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About two years ago, Dr. Brack Hattler of the University of Pittsburgh Medical Center inserted a catheter into the upper thigh of a woman who had suffered a massive stroke.

The device, a foot long and an eraser head wide, worked like an artificial lung, giving oxygen to the blood and removing carbon dioxide.

Hattler was not trying to heal her. She was already dead.

Instead, he was experimenting in a rarely discussed area of medicine -- research on the brain-dead.

The University of Pittsburgh, a national leader in the area, is one of the few places that has rules governing research on the brain-dead. Experts contend such research can save lives.

"People are watching closely at what is taking place at Pitt," said Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania. "They want to see if they can move forward without triggering too much controversy."

Nationally, research on the brain-dead is very rare, he said. One reason is the technology to keep bodies artificially alive is only about 20 years old.

"Most programs haven't thought of trying things on the brain-dead or aren't certain of the morality or, to be frank, are nervous about bad publicity, being portrayed as ghoulish," Caplan said.

Some of the squeamishness stems from confusion around matters of life and death.

A coma, for instance, is a state of unconsciousness from which a person could awake. That's what happens to boxers. A person in a persistent vegetative state is alive but unconscious, with the thinking part of the brain permanently damaged. Terry Schiavo, the Florida woman kept alive by court-mandated feeding tubes, is in this condition.

At death, though, all parts of the brain have quit functioning. What is commonly referred to as "brain-dead" is a corpse whose heart has been kept beating and its blood circulating by machines.

Door to new possibilities

Researchers believe the brain-dead provide a potential bonanza of opportunities.

"It will enable us to do research that you wouldn't be able to do otherwise on living people," said Michael A. DeVita, an ethicist and critical care specialist at Pitt. He cited research on reviving a stopped heart as an example.

DeVita is co-chairman of the Committee for the Oversight of Research Involving the Dead, the 2-year-old panel at Pitt that reviews such requests.

DeVita said the 1987 Uniform Anatomical Gift Act, the law that governs organ transplants, allows research on brain-dead bodies. Federal law requires a review of medical research on living people but not on the dead.

Enter Hattler, executive director of the Artificial Lung Laboratory at the McGowan Institute for Regenerative Medicine on the South Side and a researcher at Pitt's medical school.

He became interested in lung-assist devices in 1983, when he was working in Denver. Late one night, he treated two college students who were injured in a car crash. Despite his help, the young men died when their lungs filled with fluid.

If he had had his catheter then, Hattler said, they would have been able to breathe while their lungs were drained.

Hattler began making the catheter in a garage before he came to Pitt. He estimates that at least 1 million people a year need artificial lungs, including about 400,000 in the United States.

Road to the research

He experimented first on dogs, then on calves because they are about the same size as humans -- especially the burly soldiers for whom the U.S. Department of Defense has been sponsoring his research.

Hattler's research had gone as far as it could on animals. He was ready for humans. But if he experimented on the living, the Food and Drug Administration would require him to stop every time he needed to make a change, then start over -- a painstakingly slow process.

Instead, he considered testing on the brain-dead.

"It gives you the next step to demonstrate the effectiveness of what you're trying to prove," he said.

Hattler sought permission from Pitt's Institutional Review Board, a group of doctors and scientists that handles requests for research on humans. But the board passed, arguing that it deals with requests only on living subjects.

Hattler then turned to DeVita, who chairs UPMC's Hospital Ethics Committee. It approved his request but recognized the need for a new panel and a special set of rules.

The committee requires the family's consent when it considers the research would go beyond that to which the donor had agreed. If the brain-dead person is able to donate any organs, that takes precedence over the research.

To prevent a conflict of interest, the doctor who applied for the research cannot pronounce a potential subject brain-dead. The rules further require the researcher to respect the donor's body, prove the scientific merit of the research and reasonably limit the duration of the experiment. Hattler's experiments, for example, run six to eight hours.

"There's research that's fine for three hours but not for three days or three years," DeVita said.

Hattler said the daughter of the brain-dead woman who had a stroke asked to watch him insert the catheter into her mother. In the other case, a member of the family who was a respiratory therapist convinced the other relatives to permit the research.

"You can't do anything that's not acceptable to the family," Hattler said.

Source of concern

Even with the committee's safeguards, some people might be squeamish about this type of research, ethicists acknowledge.

"There may be those that would say that such research would not show sufficient respect for the remains of the deceased," said John Haas, president of the National Catholic Bioethics Center on Health Care and Life Sciences, a Boston-based group.

Haas said the Catholic Church, which has taken strong stances on various issues involving human life, does not have an official position on research using the brain-dead.

"It might be a good issue for us to explore," he said.

Leonard Glantz, a professor of health law at Boston University, doesn't understand why Pitt needed a special committee for research on the dead. If the family approves the experiment, he argues, why does the committee need to get involved?

"But that doesn't mean people will be comfortable taking dead bodies and doing what they will," Caplan said, defending Pitt. "It leaves them uncomfortable about dealing with the feelings of next of kin, about attitudes people may have, thinking this is macabre or exploitative."

So far, Pitt's committee has received 37 inquiries, three of which involve the brain-dead. The panel has approved two of the requests on research on the brain-dead and is reviewing a third.

In the first request that was approved, researchers studied the process of brain death in seven subjects and how it deteriorates organs, said Lisa Rossi, a UPMC spokeswoman. The second study will explore how a device can improve the quality of organs in brain-dead donors before they are removed for transplantation.

Rossi declined to discuss the third inquiry before it is approved.

Hattler would like further to test his catheter on 10 brain-dead subjects over the next six to eight months.

"We're gearing up to do this a little more frequently than we have," he said.

Experiments on the brain-dead

Schools that have conducted experiments on the brain-dead and the kinds of research they have done:

University of Pittsburgh: Catheter that works as a lung-assist device; two studies on the process of brain death and its effects on organ deterioration

Temple University: Artificial hearts

University of Texas in Houston: Cancer-fighting drugs; the process of brain death and its effects on organ deterioration

Case Western Reserve University: heart resuscitation with defibrillators

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