Proposals to permit donation from anencephalic infants or condemned prisoners aim to maintain respect for the core values underlying the dead donor rule while concluding that the benefits of relaxing the rule in these marginal cases outweigh the loss in respect for life and trust in the transplant system that might result.
One proposal to change the dead donor rule would allow the retrieval of vital organs from anencephalic infants before they have suffered whole-brain death.
1] Much of the pressure for such organ donation in fact comes from parents of anencephalic infants, who typically see such transplantations as in their interests.
Yet however deformed and handicapped anencephalic infants may be, they are persons under the law and should be treated as such, at least until the present debate is resolved.
58] It is reasonable to assume, therefore, for purposes of calculation, that around 60 percent of liveborn anencephalics will be too small to provide useful organs for transplantation, reducing the above-estimated yearly 304 liveborn anencephalics to 122 potentially useful ones.
In the case of anencephalics, there will be a need either to prolong the infant's dying process (by means of a ventilator and intensive care, while awaiting "brain death") or to remove the organs while the infant is still alive (if the laws change).
Although most anencephalic infants are stillborn, between 25 and 45 percent are live births.
1] Rarely have anencephalic infants lived to several months.
The overall gain in promoting transplants from anencephalics may prove to be very great.
This third position is grounded upon the realization that anencephalics have an absolutely unique status, and must, in the interest of human decency and beneficence, be treated uniquely.
As Alexander Capron has noted, "whatever their clinical differences from anencephalic babies, hydraencephalics and some microcephalics are conceptually indistinguishable if the characteristic separating anencephalics from normal children is their lethal neurological condition.
15] In light of the fact that the anencephalic child could have been aborted legally, the insistence that anencephalics be brain dead is a source of irritation among some transplant surgeons, as reflected in the comments of Dr.