The Ethics and Expanding Uses of Brain-Dead Bodies in Medical Research and Organ Donation

Monday - January 22 2024, 19:13 UTC - 10 months ago

Brain-dead bodies are used for both organ donation and medical research experiments, particularly in the field of organ transplants using gene-edited pigs. Organizations like Gift of Life Donor Program play a crucial role in matching organs to recipients. Recent requests for brain-dead bodies have increased due to advancements in gene-editing technology. Contrary to popular belief, not all deaths are suitable for organ donation and it can only occur in the case of brain death while under medical care.

Hooked up to a ventilation machine, a person can be dead in the eyes of the law, medical professionals, and loved ones, yet still alive enough to be useful for medical research. Such brain-dead people are often used for organ donation, but they are also of increasing importance to the biotech world.

The point was to determine whether the organ—which was mounted inside a special pumping device—could still do its job of cleaning up toxins from the body, and possibly lead to a new approach for helping patients with acute liver failure.Using entire bodies in this way—as an experimental "decedent model"—remains highly unusual. But there’s been an upsurge in requests for bodies as more companies start testing animal-to-human organ transplants using tissues from specially gene-edited pigs.

"In order to get to humans, you have to go through steps. You can’t say ‘I am going to try it tomorrow,’ as you did 50 years ago," says Abraham Shaked, the surgeon at Penn who directed the experiment.To learn how common it is to use bodies as experimental models, I checked in with Richard Hasz, CEO of Gift of Life Donor Program, a nonprofit that arranges for organ donation in Pennsylvania, New Jersey and Delaware, and which provided Penn with the body used in the liver experiment.

"It’s definitely a new model. But sometimes we repeat things that have happened before. We have been around 50 years, and this is the second time it’s been requested," says Hasz.

The previous time was in the 1980s, when researchers at Temple University sought out brain-dead bodies as a "no risk" way to test an early artificial heart made from plastic and metal. They wanted to see how it fit in a chest and test surgical techniques before trying the mechanical heart in a living patient.

Starting in 2021, though, donation organizations again started hearing from surgeons who needed brain-dead people, sometimes called "beating-heart cadavers."That was because several companies had developed gene-edited pigs and doctors were ready to start trying their organs.

According to a tally from the biotech company eGenesis, of the 10 pig-to-human transplant experiments that have taken place in the US since 2021, two have been in living people, but the other eight have involved brain-dead bodies.

The main use of such bodies is as organ donors. Although most people don’t realize it, says Hasz, only that relatively rare 1% to 2% of people who experience brain death while under medical care can have their organs collected.

"It’s a big misconception that anyone who has died in a car accident or outside the hospital can be an organ donor. You have to have died in the ICU from a devastating neurological injury to your brain," he says.

It’s that brain-dead but beating-heart state that provides the time—sometimes a day or two—to move the body to a central location, find a suitable recipient, and allow surgeons to remove the organs.

Organizations like Hasz’s are the ones that approach families, transport the bodies, and help match organs to recipients.Last year Gift of Life helped arrange for 1,734 transplants of organs taken from 693 donors.

The family of the patient in this case knew that their loved one would not recover, but they still got to say goodbye. "It wasn't really that traumatic for them. We came in and talked about donation, and it was a total mix. Some wanted it, some didn't," says Mark Pochapin, the chief of gastroenterology at NYU Langone Health.

In the 1990s, his institution had done other sorts of experiments with cadavers—one involved connecting pumping organs to circuit boards—but this one is the first time the brain-dead model has been used in one of their experiments.Back in 1990, dying required an official call of brain death. Many people held on to their critically ill loved ones in order to see that occur, particularly because the government paid a benefit to survivors of dead soldiers.