Ethics: A Death, A Life

Ethical complexities are increasing at the start of life as well. Last week Paul Holc, the youngest heart-transplant patient ever, was alive because of how a death-and-life problem was resolved in one case. Nine weeks ago, Canadians Karen, 27, and Fred, 36, learned that their unborn child lacked most of her brain. Called anencephaly, the always fatal malformation occurs in six of 10,000 births. Determined that some good should come from their tragedy, the couple decided to donate their baby's organs.

Infants in need of organ transplants greatly outnumber donors, but anencephalics have normally not been used. Reason: their organs have deteriorated too much by the time they are legally brain dead. But shortly after Baby Gabriel was born two weeks ago, Dr. Tim Frewen, head of pediatric intensive care at Children's Hospital in London, Ont., had her put on a life- support system to keep her organs healthy. Two days later, a test of her ability to breathe on her own was negative; three doctors, concluding all brain activity had ceased, declared Gabriel legally dead. Still on the life- support system, her body was flown to Loma Linda, Calif., where two days after her death, her heart was transplanted to Paul 2 1/2 hours after his caesarean delivery.

Answering criticism about the temptation to declare death prematurely, Dr. Calvin Stiller, London's transplant-unit chief, insisted Gabriel's case represented "no slippery slope." Gabriel's parents agreed. "We cried, but we cried with joy," Karen remembers. They went out, ordered champagne and "celebrated Gabriel's contribution to this world."