A report describing three cardiac-death transplants involving infants at Denver Children’s Hospital published in Thursday’s New England Journal of Medicine has provoked serious concern among some medical experts. More exactly, the way Denver doctors proceeded challenges current guidelines on how long after cardiac death doctors must wait before taking a heart from an infant organ donor.

The report describes three cases in infant donors where surgeons reduced the time between when the heart stopped and when organ retrieval began. In one case, the time was shortened to three minutes, and the other two to just 75 seconds. The hearts were then transplanted in three babies who were dying while awaiting donor organs.

“Adding an additional two, three or five minutes, or even 75 seconds, does add some additional injury. It could be 10 percent. The 6-moth survival rate was 100 percent for the 3 transplant recipients and 84 percent for 17 control infants who received transplants procured through standard organ donation,” Dr. Mark Boucek, who led the Denver team and who now is at the Joe DiMaggio Children's Hospital in Hollywood, Florida, said.

The surgeries were part of a research project funded by the Department of Health and Human Services. The doctors involved and some advocates for organ donation praised the procedures as offering the first clear evidence that they could provide desperately needed hearts for terminally ill babies.

On the other hand, the Institute of Medicine, a nonprofit advisory organization, recommended in 1997 that 5 minutes should elapse between the time the heart stops and the organ retrieval begins and that’s because sometimes the heart can restart. However, this clearly interferes with a transplant’s success. Removing the heart earlier increases the chances of a successful transplant since it limits the damage caused by a lack of oxygen to the organ.

The way Denver surgeon proceeded is seriously questioned by Georgetown University medical ethicist Robert Veatch and others who strongly believe that the infants did not meet the long-accepted definitions of death – complete, irreversible cessation of brain function or of heart and lung function.

“If a heart is restarted, the person from whom it was taken cannot have been dead, according to cardiac criteria. Removing organs from a patient whose heart not only can be restarted, but also has been or will be restarted in another body, is ending a life by organ removal,” Veatch wrote n a commentary to the paper, questioning whether the procedure was legal when the event is declared a cardiac death.

In another commentary, James L. Bernat, a Dartmouth medical professor says the experiment “is pushing the boundaries and raising many questions. This clearly shows the feasibility of doing this. The question is: Should this be done,” he wrote.

Robert M. Veatch, a Georgetown University bioethicist even said the procedures were equivalent to murder. He believes the babies were not dead in the moment their hearts were removed. Moreover, he thinks the procedures were “illegal,” “immoral” and “should be stopped.”

On the other hand, the procedure, called donation after cardiac death (DCD usually involves patients who have devastating and irreversible brain damage but are not actually brain-dead) is being encouraged by the federal government, organ banks, and other as a way to make organs available and give more families the option to donate. The procedure is also seen as a way to bridge the gap between the number of available liver, kidneys, hearts and other organs and the number of Americans on the waiting list for transplants.