A report on three heart transplants involving infants at Denver Children’s Hospital published in Thursday’s New England Journal of Medicine has stirred controversy among medical experts. The authors of the report said they published it an attempt to promote discussion on cardiac-death donation.

The report describes three infant donor cases where surgeons reduced the time between the moment when the heart stopped and the time when organ retrieval began. In the first case, doctors waited for three minutes after the heart stopped before death was declared. Parents were asked about organ donation and agreed. The baby’s heart was given to another Denver-area baby, 2-month-old Zachary Apmann. The baby was born prematurely with an underdeveloped heart. In the other two cases, the time between when the heart stopped and when organ retrieval began was shortened to just 75 seconds.

The Institute of Medicine recommends that 5 minutes should elapse between the time the heart stops and the organ retrieval begins. On the other hand, removing the heart earlier increases the chances of a successful transplant because it limits the damage caused by a lack of oxygen to the organ. According to state laws, donors must be declared dead before donation, based on either total loss of brain function or heart function that is irreversible.

“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, said.