0
March 24, 1989, Vol 261, No. 12 >
ARTICLE | March 24, 1989

The Use of Anencephalic Infants as Organ Sources: Title and subTitle BreakA Critique FREE

D. Alan Shewmon, MD; Alexander M. Capron, LLB; Warwick J. Peacock, MD; Barbara L. Schulman, RN
[+] Author Affiliations

Reprint requests to UCLA Medical Center, MDCC 22-464,10833 LeConte Ave, Los Angeles, CA 90024-1752 (Dr Shewmon).


JAMA. 1989;261(12):1773-1781. doi:10.1001/jama.1989.03420120111036
Text Size: A A A
Published online
Article
References

The recent abandonment of the only active US protocol for harvesting organs from anencephalic "donors" indicates both the practical and the ethical problems inherent in such an effort. Various data suggest that surprisingly few such organs would actually end up benefiting other children. Attempts to revise either the Uniform Anatomical Gift Act or the Uniform Determination of Death Act to allow organ removal from spontaneously breathing anencephalic infants face major ethical objections. Even if this posed no ethical problem in theory, the ultimate harm to society would not be offset by the good of the few surviving recipients of these organs. Furthermore, providing anencephalic infants with intensive care would tend to preserve the brain stem as effectively as the other organs, predictably rendering the occurrence of brain death unlikely. Thus, despite the great need for newborn organs, anencephalic infants are not as attractive a source as some had hoped.

(JAMA. 1989;261:1773-1781)

REFERENCES

1 +
Walters JW, Ashwal S.  Organ prolongation in anencephalic infants: ethical and medical issues . Hastings Cent Rep. (October) /November 1988;;18: 19-27.
2 +
Task Force on Organ Transplantation. Organ Transplantation: Issues and Recommendations . Rockville, Md: US Dept of Health and Human Services; 1986;:27-37.
3 +
Defining Death: Medical, Legal and Ethical Issues in the Determination of Death . Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research; 1981;.
4 +
Shewmon DA.  Caution in the definition and diagnosis of infant brain death . In: Thomasma DC, Monagle JF, eds. Medical Ethics: A Guide for Health Professionals . Rockville, Md: Aspen Systems Corp; 1987;:38-57.
5 +
Coulter DL.  Neurologic uncertainty in newborn intensive care . N Engl J Med. 1987;;316:840-844.
6 +
Task Force for the Determination of Brain Death in Children.  Guidelines for the determination of brain death in children . Ann Neurol. 1987;;21:616-617.
7 +
Arch Neurol. 1987;; 44:587-588
8 +
Neurology . 1987;;37:1077-1078
9 +
Pediatrics . 1987;;80:298-300
10 +
Pediatr Neurol. 1987;; 3:242-243
11 +
Shewmon DA.  Commentary on guidelines for the determination of brain death in children . Ann Neurol. 1988;;24:789-791.
12 +
Volpe JJ.  Brain death determination in the newborn . Pediatrics. 1987;;80:293-297.
13 +
Kantrowitz A, Haller JD, Joos H, Cerruti MM, Carstensen HE.  Transplantation of the heart in an infant and an adult . Am J Cardiol. 1968;;22:782-790.
14 +
Cooley DA, Hallman GL, Bloodwell RD, Nora JJ, Leachman RD.  Human heart transplantation: experience with twelve cases . Am J Cardiol. 1968;;22:804-810.
15 +
Annas GJ.  From Canada with love: anencephalic newborns as organ donors? Hastings Cent Rep. (December) 1987;;17:36-38.
16 +
Goodwin WE, Kaufman JJ, Mims MM, et al.  Human renal transplantation, I: clinical experiences with six cases of renal homotransplantation . J Urol. 1963;;89:13-24.
17 +
Martin LW, Gonzales LL, West CD, Swartz RA, Sutorius DJ.  Homotransplantation of both kidneys from an anencephalic monster to a 17 pound boy with Eagle-Barrett syndrome . Surgery . 1969;;66:603-607.
18 +
Fine RN, Korsch BM, Stiles Q, et al.  Renal homotransplantation in children . J Pediatr. 1970;; 76:347-357.
19 +
LaPlante MP, Kaufman JJ, Goldman R, Gonick HC, Martin DC, Goodwin WE.  Kidney transplantation in children . Pediatrics . 1970;;46:665-677.
20 +
King LR, Gerbie AG, Idriss FS, et al.  Human renal transplantation with kidney grafts from the newborn . Invest Urol. 1971;;8:622-628.
21 +
Lawson RK, Bennett WM, Campbell RA, Pirofsky B, Hodges CV.  Hyperacute renal allograft rejection in the human neonate . Invest Urol. 1973;;10:444-449.
22 +
Salvatierra O Jr, Belzer FO.  Pediatric cadaver kidneys: their use in renal transplantation . Arch Surg. 1975;;110:181-183.
23 +
Dreikorn K, Röhl L, Horsch R.  The use of double renal transplants from paediatric cadaver donors . Br J Urol. 1977;;49:361-364.
24 +
Kwun YA, Butt KMH, Kim KH, Kountz SL, Moel DI.  Successful renal transplantation in a 3-month-old infant . J Pediatr. 1978;;92:426-429.
25 +
Iitaka K, Martin LW, Cox JA, McEnery PT, West CD.  Transplantation of cadaver kidneys from anencephalic donors . J Pediatr. 1978;;93:216-220.
26 +
Martin LW, McEnery PT, Rosenkrantz JG, Cox JA, West CD, LeCoultre C.  Renal homotransplantation in children . J Pediatr Surg. 1979;;14:571-576.
27 +
Moel DI, Butt KMH.  Renal transplantation in children less than 2 years of age . J Pediatr. 1981;;99:535-539.
