE ANENCEPHALIC DEBATE. 4
III. THE EVOLUTION OF DEATH'S DEFINITION AND DIAGNOSIS... 23
IV. A CLOSER LOOK AT THE AD HOC COMMITTEE. 55
V. THE ANENCEPHALIC DEBATE REVISITED. 71
Notes. 74
References. 84

ABSTRACT
ANENCEPHALICS AS ORGANS DONORS: AN ANALYSIS AND APPLICATION OF
THE ORIGINAL INTENT OF THE AD HOC COMMITTEE ON BRAIN DEATH.
Neely Anne Towe Egan. (Sponsored by Robert J. Levine). Department of
Internal Medicine, Yale University, School of Medicine, New Haven, CT.
In 1968, the Harvard Ad Hoc Committee on Brain Death created the
criteria to determine brain death and consequently revolutionized the
practices of intensive medicine and organ transplantation. Since their
drafting, the brain death criteria have been slightly adapted as
advancements have been made in brain function measurements, but the
basic requirements of loss of consciousness, responsiveness,
spontaneous movements and breathing, and reflexes have been strictly
adhered to despite much criticism. The most recent tide of criticism
has surfaced in the debate over whether to use anencephallc infants as
organ donors. The anencephallc is born without the cerebral
hemispheres which would give the infant consciousness, responsiveness
and voluntary movements, but Is born with a brainstem which gives him
or her spontaneous breathing and reflexes and thus Is excluded from
acceptance as a suitable organ donor under the brain death criteria.
However, an analysis of the Influences which surrounded the Ad Hoc
Committee and a careful study of the unpublished papers of the
Committee’s chairman. Dr. Henry Beecher, and of the correspondence he
conducted with members of the Committee reveals the true intent of
the Ad Hoc Committee and that this intent is far from today's practice
of the criteria of brain death. If the original intent of the Ad Hoc
Committee on Brain Death were applied to the anencephallc, then the
anencephallc could be accepted as a suitable organ donor.