A Balancing Act of Life and Death

After years of research, doctors feel they are ready to try to alleviate many incurable conditions, ranging from congenital heart defects to degenerative nerve diseases, through the transplanting of organs and tissues. Their pioneering triumphs, however, have created a Faustian dilemma. Each year in the U.S. hundreds of infants die who could have been saved by a new heart; literally millions of people with diseases like Parkinson's and Alzheimer's may eventually benefit from tissue implants. Should physicians manipulate the definitions of life and death to meet this growing demand for donor tissue? The question is taking on a new immediacy as doctors begin transplanting tissue from once unimagined sources: aborted fetuses and anencephalic newborns.

Surgeons at Loma Linda University Medical Center in California only last October transplanted a heart into Newborn Paul Holc. What made the transplant different was that the donor, a Canadian infant known as Baby Gabriel, was born anencephalic, that is, without most of her brain. Like virtually all anencephalics, she could not have survived more than a few days outside the womb; unlike most, Gabriel died before her healthy organs deteriorated. Then, early in January, surgeons in Mexico City announced that for the first time, they had successfully grafted tissue from a miscarried fetus into the brains of two Parkinson's victims, who have since improved dramatically.

To many, the fetal-tissue transplant raised a troubling question: Should doctors be allowed to use tissue from intentionally aborted fetuses to alleviate an otherwise hopeless condition? The Baby Gabriel case focused on even knottier dilemmas: Should laws defining death be rewritten to allow the "harvesting" of anencephalic donors? Should their existence be prolonged solely to enable doctors to take their organs?

Such issues are not academic. In the past few months, TIME has learned, Baby Gabriel's Canadian physicians kept three other anencephalic children on respirators in order to use their organs for transplantation. "I can't imagine a time when there have been so many advances in medical research that have raised such serious issues," says Neonatologist Lawrence Platt of the University of Southern California. Declares Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota: "Our fear is that somehow reproduction has shifted away from an act that creates a family into an arena in which money, profit and benefit for others start to enter."

Parents of anencephalics have been in the forefront of the campaign to make use of their infants' organs, as a way of making their brief, tragic lives meaningful. Such babies are often born with no skin or skull above their eyes. They have only an exposed bud of a brain and a brain stem that keeps their heart and lungs working erratically. Under current state laws, death occurs when all brain activity has ceased. Anencephalic infants are technically alive until their brain stem stops functioning. By then, however, the increasingly insufficient oxygen supply has ruined any potentially useful organs.