28 +
Kinnaert P, Vereerstraeten P, Van Asperen de Boer F, et al.  Transplantation of both kidneys of an anencephalic newborn to a 23-year-old patient . Eur Urol. 1981;;7:373-376.
29 +
Kinnaert P, Persijn G, Cohen B, Van Geertruyden J.  Transplantation of kidneys from anencephalic donors . Transplant Proc. 1984;;16:71-72.
30 +
Ohshima S, Ono Y, Kinukawa T, Matsuura O, Tsuzuki K, Itoh S.  Kidney transplantation from an anencephalic baby: a case report . J Urol. 1984;; 132:546-547.
31 +
Gutierrez Calzada JL, Martinez JL, Baena V, et al.  En bloc kidney and bladder transplantation from an anencephalic donor into an adult recipient . J Urol. 1987;;138:125-126.
32 +
Holzgreve W, Beller FK, Buchholz B, Hansmann M, Köhler K.  Kidney transplantation from anencephalic donors . N Engl J Med. 1987;;316:1069-1070.
33 +
Harrison MR.  The anencephalic newborn as organ donor . Hastings Cent Rep. April 1986;;16:2122.
34 +
Harrison MR.  Organ procurement for children: the anencephalic fetus as donor . Lancet . 1986;;2: 1383-1386.
35 +
Capron AM.  Anencephalic donors: separate the dead from the dying . Hastings Cent Rep. (February) 1987;;17:5-9.
36 +
Position Statement on Anencephalic Infants as Organ Donors . San Francisco: California Nurses Association; 1988;.
37 +
Report of the Ethics Committee (approved by the Board of Directors) . Richmond, Va: United Network for Organ Sharing; February 1989;.
38 +
Ethics and Social Impact Committee, Transplant Policy Center.  Anencephalic infants as sources of transplantable organs . Hastings Cent Rep. (October) /November 1988;;18:28-30.
39 +
Shewmon DA.  Anencephaly: selected medical aspects . Hastings Cent Rep. (October) /November 1988;;18:11-19.
40 +
Radic A, Dolk H, De Wals P.  Declining rate of neural tube defects in three eastern counties of Ireland: 1979-1984 . Irish Med J. 1987;;80:226-228.
41 +
Romijn JA, Treffers PE.  Anencephaly in the Netherlands: a remarkable decline . Lancet . 1983;; 1:64-65.
42 +
Leck I.  Spina bifida and anencephaly: fewer patients, more problems . Br Med J. 1983;;286:1679-1680.
43 +
Elwood JM, Elwood JH. Epidemiology of Anencephalus and Spina Bifida . Oxford (England) University Press; 1980;:87-90,107-119.
44 +
Stein SC, Feldman JG, Friedlander M, Klein RJ.  Is myelomeningocele a disappearing disease? Pediatrics . 1982;;69:511-514.
45 +
Windham GC, Edmonds LD.  Current trends in the incidence of neural tube defects . Pediatrics . 1982;;70:333-337.
46 +
Borman GB, Howard JK, Chapman CJ.  Secular trends in anencephalus prevalence in New Zealand . NZ Med J. 1986;;99:183-185.
47 +
Statistical Abstract of the United States: 1988 . 108th ed. Washington, DC: US Bureau of the Census; 1987:59-60 (Tables 81 and 83).
48 +
Jorde LB, Fineman RM, Martin RA.  Epidemiology of neural tube defects in Utah, 1940-1979 . Am J Epidemiol. 1984;;119:487-495.
49 +
Cassady G.  Anencephaly: a 6 year study of 367 cases . Am J Obstet Gynecol. 1969;;103:1154-1159.
50 +
Pomerance JJ, Morrison A, Schifrin BS, Williams RL.  Anencephalic infants: life expectancy and organ donation . J Perinatol. In press.
51 +
Ettenger RB, Fine RN.  Renal transplantation . In: Holliday MA, Barratt TM, Vernier RL, eds. Pediatric Nephrology . 2nd ed. Baltimore, Md: Williams & Wilkins; 1987;:828-846.
52 +
Lum CT, Wassner SJ, Martin DE.  Current thinking in transplantation in infants and children . Pediatr Clin North Am. 1985;;32:1203-1230.
53 +
Cabasson J, Blanc WA, Joos HA.  The anencephalic infant as a possible donor for cardiac transplantation . Clin Pediatr. 1969;;2:86-89.
54 +
Melnick M, Myrianthopoulos NC.  Studies in neural tube defects, II: pathologic findings in a prospectively collected series of anencephalics . Am J Med Genet. 1987;;26:797-810.
55 +
Lemire RJ, Beckwith JB, Warkany J. Anencephaly . New York, NY: Raven Press; 1978;:73-74.
56 +
David TJ, Nixon A.  Congenital malformations associated with anencephaly and iniencephaly . J Med Genet. 1976;;13:263-265.
57 +
Naeye RL, Blanc WA.  Organ and body growth in anencephaly: a quantitative, morphological study . Arch Pathol. 1971;;91:140-147.
58 +
Esquivel CO, Koneru B, Karrer F, et al.  Liver transplantation before 1 year of age . J Pediatr. 1987;;110:545-548.
59 +
Lilly JR, Hall RJ, Altman RP.  Liver transplantation and Kasai operation in the first year of life: therapeutic dilemma in biliary atresia . J Pediatr. 1987;;110:561-562.
60 +
Mahowald MB, Silver J, Ratcheson RA.  The ethical options in transplanting fetal tissue . Hastings Cent Rep. (February) 1987;;17:9-15.
61 +
Warren MA.  Can the fetus be an organ farm? Hastings Cent Rep. (October) 1978;;8:23-24.
62 +
Brahams D.  Fetal spare parts . Lancet . 1988;; 1:424.
63 +
Caplan AL.  Should foetuses or infants be utilized as organ donors? Bioethics . 1987;;1:119-140.
