By Amy Norton

NEW YORK, Mar 16 (Reuters Health) - Swedish surgeons have successfully transplanted the lung of a man who suffered a heart attack to a woman dying of chronic obstructive pulmonary disease (COPD). While lung transplants are nothing new, the circumstances of this case raise ethical questions about when it is acceptable to harvest organs, experts say.

The donor was declared dead after doctors could not resuscitate him after the heart attack. Such donors are called non-beating-heart donors, as opposed to donors who have been declared brain-dead. And the ethical questions that surround this type of transplant range from whether the harvested organs are healthy enough to whether the pressure to get a still-healthy organ will influence how long doctors try to resuscitate a patient.

In the March 17th issue of The Lancet, researchers at the University Hospital of Lund, Sweden, report that they may have developed a way to get around the problem by preserving a potential donor's lungs for several hours after the heart stops. "Cooling" the lungs with intravenous fluids within an hour of death keeps the lungs healthy enough for transplant hours later, according to Dr. Stig Steen and his colleagues.

The investigators found that this method showed at least short-term success for a 54-year-old woman with severe COPD. Five months after the transplant, her new lung was functioning well, the Swedish researchers report.

Before attempting the procedure, Steen's team had consulted with health professionals, clergy, judges and "ordinary citizens" to come up with an ethical approach. The consensus, they write, was that any surgery on a body within 1 hour of death was unethical, but cooling of the lungs "ought to be acceptable."

But ethical problems remain. First, there is the question of when to declare death during cardiac arrest, according to Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. There are standards for when to declare a patient brain-dead, he noted in an interview with Reuters Health.

"There's no doubt you can be dead without being (declared) brain-dead," Caplan said. "But what hasn't been established is how long you have to wait to declare heart-lung death."

And unlike the case of brain-dead patients on life support--who are clearly dead but have organs that are still in good condition--time creates a dilemma with a non-beating-heart donor. Even with the hour window the Swedish doctors report, taking organs from patients after cardiopulmonary resuscitation fails "blurs the line between organ procurement and care," according to Caplan.

In the interest of saving the organ, Caplan said, "how hard do you try to resuscitate the patient?"

In an editorial accompanying the report, UK doctors doubt that the ethical consensus the Swedish team found would extend to their country. A recent scandal involving a hospital that stripped organs and body parts from dead children without their parents' permission has triggered public distrust of doctors when it comes to transplants, according to Dr. Martin J. Elliott of Great Ormond Street Hospital in London, and his co-authors.

In addition, the editorialists write, with conventional organ procurement, the doctors treating the potential donor are separate from the organ transplant team. The Swedish team's method, they note, seems to "demand mingling of these interests."

In the US, transplant centers create their own policies on using organs from non-beating-heart donors. According to Caplan, the nation's long waiting lists for donated organs are "100%" of the reason some centers have turned to non-beating-heart donors for some organs.

But, echoing the UK doctors, Caplan said that this tactic could worsen the organ shortage by making an already-skeptical public wary of becoming organ donors. National standards on these types of transplants are needed, he said.

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