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THE DIFFICULT ethical problems thrust upon society and medicine by heart transplant operations were discussed in an editorial in the May 1968 Archives.
Jurists, clergymen, and legislators have joined throughtful physicians in the discussions, and gradually there begin to emerge principles to guide physicians in the difficult ethical decisions involved. A former President of the American Medical Association2 lists the four criteria that have been accepted by many physicians in most countries for determining when death has occurred:
Complete bilateral dilation of the pupils with no reaction to local constricting stimuli.
Complete abolition of reflexes.
Complete cessation of respiration five minutes after cessation of artificial respiration.
Falling blood pressure (maintenance of blood pressure demanding increasing vasoconstrictor drugs).
It is noteworthy that cessation of cardiac contractions is not included in this list of criteria of death, for to be of value for transplantation
SHAMBAUGH GE. Developing Ethical Code for Organ Transplantation. Arch Otolaryngol. 1969;89(4):567–568. doi:10.1001/archotol.1969.00770020569002
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