64 +
Chargaff E.  Engineering a molecular nightmare . Nature . 1987;;327:199-200.
65 +
Warren MA.  Postscript on infanticide . In: Wasserstrom RA, ed. Today's Moral Problems . New York, NY: Macmillan Publishing Co Inc; 1975;:135-136.
66 +
Tooley M.  Abortion and infanticide . In: Gorovitz A, Jameton AL, Macklin R, et al, eds. Moral Problems in Medicine . Englewood Cliffs, NJ: Prentice-Hall International Inc; 1976;:297-317.
67 +
Fletcher J.  Indicators of humanhood: a tentative profile of man . Hastings Cent Rep. (November) 1972;;2:1-4.
68 +
Singer P.  Sanctity of life or quality of life? Pediatrics . 1983;;72:128-129.
69 +
Lachs J.  Humane treatment and the treatment of humans . N Engl J Med. 1976;;294:838-840.
70 +
Chervenak FA, Farley MA, Walters L, Hobbins JC, Mahoney MJ.  When is termination of pregnancy during the third trimester morally justifiable? N Engl J Med. 1984;;310:501-504.
71 +
Gianelli DM.  Pediatric surgeon back in spotlight—with controversial new donor . Am Med News . (November 6) , 1987;:48.
72 +
Coulter DL.  Beyond Baby Doe: does infant transplantation justify euthanasia? J Assoc Persons With Severe Handicaps . 1988;;13:71-75.
73 +
Arras JD, Shinnar S.  Anencephalic newborns as organ donors: a critique . JAMA . 1988;;259:2284-2285.
74 +
Feeney DM, Hovda DA.  Reinstatement of binocular depth perception by amphetamine and visual experience after visual cortex ablation . Brain Res. 1985;;342:352-356.
75 +
Bromiley RB.  Conditioned responses in a dog after removal of neocortex . J Comp Physiol Psychol. 1948;;41:102-110.
76 +
Travis AM, Woolsey CN.  Motor performance of monkeys after bilateral partial and total cerebral decortications . Am J Phys Med. 1956;;35:273-310.
77 +
Finger S, Stein DG. Brain Damage and Recovery: Research and Clinical Perspectives . New York, NY: Academic Press Inc; 1982;:245-250.
78 +
Huston JP, Borbély AA.  The thalamic rat: general behavior, operant learning with rewarding hypothalamic stimulation, and effects of amphetamine . Physiol Behav. 1974;;12:433-448.
79 +
Norman RJ, Buchwald JS, Villablanca JR.  Classical conditioning with auditory discrimination of the eye blink in decerebrate cats . Science . 1977;;196:551-553.
80 +
Francis PL, Self PA, McCaffree MA.  Behavioral assessment of a hydranencephalic neonate . Child Dev. 1984;;55:262-266. (Judging from the authors' description, this infant probably suffered from maximal hydrocephalus rather than hydranencephaly.)
81 +
Aylward GP, Lazzara A, Meyer J.  Behavioral and neurological characteristics of a hydranencephalic infant . Dev Med Child Neurol. 1978;;20:211-277.
82 +
Berntson GG, Micco DJ.  Organization of brainstem behavioral systems . Brain Res Bull. 1976;; 1:471-483.
83 +
Berntson GG, Tuber DS, Ronca AE, Bachman DS.  The decerebrate human: associative learning . Exp Neurol. 1983;;81:77-88.
84 +
Graham FK, Leavitt LA, Strock BD, Brown JW.  Precocious cardiac orienting in a human anencephalic infant . Science . 1978;;199:322-324.
85 +
Brackbill Y.  The role of the cortex in orienting: orienting reflex in an anencephalic human infant . Dev Psychol. 1971;;5:195-201.
86 +
Lorber J.  Hydranencephaly with normal development . Dev Med Child Neurol. 1965;;7:628-633.
87 +
Lemire RJ, Loeser JD, Leech RW, Alvord EC Jr. Normal and Abnormal Development of the Human Nervous System . Hagerstown, Md: Harper & Row Publishers Inc; 1975;.
88 +
Chugani HT, Phelps ME, Mazziotta JC.  Positron emission tomography study of human brain functional development . Ann Neurol. 1987;;22:487-497.
89 +
Bjursten L-M, Norrsell K, Norrsell U.  Behavioural repertory of cats without cerebral cortex from infancy . Exp Brain Res. 1976;;25:115-130.
90 +
Hovda DA, Villablanca JR, Shook BL.  Sparing of the visual field is associated with less metabolic depression in the superior colliculus of neonatal versus adult hemispherectomized cats . Soc Neurosci Abstr. 1987;;13:1692.
91 +
Goldman PS, Galkin TW.  Prenatal removal of frontal association cortex in the fetal rhesus monkey: anatomical and functional consequences in postnatal life . Brain Res. 1978;;152:451-458.
92 +
Fletcher JC, Robertson JA, Harrison MR.  Primates and anencephalics as sources for pediatric organ transplants: medical, legal, and ethical issues . Fetal Ther. 1986;;1:150-164.
93 +
Baird PA, Sadovnick AD.  Survival in infants with anencephaly . Clin Pediatr. 1984;;23:268-271.
94 +
Harmon JB, Miller CA, Turkel SB.  The cerebral malformation of the amniotic band syndrome . Bull Los Angeles Neurol Soc. 1978;;43:87-90.
95 +
Urich H, Herrick MK.  The amniotic band syndrome as a cause of anencephaly: report of a case . Acta Neuropathol (Berl). 1985;;67:190-194.
96 +
Lemire RJ, Cohen MM Jr, Beckwith JB, Kokich VG, Siebert JR.  The facial features of holoprosencephaly in anencephalic human specimens, I: historical review and associated malformations . Teratology . 1981;;23:297-303.
