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Implant Not a Legal Problem for Swedes With AM-Sweden-Heart

April 13, 1985

STOCKHOLM, Sweden (AP) _ The fact that Europe’s first artificial heart recipient may be under indictment for tax fraud has provoked no ethical controversies in Sweden.

Doctors at Karolinska Hospital, where the implant was performed last Saturday, have refused to identify the recipient. TheScandinavian press has told readers the newest person to get a Jarvik-7 plastic-and-metal heart is Leif Stenberg.

Whether the 53-year-old Stenberg is the recipient or not, Swedes are not questioning his right to receive the device or saying it should have been given to someone else.

″His background is irrelevant,″ Dr. Bjarne Semb, head of the operating team, told reporters last week when quizzed about his patient’s identity.

″To us, all patients are human beings, and are treated alike whoever they may be.″

The archbishop of Sweden’s Lutheran state church, asked to comment by a Stockholm newspaper, affirmed the moral legitimacy of artificial hearts and organ transplants.

″From an ethical point of view it is not negative,″ said Archbishop Bertil Werkstrom. ″When it comes to transplants, it is natural for Christians to sacrifice and share with each other, among other things to share your kidney and heart.″

Stenberg has often been mentioned by Swedish newspapers in connection with a variety of questionable enterprises, but he has only been indicted once, on charges on tax evasion in a 1978 case involving some $67,000.

That case has not come to trial.

The heart implant has touched off one controversy, but it seemed generated more by the news media than by legal scholars. It concerned whether, under Swedish medical practice, the removal of a natural heart would make a person legally dead and therefore immune from prosecution.

″The fact Stenberg appears to have received a plastic heart has nothing whatever to do with the case,″ said Special Prosecutor Robert Clementz, who pushed for Stenberg’s indictment in 1978.

″Common sense says that he is still alive,″ he said.

Many Western countries determine legal death by brain death, or when the brain ceases to function. The heart implant reminded Sweden that it had no written rule, and that its doctors still follow the practice of ruling someone dead when his heart has stopped.

″I think we can finally say goodbye to the notion of heart death,″ said Semb this past week. ″This is 1985.″

Even before the operation, a commission was at work on the issue of what constitues legal death. Its recommendation of a brain death criterion is expected to come before Parliament in the fall.

One reason Stenberg has not come to trial on the tax charge is his health. He has been described by friends as a ″man with fighting spirit.″

Doctors at Karolinska said their patient had only a few weeks to live without a new heart, and he had little chance of surviving a regular transplant.

Semb told reporters his patient had read about artificial hearts and suggested one be tried in his chest.

″The patient has an enormous will to live,″ Semb said. ″When we discussed an artificial heart, the patient told that all he was afraid of was that we would not give him one.″

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