THE case of a man whose heart stopped beating for 1-1/2 hours only to revive just as doctors were preparing to remove his organs for transplants is fuelling ethical debates in France about when a person is dead.
The 45-year-old man suffered a massive heart attack and rescuers used cardiac massage to try and revive him without success before transferring him to a nearby hospital.
Due to a series of complex circumstances, revival efforts continued for longer than usual for a patient whose heart was not responding to treatment, until doctors started preparations to remove organs.
It was at that point that the astonished surgeons noticed the man was beginning to breathe unaided again, his pupils were active, he was giving signs that he could feel pain — and finally, his heart started beating again.
Several weeks later, the man can walk and talk.
“This situation was a striking illustration of the questions that remain in the field of re-animation … and what criteria can be used to determine that a re-animation has failed,” says a report on the case, published online by an ethics committee.
The case has stirred debate among medical professionals and daily newspaper Le Monde on Tuesday dedicated a full page to the subject under the headline: “The organ donor wasn’t dead”.
“What is under consideration here is the status of a person, whether they are a patient who can be re-animated or a potential (organ) donor,” said the ethics committee report.
The hospital where the man was treated is one of only nine in France that are allowed to perform organ transplants on patients in cardiac arrest, in very specific conditions, under a pilot programme launched in 2007. Elsewhere, organ transplants are possible on other categories of patients under older rules.
The programme, which was approved by the French agency in charge of bio-ethics, aims to help reduce the number of people waiting for a transplant by making it possible to take organs from new categories of patients.
Le Monde said more than 13,000 people were waiting for transplants in France and 231 people died last year as a direct result of the lack of a donor. The newspaper said the pilot programme had already yielded an extra 60 organs.
Assistance Publique-Hopitaux de Paris (AP-HP), a body that runs public hospitals in the Paris region, has set up a committee specifically to discuss ethical issues arising from the practice of transplants on people in cardiac arrest.
The committee, made up of medical professionals involved in the revival of heart attack patients as well as organ transplants, held lengthy discussions on the case of the man on Feb. 19 and a summary was later published on the AP-HP website.
“During the meeting, other re-animators … spoke of situations in which a person whom everyone was sure had died in fact survived after re-animation efforts that went on much longer than usual,” say the minutes of the committee meeting.
“Participants conceded that these were completely exceptional cases, but ones that were nevertheless seen in the course of a career.”