97 +
Siebert JR, Kokich VG, Beckwith JB, Cohen MM Jr, Lemire RJ.  The facial features of holoprosencephaly in anencephalic human specimens, II: craniofacial anatomy . Teratology . 1981;;23:305-315.
98 +
Warkany J. Congenital Malformations . Chicago, Ill: Year Book Medical Publishers Inc; 1971;.
99 +
Chaurasia BD.  Calvarial defect in human anencephaly . Teratology . 1984;;29:165-172.
100 +
Lemire RJ.  Neural tube defects . JAMA . 1988;;259:558-562.
101 +
Gardner WJ.  Klippel-Feil syndrome, iniencephalus, anencephalus, hindbrain hernia and mirror movements: overdistention of the neural tube . Child's Brain. 1979;;5:361-379.
102 +
Wood LR, Smith MT.  Generation of anencephaly: 1. aberrant neurulation and 2. conversion of exencephaly to anencephaly . J Neuropathol Exp Neurol. 1984;;43:620-633.
103 +
Bell JE, Green RJL.  Studies on the area cerebrovasculosa of anencephalic fetuses . J Pathol. 1982;;137:315-328.
104 +
Chaurasia BD.  Forebrain in human anencephaly . Anat Anz. 1977;;142:471-478.
105 +
Terao T, Kawashima Y, Noto H, et al.  Neurological control of fetal heart rate in 20 cases of anencephalic fetuses . Am J Obstet Gynecol. 1984;;149:201-208.
106 +
Gianelli DM.  Anencephalic heart donor creates new ethics debate . Am Med News . (November 6) , 1987;:3,47-49.
107 +
Nielsen JM, Sedgwick RP.  Instincts and emotions in an anencephalic monster . J Nerv Ment Dis. 1949;;110:387-394.
108 +
Keller H, Neuhauser G, Durkin-Stamm MV, Kaveggia EG, Schaaff A, Sitzmann F.  `ADAM complex' (amniotic deformity, adhesions, mutilations): a pattern of craniofacial and limb defects . Am J Med Genet. 1978;;2:81-98.
109 +
Shewmon DA, Sherman MP, Danner R.  Atelencephalic microcephaly . Clin Pediatr. 1984;; 23:649-651.
110 +
Siebert JR, Kokich VG, Warkany J, Lemire RJ.  Atelencephalic microcephaly: craniofacial anatomy and morphologic comparisons with holoprosencephaly and anencephaly . Teratology . 1987;; 36:279-285.
111 +
Veatch RM.  The whole-brain oriented concept of death: an outmoded philosophical formulation . J Thanatol. 1975;;3:13-30.
112 +
Youngner SJ, Bartlett ET.  Human death and high technology: the failure of the whole-brain formulations . Ann Intern Med. 1983;;99:252-258.
113 +
Oski FA, Fost NC, Freeman JM, Seidel HM, Joffe A.  Ethical dilemma: should organs be taken from this patient? Contemp Pediatr. 1987;;4:110-117.
114 +
Cranford RE, Roberts JC.  Use of anencephalic infants as organ donors: crossing a threshold . In: Kaufman HH, ed. Pediatric Brain Death and Organ Retrieval . New York, NY: Plenum Press. In press.
115 +
Cranford RE.  Anencephalic organ donation raises broader ethical issues . Hennepin County Med Cent Alumni Q. (November) 1987;;3:2-5,8.
116 +
Pomerance JJ, Schifrin BS.  Anencephaly and the 'Baby Doe' regulations . Pediatr Res. 1987;;21( (4) , pt2):373A. Abstract.
117 +
De Morsier G, Bamatter F.  Anencéphalie (télencéphaloschizis total) et rhomboschizis avec hétérotopies cérébelleuses médianes: survie de 32 jours . Arch Psicol Neurol Psichiatr. 1952;;13:2-3.
118 +
Potts SG.  Headaches in Britain over brain death criteria . Hastings Cent Rep. (April) 1987;;17:2-3.
119 +
Carr BR, Parker CR Jr, Porter JC, MacDonald PC, Simpson ER.  Regulation of steroid secretion by adrenal tissue of a human anencephalic fetus . J Clin Endocrinol Metab. 1980;;50:870-873.
120 +
Cavallo L, Altomare M, Palmieri P, Licci D, Carnimeo F, Mastro F.  Endocrine function in four anencephalic infants . Hormone Res. 1981;;15:159-166.
121 +
Cawood ML, Heys RF, Oakey RE.  Corticosteroid production by the human foetus: evidence from analysis of urine from women pregnant with a normal or anencephalic foetus . J Endocrinol. 1976;;70:117-126.
122 +
McGrath P.  Aspects of the human pharyngeal hypophysis in normal and anencephalic fetuses and neonates and their possible significance in the mechanism of its control . J Anat. 1978;;127:65-81.
123 +
Pajor L, Németh Á, Illés T.  Functional morphology of the adrenal cortex in newborns, I: morphometric study . Acta Morphol Hung. 1986;;34:31-37.
124 +
Papp A, Csécsei K, Tóth Z, Polgár K, Szeifert GT.  Exencephaly in human fetuses . Clin Genet. 1986;;30:440-444.
125 +
Baird PA, Sadovnick AD.  Survival in liveborn infants with anencephaly . Am J Med Genet. 1987;;28:1019-1020.
126 +
Boniuk V, Ho PK.  Ocular findings in anencephaly . Am J Ophthalmol. 1979;;88:613-617.
127 +
Friedmann I, Wright JLW, Phelps PD.  Temporal bone studies in anencephaly . J Laryngol Otol. 1980;;94:929-944.
128 +
Molinari GF.  Review of clinical criteria of brain death . Ann NY Acad Sci. 1978;;315:62-69.
