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Is it Morally Acceptable to Remove Organs from Brain-Dead Children?

Masahiro Morioka

-- Lancet Neurology, Vol.6, January, 2007, p.90

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Children have the right not to be exploited by the desire of adults. When a brain dead child has said nothing about brain death, we have to think that the child has a right to live and die peacefully, fully protected against the interests of others.

        In Japan, according to several surveys, around 30% of the population do not accept brain death as death of the human being. The current law on organ transplantation was established on the basis of the idea of pluralism on human death -- that is, people can determine beforehand, if they want, whether to choose brain death as their own death or not, and if they have not declared anything, their death is diagnosed by the cessation of heartbeat. Personally, I highly appreciate Japanese pluralism on human death because it shows a deep respect for the diversity of ideas on life and death (1).
        The basic policy of organ transplantation from brain dead donors in Japan is: “From those who wish to donate to those who wish to receive.” This is called the donor’s prior declaration principle. According to this principle, only when a donor has declared his or her consent beforehand in the form of a donor card, both a legal brain-dead diagnosis and an organ removal become possible on the premise that the family does not refuse it.
        However, this principle has created some difficult problems we had never imagined. The most difficult of which is organ removal from a brain-dead child. First, the current guideline stipulates that the legal brain-death diagnosis of a child younger than 15 years of age must not be performed because the statement of a child younger than 15 years of age written in a donor card is not deemed legally valid. This means that organ transplants from brain-dead children younger than this age are forbidden. Second, doctors and nurses continue caring for brain-dead children until their heart naturally stops beating because a brain dead child is regarded as legally alive under the current law for the above reason, and since most parents wish to continue caring for their brain dead child, sometimes the heart of a brain-dead child continues beating more than a month in a hospital. A doubt about the idea of infant brain death is beginning to arise among specialists.
        How should we think about organ transplantation from brain dead children?
        First, as I noted above, there are many people in Japan who think that a brain dead patient with a warm body should not be considered dead even if he or she has permanently lost consciousness. The 6 year old son of Dr. Tateo Sugimoto was hit by a car and became brain dead. Sugimoto was a neurologist; however, he could not accept the view that his brain-dead son was dead. He continued to think that his son was alive until his heart stopped beating. According to Alan Shewmon, brain-dead children are more likely than brain-dead adults to progress to a state of chronic brain death (2). In 1995, a Japanese baby became brain dead soon after she was born. She grew taller and “lived” until the age of 4 years in the state of brain death (3). These cases strongly suggest that it should be considered reasonable for the parents to believe that their brain dead-child is alive, especially when the child’s body is warm, the limbs move, or the child grows taller. Pluralism on human death should not be abandoned, especially in the case of children.
        Second, concerning the donor’s prior declaration principle, Dr. Tateo Sugimoto and I have proposed to revise the current law and allow children between 6 years and 15 years to be able to have donor cards and express their wishes on brain death and organ transplants. A donor card without the signature of a person with parental authority should not be accepted (4). This approach is the only way to remove organs from brain-dead children, maintaining the donor’s prior declaration principle. In the Article 12 of “Convention on the Rights of the Child,” we can find this expression, “States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child.” This is the basic idea of our proposal.
        Then, what about when a brain-dead child does not have a valid donor card, or when the child is younger than 6 years of age? I think in this case the organs should not be removed from a brain-dead child even if the parents wish to do so. The silent child might have been thinking that a brain-dead person is not really dead, or it might be that organ removal was against the child’s inner wish. Organ removal from such a child is equivalent to exploitation of a “living” child. Children have the right not to be exploited by the desire of adults. When a brain dead child has said nothing about brain death, we have to think that the child has a right to live and die peacefully, fully protected against the interests of others. One might say that this means to discard babies with severe diseases who can’t survive without transplantation. Last year (2005) a 1 year old Japanese baby received five organs in the USA, but unfortunately she lived only 5 months and died early this year (2006). By contrast, the brain-dead baby, mentioned above, “lived” 4 years with her parents in a hospital. Every year her birthday was celebrated by the medical staff. No one can decide which life is superior to or more valuable than the other. It is time to reconsider organ transplantation from brain-dead children.

1) Masahiro Morioka, “Reconsidering Brain Death,” Hastings Center Report 31, no.4 (2001): 41-46

2) D. A. Shewmon, “Chronic ‘Brain Death,’” Neurology 51 (1998): 1538-45.

3) Chisen Kamei, Hidamari no Byoshitsu de. Medica Shuppan, 2002.

4) Masahiro Morioka and Tateo Sugimoto, “A Proposal for Revision of the Organ Transplantation Law Based on a Child Donor’s Prior Declaration,” EJAIB 11 (2001):108-110.

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