THE YOUNG MAN HAD FALLEN OFF A CLIFF WHILE HIKING. Now he was in a coma. His doctors in Stanford’s intensive care unit determined that he had suffered massive, irreversible brain damage and would never make a meaningful recovery. His parents, who knew their son would not have wanted to remain in the zombie-like limbo afforded by a mechanical ventilator, decided to withdraw life support. They also wanted to donate his organs. “It was an incredibly altruistic gesture in the midst of a tragedy,” recalls Carlos Esquivel, MD, PhD, chief of Stanford’s Transplantation Division, of the seven-year-old case.
But Esquivel also recognized that organ donation helps many parents cope with their grief over the loss of a child. So he was upset when David Magnus, PhD, director of the Stanford Center for Biomedical Ethics, arrived at the scene to inform the transplant team that the procedure could not go forward. “It was just the thought that we couldn’t fulfill the parents’ wishes,” Esquivel says.
Magnus, who is occasionally summoned to the hospital to advise doctors on end-of-life issues, including the advisability of organ donation, recalls the scene as “very tense.” At the time, Stanford permitted the removal of organs only from voluntary living donors — a mother donating a kidney to her daughter, for example — and from non-living donors whose deaths were based on the loss of all brain function. But this young man’s brain stem was still active, albeit barely, so donation was not an option.