129 +
Walker AE. Cerebral Death . 2nd ed. Baltimore, Md: Urban & Schwarzenberg; 1981;:175.
130 +
Lamb D. Death, Brain Death and Ethics . Albany, NY: State University of New York Press; 1985;:8.
131 +
Fost N.  Organs from anencephalic infants: an idea whose time has not yet come . Hastings Cent Rep. (October) /November 1988;;18:5-10.
132 +
Rue VM, Speckhard A, Rogers JL, Franz W. The Psychological Aftermath of Abortion: A White Paper . Rockville, Md: Office of the Surgeon General; 1987;.
133 +
DavidH, RasmussenN, Holst E.  Postpartum and postabortion psychotic reactions . Fam Plan Perspect . 1981;;13:88-91.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Walters JW, Ashwal S.  Organ prolongation in anencephalic infants: ethical and medical issues . Hastings Cent Rep. (October) /November 1988;;18: 19-27.
2 +
Task Force on Organ Transplantation. Organ Transplantation: Issues and Recommendations . Rockville, Md: US Dept of Health and Human Services; 1986;:27-37.
3 +
Defining Death: Medical, Legal and Ethical Issues in the Determination of Death . Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research; 1981;.
4 +
Shewmon DA.  Caution in the definition and diagnosis of infant brain death . In: Thomasma DC, Monagle JF, eds. Medical Ethics: A Guide for Health Professionals . Rockville, Md: Aspen Systems Corp; 1987;:38-57.
5 +
Coulter DL.  Neurologic uncertainty in newborn intensive care . N Engl J Med. 1987;;316:840-844.
6 +
Task Force for the Determination of Brain Death in Children.  Guidelines for the determination of brain death in children . Ann Neurol. 1987;;21:616-617.
7 +
Arch Neurol. 1987;; 44:587-588
8 +
Neurology . 1987;;37:1077-1078
9 +
Pediatrics . 1987;;80:298-300
10 +
Pediatr Neurol. 1987;; 3:242-243
11 +
Shewmon DA.  Commentary on guidelines for the determination of brain death in children . Ann Neurol. 1988;;24:789-791.
12 +
Volpe JJ.  Brain death determination in the newborn . Pediatrics. 1987;;80:293-297.
13 +
Kantrowitz A, Haller JD, Joos H, Cerruti MM, Carstensen HE.  Transplantation of the heart in an infant and an adult . Am J Cardiol. 1968;;22:782-790.
14 +
Cooley DA, Hallman GL, Bloodwell RD, Nora JJ, Leachman RD.  Human heart transplantation: experience with twelve cases . Am J Cardiol. 1968;;22:804-810.
15 +
Annas GJ.  From Canada with love: anencephalic newborns as organ donors? Hastings Cent Rep. (December) 1987;;17:36-38.
16 +
Goodwin WE, Kaufman JJ, Mims MM, et al.  Human renal transplantation, I: clinical experiences with six cases of renal homotransplantation . J Urol. 1963;;89:13-24.
17 +
Martin LW, Gonzales LL, West CD, Swartz RA, Sutorius DJ.  Homotransplantation of both kidneys from an anencephalic monster to a 17 pound boy with Eagle-Barrett syndrome . Surgery . 1969;;66:603-607.
18 +
Fine RN, Korsch BM, Stiles Q, et al.  Renal homotransplantation in children . J Pediatr. 1970;; 76:347-357.
19 +
LaPlante MP, Kaufman JJ, Goldman R, Gonick HC, Martin DC, Goodwin WE.  Kidney transplantation in children . Pediatrics . 1970;;46:665-677.
20 +
King LR, Gerbie AG, Idriss FS, et al.  Human renal transplantation with kidney grafts from the newborn . Invest Urol. 1971;;8:622-628.
21 +
Lawson RK, Bennett WM, Campbell RA, Pirofsky B, Hodges CV.  Hyperacute renal allograft rejection in the human neonate . Invest Urol. 1973;;10:444-449.
22 +
Salvatierra O Jr, Belzer FO.  Pediatric cadaver kidneys: their use in renal transplantation . Arch Surg. 1975;;110:181-183.
23 +
Dreikorn K, Röhl L, Horsch R.  The use of double renal transplants from paediatric cadaver donors . Br J Urol. 1977;;49:361-364.
24 +
Kwun YA, Butt KMH, Kim KH, Kountz SL, Moel DI.  Successful renal transplantation in a 3-month-old infant . J Pediatr. 1978;;92:426-429.
25 +
Iitaka K, Martin LW, Cox JA, McEnery PT, West CD.  Transplantation of cadaver kidneys from anencephalic donors . J Pediatr. 1978;;93:216-220.
26 +
Martin LW, McEnery PT, Rosenkrantz JG, Cox JA, West CD, LeCoultre C.  Renal homotransplantation in children . J Pediatr Surg. 1979;;14:571-576.
27 +
Moel DI, Butt KMH.  Renal transplantation in children less than 2 years of age . J Pediatr. 1981;;99:535-539.
28 +
Kinnaert P, Vereerstraeten P, Van Asperen de Boer F, et al.  Transplantation of both kidneys of an anencephalic newborn to a 23-year-old patient . Eur Urol. 1981;;7:373-376.
29 +
Kinnaert P, Persijn G, Cohen B, Van Geertruyden J.  Transplantation of kidneys from anencephalic donors . Transplant Proc. 1984;;16:71-72.
30 +
Ohshima S, Ono Y, Kinukawa T, Matsuura O, Tsuzuki K, Itoh S.  Kidney transplantation from an anencephalic baby: a case report . J Urol. 1984;; 132:546-547.
31 +
Gutierrez Calzada JL, Martinez JL, Baena V, et al.  En bloc kidney and bladder transplantation from an anencephalic donor into an adult recipient . J Urol. 1987;;138:125-126.
