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Anencephalics as organ donors
Anencephalies as organ donors F. Andre Van Assche, MD, PhD Leuven, Belgium Anencephalies can be divided into a large group without a functional hypothalamohypophysial system and a smaller group with a functional hypothalamohypophysial system. Anencephalies of the first group do not live more than a few hours, whereas the anencephalies of the second group can live up to 3 days. Those with a functional hypothalamohypophysial system have shown pain reaction. In anencephalies without a functional hypothalamohypophysial system, the endocrine pancreas does not reach full maturation and the use of these glands for islet transplantation can be questioned. (AM J OBSTET GVNECOL 1990;163:599-600.)
Key words: Anencephaly, transplantation, endocrine pancreas
The use of anencephalic newborns as organ donors is currently of interest. 1 An important ethical question remains regarding at what time after birth organs can be used, without damage of these organs. Although we do not as yet have any personal practical experience in transplantation from such donors, it is important to relate our data on these cases collected 20 years ago in northern Ireland. The main purpose was the study of the fetal endocrine pancreas! In nearly all cases diagnosis of anencephaly was made before birth; induction of labor was performed by rupture of the membranes associated with oxytocin infusion. In resistant situations hypertonic saline solution was injected into the amniotic fluid. Because we needed fresh material only anencephalies who were born alive were used. An autopsy was performed after death was confirmed by a pediatrician of the local hospital. In connection with our experimental design only anencephalies born after 30 weeks' gestation were used. The results of our previous studies 2 had clearly demonstrated that a functional hypothalamohypophysial system was necessary for complete morphologic and functional maturation of the fetal endocrine pancreas. Changes as seen in newborns of mothers with diabetes were only present in anencephalies with a functional hypothalamohypophysial system. Islet hypertrophy, B cell hyperplasia, and hyperinsulinism were not found in anencephalies without a functional hypothalamohypophysial system born to a mother with di-
From the Department of Obstetrics and Gynecology of the University of Leuven. Supported by research grants of A.SLK. and Nat. Bank. Received for publicationJanuary 30, 1990; accepted March 1, 1990. Reprint requests: F. A. Van Assche, MD, PhD, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Herestmat 49, 3000 Leuven, Belgium.
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abetes. 2 We collected data on 33 cases. The criteria for the presence of a functional hypothalamohypophysial system were as follows: (1) the macroscopic presence of a hypothalamohypophysial structure, (2) the presence of a fetal adrenal cortex by microscopic examination, and (3) a normal estrogen level in a maternal urine sample. Twenty-six cases were classified without a functional hypothalamohypophysial system and seven had a functional hypothalamohypophysial system. Birth weight was increased only in anencephalies with a functional hypothalamohypophysial system born to a mother with diabetes. The birth weight of anencephalies without a functional hypothalamohypophysial system was between the 10th and 25th percentiles. Polyhydramnios (more than 2 L of fluid) was present in 24 of 26 cases without a functional hypothalamohypophysial system and in only one of seven anencephalies with a functional HH system (the mother had diabetes). We suggested at that time that only anencephalies with a functional hypothalamohypophysial system are capable of swallowing. Because we did make some clinical observations of these cases, information is available on the natural history of anencephaly after birth. The Apgar score 5 minutes after birth was always <4 in anencephalies without a functional hypothalamohypophysial system, except in one case the Apgar score was >4 in an anencephalic with a functional hypothalamohypophysial system. The anencephalies did not receive any intensive treatment. Of the 26 cases without a functional hypothalamohypophysial system, 12 newborns died within 1 hour, 7 died the next hour, and all died within 4 hours. Of the seven cases with a functional hypothalamohypophysial system, one newborn died within 4 hours, a second died within 24 hours, two died the second day, and three died the third day. It seems that anencephalies are certainly not a ho-
599
600 Van Assche
mogeneous group with regard to transplantation; furthermore we thought that such cases with a functional hypothalamohypophysial system did have pain reactions. In addition, endocrine disorders are present in such newborns. These changes may be of importance concerning the functional capacity of the donated organ . Certainly in anencephalies without a functional hypothalamohypophysial system the endocrine pancreas does not reach full maturation, which can cause
August 1990 Am J Obstet Gynecol
problems when these glands are used for islet transplantation. REFERENCES 1. Peabody JL, Emery JR, Ashwas S. Experience with anencephalic infants as prospective organ donors. N EnglJ Med 1989;321:344-51. 2. Van Assche FA, Gepts W, de Gasparo M. Endocrine pancreas in anencephalics. Bioi Neonat 1970; 14:374-88.