32 +
Holzgreve W, Beller FK, Buchholz B, Hansmann M, Köhler K.  Kidney transplantation from anencephalic donors . N Engl J Med. 1987;;316:1069-1070.
33 +
Harrison MR.  The anencephalic newborn as organ donor . Hastings Cent Rep. April 1986;;16:2122.
34 +
Harrison MR.  Organ procurement for children: the anencephalic fetus as donor . Lancet . 1986;;2: 1383-1386.
35 +
Capron AM.  Anencephalic donors: separate the dead from the dying . Hastings Cent Rep. (February) 1987;;17:5-9.
36 +
Position Statement on Anencephalic Infants as Organ Donors . San Francisco: California Nurses Association; 1988;.
37 +
Report of the Ethics Committee (approved by the Board of Directors) . Richmond, Va: United Network for Organ Sharing; February 1989;.
38 +
Ethics and Social Impact Committee, Transplant Policy Center.  Anencephalic infants as sources of transplantable organs . Hastings Cent Rep. (October) /November 1988;;18:28-30.
39 +
Shewmon DA.  Anencephaly: selected medical aspects . Hastings Cent Rep. (October) /November 1988;;18:11-19.
40 +
Radic A, Dolk H, De Wals P.  Declining rate of neural tube defects in three eastern counties of Ireland: 1979-1984 . Irish Med J. 1987;;80:226-228.
41 +
Romijn JA, Treffers PE.  Anencephaly in the Netherlands: a remarkable decline . Lancet . 1983;; 1:64-65.
42 +
Leck I.  Spina bifida and anencephaly: fewer patients, more problems . Br Med J. 1983;;286:1679-1680.
43 +
Elwood JM, Elwood JH. Epidemiology of Anencephalus and Spina Bifida . Oxford (England) University Press; 1980;:87-90,107-119.
44 +
Stein SC, Feldman JG, Friedlander M, Klein RJ.  Is myelomeningocele a disappearing disease? Pediatrics . 1982;;69:511-514.
45 +
Windham GC, Edmonds LD.  Current trends in the incidence of neural tube defects . Pediatrics . 1982;;70:333-337.
46 +
Borman GB, Howard JK, Chapman CJ.  Secular trends in anencephalus prevalence in New Zealand . NZ Med J. 1986;;99:183-185.
47 +
Statistical Abstract of the United States: 1988 . 108th ed. Washington, DC: US Bureau of the Census; 1987:59-60 (Tables 81 and 83).
48 +
Jorde LB, Fineman RM, Martin RA.  Epidemiology of neural tube defects in Utah, 1940-1979 . Am J Epidemiol. 1984;;119:487-495.
49 +
Cassady G.  Anencephaly: a 6 year study of 367 cases . Am J Obstet Gynecol. 1969;;103:1154-1159.
50 +
Pomerance JJ, Morrison A, Schifrin BS, Williams RL.  Anencephalic infants: life expectancy and organ donation . J Perinatol. In press.
51 +
Ettenger RB, Fine RN.  Renal transplantation . In: Holliday MA, Barratt TM, Vernier RL, eds. Pediatric Nephrology . 2nd ed. Baltimore, Md: Williams & Wilkins; 1987;:828-846.
52 +
Lum CT, Wassner SJ, Martin DE.  Current thinking in transplantation in infants and children . Pediatr Clin North Am. 1985;;32:1203-1230.
53 +
Cabasson J, Blanc WA, Joos HA.  The anencephalic infant as a possible donor for cardiac transplantation . Clin Pediatr. 1969;;2:86-89.
54 +
Melnick M, Myrianthopoulos NC.  Studies in neural tube defects, II: pathologic findings in a prospectively collected series of anencephalics . Am J Med Genet. 1987;;26:797-810.
55 +
Lemire RJ, Beckwith JB, Warkany J. Anencephaly . New York, NY: Raven Press; 1978;:73-74.
56 +
David TJ, Nixon A.  Congenital malformations associated with anencephaly and iniencephaly . J Med Genet. 1976;;13:263-265.
57 +
Naeye RL, Blanc WA.  Organ and body growth in anencephaly: a quantitative, morphological study . Arch Pathol. 1971;;91:140-147.
58 +
Esquivel CO, Koneru B, Karrer F, et al.  Liver transplantation before 1 year of age . J Pediatr. 1987;;110:545-548.
59 +
Lilly JR, Hall RJ, Altman RP.  Liver transplantation and Kasai operation in the first year of life: therapeutic dilemma in biliary atresia . J Pediatr. 1987;;110:561-562.
60 +
Mahowald MB, Silver J, Ratcheson RA.  The ethical options in transplanting fetal tissue . Hastings Cent Rep. (February) 1987;;17:9-15.
61 +
Warren MA.  Can the fetus be an organ farm? Hastings Cent Rep. (October) 1978;;8:23-24.
62 +
Brahams D.  Fetal spare parts . Lancet . 1988;; 1:424.
63 +
Caplan AL.  Should foetuses or infants be utilized as organ donors? Bioethics . 1987;;1:119-140.
64 +
Chargaff E.  Engineering a molecular nightmare . Nature . 1987;;327:199-200.
65 +
Warren MA.  Postscript on infanticide . In: Wasserstrom RA, ed. Today's Moral Problems . New York, NY: Macmillan Publishing Co Inc; 1975;:135-136.
66 +
Tooley M.  Abortion and infanticide . In: Gorovitz A, Jameton AL, Macklin R, et al, eds. Moral Problems in Medicine . Englewood Cliffs, NJ: Prentice-Hall International Inc; 1976;:297-317.
67 +
Fletcher J.  Indicators of humanhood: a tentative profile of man . Hastings Cent Rep. (November) 1972;;2:1-4.
68 +
Singer P.  Sanctity of life or quality of life? Pediatrics . 1983;;72:128-129.
69 +
Lachs J.  Humane treatment and the treatment of humans . N Engl J Med. 1976;;294:838-840.
70 +
Chervenak FA, Farley MA, Walters L, Hobbins JC, Mahoney MJ.  When is termination of pregnancy during the third trimester morally justifiable? N Engl J Med. 1984;;310:501-504.
71 +
Gianelli DM.  Pediatric surgeon back in spotlight—with controversial new donor . Am Med News . (November 6) , 1987;:48.
72 +
Coulter DL.  Beyond Baby Doe: does infant transplantation justify euthanasia? J Assoc Persons With Severe Handicaps . 1988;;13:71-75.
73 +
Arras JD, Shinnar S.  Anencephalic newborns as organ donors: a critique . JAMA . 1988;;259:2284-2285.
74 +
Feeney DM, Hovda DA.  Reinstatement of binocular depth perception by amphetamine and visual experience after visual cortex ablation . Brain Res. 1985;;342:352-356.
75 +
Bromiley RB.  Conditioned responses in a dog after removal of neocortex . J Comp Physiol Psychol. 1948;;41:102-110.
76 +
Travis AM, Woolsey CN.  Motor performance of monkeys after bilateral partial and total cerebral decortications . Am J Phys Med. 1956;;35:273-310.
77 +
Finger S, Stein DG. Brain Damage and Recovery: Research and Clinical Perspectives . New York, NY: Academic Press Inc; 1982;:245-250.
78 +
Huston JP, Borbély AA.  The thalamic rat: general behavior, operant learning with rewarding hypothalamic stimulation, and effects of amphetamine . Physiol Behav. 1974;;12:433-448.
79 +
Norman RJ, Buchwald JS, Villablanca JR.  Classical conditioning with auditory discrimination of the eye blink in decerebrate cats . Science . 1977;;196:551-553.
80 +
Francis PL, Self PA, McCaffree MA.  Behavioral assessment of a hydranencephalic neonate . Child Dev. 1984;;55:262-266. (Judging from the authors' description, this infant probably suffered from maximal hydrocephalus rather than hydranencephaly.)
81 +
Aylward GP, Lazzara A, Meyer J.  Behavioral and neurological characteristics of a hydranencephalic infant . Dev Med Child Neurol. 1978;;20:211-277.
82 +
Berntson GG, Micco DJ.  Organization of brainstem behavioral systems . Brain Res Bull. 1976;; 1:471-483.
83 +
Berntson GG, Tuber DS, Ronca AE, Bachman DS.  The decerebrate human: associative learning . Exp Neurol. 1983;;81:77-88.
84 +
Graham FK, Leavitt LA, Strock BD, Brown JW.  Precocious cardiac orienting in a human anencephalic infant . Science . 1978;;199:322-324.
85 +
Brackbill Y.  The role of the cortex in orienting: orienting reflex in an anencephalic human infant . Dev Psychol. 1971;;5:195-201.
86 +
Lorber J.  Hydranencephaly with normal development . Dev Med Child Neurol. 1965;;7:628-633.
87 +
Lemire RJ, Loeser JD, Leech RW, Alvord EC Jr. Normal and Abnormal Development of the Human Nervous System . Hagerstown, Md: Harper & Row Publishers Inc; 1975;.
88 +
Chugani HT, Phelps ME, Mazziotta JC.  Positron emission tomography study of human brain functional development . Ann Neurol. 1987;;22:487-497.
89 +
Bjursten L-M, Norrsell K, Norrsell U.  Behavioural repertory of cats without cerebral cortex from infancy . Exp Brain Res. 1976;;25:115-130.
90 +
Hovda DA, Villablanca JR, Shook BL.  Sparing of the visual field is associated with less metabolic depression in the superior colliculus of neonatal versus adult hemispherectomized cats . Soc Neurosci Abstr. 1987;;13:1692.
91 +
Goldman PS, Galkin TW.  Prenatal removal of frontal association cortex in the fetal rhesus monkey: anatomical and functional consequences in postnatal life . Brain Res. 1978;;152:451-458.
92 +
Fletcher JC, Robertson JA, Harrison MR.  Primates and anencephalics as sources for pediatric organ transplants: medical, legal, and ethical issues . Fetal Ther. 1986;;1:150-164.
93 +
Baird PA, Sadovnick AD.  Survival in infants with anencephaly . Clin Pediatr. 1984;;23:268-271.
94 +
Harmon JB, Miller CA, Turkel SB.  The cerebral malformation of the amniotic band syndrome . Bull Los Angeles Neurol Soc. 1978;;43:87-90.
95 +
Urich H, Herrick MK.  The amniotic band syndrome as a cause of anencephaly: report of a case . Acta Neuropathol (Berl). 1985;;67:190-194.
96 +
Lemire RJ, Cohen MM Jr, Beckwith JB, Kokich VG, Siebert JR.  The facial features of holoprosencephaly in anencephalic human specimens, I: historical review and associated malformations . Teratology . 1981;;23:297-303.
97 +
Siebert JR, Kokich VG, Beckwith JB, Cohen MM Jr, Lemire RJ.  The facial features of holoprosencephaly in anencephalic human specimens, II: craniofacial anatomy . Teratology . 1981;;23:305-315.
98 +
Warkany J. Congenital Malformations . Chicago, Ill: Year Book Medical Publishers Inc; 1971;.
99 +
Chaurasia BD.  Calvarial defect in human anencephaly . Teratology . 1984;;29:165-172.
100 +
Lemire RJ.  Neural tube defects . JAMA . 1988;;259:558-562.
101 +
Gardner WJ.  Klippel-Feil syndrome, iniencephalus, anencephalus, hindbrain hernia and mirror movements: overdistention of the neural tube . Child's Brain. 1979;;5:361-379.