Bound volumes available to subscribers Bound volumes of the AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY are available to subscribers (only) for the 1990 issues from the Publisher, at a cost of $56.00 ($79.00 international) for Vol. 162 (January-June) and Vol. 163 (July-December). Shipping charges are included. Each bound volume contains a subject and author index and all advertising is removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the JOURNAL name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Mosby- Year Book, Inc., Circulation Department, 11830 Westline Industrial Drive, St. Louis, Missouri 63146-3318, USA; phone (800) 325-4177, ext. 7351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
Key words: Anencephaly, transplantation, endocrine pancreas
The use of anencephalic newborns as organ donors is currently of interest. 1 An important ethical question remains regarding at what time after birth organs can be used, without damage of these organs. Although we do not as yet have any personal practical experience in transplantation from such donors, it is important to relate our data on these cases collected 20 years ago in northern Ireland. The main purpose was the study of the fetal endocrine pancreas! In nearly all cases diagnosis of anencephaly was made before birth; induction of labor was performed by rupture of the membranes associated with oxytocin infusion. In resistant situations hypertonic saline solution was injected into the amniotic fluid. Because we needed fresh material only anencephalies who were born alive were used. An autopsy was performed after death was confirmed by a pediatrician of the local hospital. In connection with our experimental design only anencephalies born after 30 weeks' gestation were used. The results of our previous studies 2 had clearly demonstrated that a functional hypothalamohypophysial system was necessary for complete morphologic and functional maturation of the fetal endocrine pancreas. Changes as seen in newborns of mothers with diabetes were only present in anencephalies with a functional hypothalamohypophysial system. Islet hypertrophy, B cell hyperplasia, and hyperinsulinism were not found in anencephalies without a functional hypothalamohypophysial system born to a mother with di-
From the Department of Obstetrics and Gynecology of the University of Leuven. Supported by research grants of A.SLK. and Nat. Bank. Received for publicationJanuary 30, 1990; accepted March 1, 1990. Reprint requests: F. A. Van Assche, MD, PhD, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Herestmat 49, 3000 Leuven, Belgium.
611120578
abetes. 2 We collected data on 33 cases. The criteria for the presence of a functional hypothalamohypophysial system were as follows: (1) the macroscopic presence of a hypothalamohypophysial structure, (2) the presence of a fetal adrenal cortex by microscopic examination, and (3) a normal estrogen level in a maternal urine sample. Twenty-six cases were classified without a functional hypothalamohypophysial system and seven had a functional hypothalamohypophysial system. Birth weight was increased only in anencephalies with a functional hypothalamohypophysial system born to a mother with diabetes. The birth weight of anencephalies without a functional hypothalamohypophysial system was between the 10th and 25th percentiles. Polyhydramnios (more than 2 L of fluid) was present in 24 of 26 cases without a functional hypothalamohypophysial system and in only one of seven anencephalies with a functional HH system (the mother had diabetes). We suggested at that time that only anencephalies with a functional hypothalamohypophysial system are capable of swallowing. Because we did make some clinical observations of these cases, information is available on the natural history of anencephaly after birth. The Apgar score 5 minutes after birth was always <4 in anencephalies without a functional hypothalamohypophysial system, except in one case the Apgar score was >4 in an anencephalic with a functional hypothalamohypophysial system. The anencephalies did not receive any intensive treatment. Of the 26 cases without a functional hypothalamohypophysial system, 12 newborns died within 1 hour, 7 died the next hour, and all died within 4 hours. Of the seven cases with a functional hypothalamohypophysial system, one newborn died within 4 hours, a second died within 24 hours, two died the second day, and three died the third day. It seems that anencephalies are certainly not a ho-
599
600 Van Assche
mogeneous group with regard to transplantation; furthermore we thought that such cases with a functional hypothalamohypophysial system did have pain reactions. In addition, endocrine disorders are present in such newborns. These changes may be of importance concerning the functional capacity of the donated organ . Certainly in anencephalies without a functional hypothalamohypophysial system the endocrine pancreas does not reach full maturation, which can cause
August 1990 Am J Obstet Gynecol
problems when these glands are used for islet transplantation. REFERENCES 1. Peabody JL, Emery JR, Ashwas S. Experience with anencephalic infants as prospective organ donors. N EnglJ Med 1989;321:344-51. 2. Van Assche FA, Gepts W, de Gasparo M. Endocrine pancreas in anencephalics. Bioi Neonat 1970; 14:374-88.
Bound volumes available to subscribers Bound volumes of the AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY are available to subscribers (only) for the 1990 issues from the Publisher, at a cost of $56.00 ($79.00 international) for Vol. 162 (January-June) and Vol. 163 (July-December). Shipping charges are included. Each bound volume contains a subject and author index and all advertising is removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the JOURNAL name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Mosby- Year Book, Inc., Circulation Department, 11830 Westline Industrial Drive, St. Louis, Missouri 63146-3318, USA; phone (800) 325-4177, ext. 7351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.