102 +
Wood LR, Smith MT.  Generation of anencephaly: 1. aberrant neurulation and 2. conversion of exencephaly to anencephaly . J Neuropathol Exp Neurol. 1984;;43:620-633.
103 +
Bell JE, Green RJL.  Studies on the area cerebrovasculosa of anencephalic fetuses . J Pathol. 1982;;137:315-328.
104 +
Chaurasia BD.  Forebrain in human anencephaly . Anat Anz. 1977;;142:471-478.
105 +
Terao T, Kawashima Y, Noto H, et al.  Neurological control of fetal heart rate in 20 cases of anencephalic fetuses . Am J Obstet Gynecol. 1984;;149:201-208.
106 +
Gianelli DM.  Anencephalic heart donor creates new ethics debate . Am Med News . (November 6) , 1987;:3,47-49.
107 +
Nielsen JM, Sedgwick RP.  Instincts and emotions in an anencephalic monster . J Nerv Ment Dis. 1949;;110:387-394.
108 +
Keller H, Neuhauser G, Durkin-Stamm MV, Kaveggia EG, Schaaff A, Sitzmann F.  `ADAM complex' (amniotic deformity, adhesions, mutilations): a pattern of craniofacial and limb defects . Am J Med Genet. 1978;;2:81-98.
109 +
Shewmon DA, Sherman MP, Danner R.  Atelencephalic microcephaly . Clin Pediatr. 1984;; 23:649-651.
110 +
Siebert JR, Kokich VG, Warkany J, Lemire RJ.  Atelencephalic microcephaly: craniofacial anatomy and morphologic comparisons with holoprosencephaly and anencephaly . Teratology . 1987;; 36:279-285.
111 +
Veatch RM.  The whole-brain oriented concept of death: an outmoded philosophical formulation . J Thanatol. 1975;;3:13-30.
112 +
Youngner SJ, Bartlett ET.  Human death and high technology: the failure of the whole-brain formulations . Ann Intern Med. 1983;;99:252-258.
113 +
Oski FA, Fost NC, Freeman JM, Seidel HM, Joffe A.  Ethical dilemma: should organs be taken from this patient? Contemp Pediatr. 1987;;4:110-117.
114 +
Cranford RE, Roberts JC.  Use of anencephalic infants as organ donors: crossing a threshold . In: Kaufman HH, ed. Pediatric Brain Death and Organ Retrieval . New York, NY: Plenum Press. In press.
115 +
Cranford RE.  Anencephalic organ donation raises broader ethical issues . Hennepin County Med Cent Alumni Q. (November) 1987;;3:2-5,8.
116 +
Pomerance JJ, Schifrin BS.  Anencephaly and the 'Baby Doe' regulations . Pediatr Res. 1987;;21( (4) , pt2):373A. Abstract.
117 +
De Morsier G, Bamatter F.  Anencéphalie (télencéphaloschizis total) et rhomboschizis avec hétérotopies cérébelleuses médianes: survie de 32 jours . Arch Psicol Neurol Psichiatr. 1952;;13:2-3.
118 +
Potts SG.  Headaches in Britain over brain death criteria . Hastings Cent Rep. (April) 1987;;17:2-3.
119 +
Carr BR, Parker CR Jr, Porter JC, MacDonald PC, Simpson ER.  Regulation of steroid secretion by adrenal tissue of a human anencephalic fetus . J Clin Endocrinol Metab. 1980;;50:870-873.
120 +
Cavallo L, Altomare M, Palmieri P, Licci D, Carnimeo F, Mastro F.  Endocrine function in four anencephalic infants . Hormone Res. 1981;;15:159-166.
121 +
Cawood ML, Heys RF, Oakey RE.  Corticosteroid production by the human foetus: evidence from analysis of urine from women pregnant with a normal or anencephalic foetus . J Endocrinol. 1976;;70:117-126.
122 +
McGrath P.  Aspects of the human pharyngeal hypophysis in normal and anencephalic fetuses and neonates and their possible significance in the mechanism of its control . J Anat. 1978;;127:65-81.
123 +
Pajor L, Németh Á, Illés T.  Functional morphology of the adrenal cortex in newborns, I: morphometric study . Acta Morphol Hung. 1986;;34:31-37.
124 +
Papp A, Csécsei K, Tóth Z, Polgár K, Szeifert GT.  Exencephaly in human fetuses . Clin Genet. 1986;;30:440-444.
125 +
Baird PA, Sadovnick AD.  Survival in liveborn infants with anencephaly . Am J Med Genet. 1987;;28:1019-1020.
126 +
Boniuk V, Ho PK.  Ocular findings in anencephaly . Am J Ophthalmol. 1979;;88:613-617.
127 +
Friedmann I, Wright JLW, Phelps PD.  Temporal bone studies in anencephaly . J Laryngol Otol. 1980;;94:929-944.
128 +
Molinari GF.  Review of clinical criteria of brain death . Ann NY Acad Sci. 1978;;315:62-69.
129 +
Walker AE. Cerebral Death . 2nd ed. Baltimore, Md: Urban & Schwarzenberg; 1981;:175.
130 +
Lamb D. Death, Brain Death and Ethics . Albany, NY: State University of New York Press; 1985;:8.
131 +
Fost N.  Organs from anencephalic infants: an idea whose time has not yet come . Hastings Cent Rep. (October) /November 1988;;18:5-10.
132 +
Rue VM, Speckhard A, Rogers JL, Franz W. The Psychological Aftermath of Abortion: A White Paper . Rockville, Md: Office of the Surgeon General; 1987;.
133 +
DavidH, RasmussenN, Holst E.  Postpartum and postabortion psychotic reactions . Fam Plan Perspect . 1981;;13:88-91.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems