While Sarah Murnaghan recovers from lung transplant surgery, her ordeal highlights the policy dilemmas regarding which critically ill patients receive organs in short supply. The case of the 10-year-old cystic fibrosis patient should hasten refinement of the criteria for determining access to lungs for transplantation.
In 2005, the Organ Procurement and Transplantation Network, which oversees the national system for acquiring and sharing organs, adopted tiered waiting lists in the ongoing effort to enhance efficiency, safety and equity in the transplant process. Children under 12 years are put on a pediatric list, first in line to receive lungs from donors in their age group and second in line after adolescent candidates, 12 to 17 years old, when lungs in that age group become available. Adult lungs are offered first to adults and then to adolescents. Children rarely have access to adult lungs.
The policy to allocate organs as closely as possible within age ranges was based on data on survival rates, the differences in adult and children’s lung diseases and the fact that adult lungs typically are too large for children. But as Sarah’s condition worsened, her parents mounted an online petition drive and filed suit to put her on the adult waiting list. A federal judge ordered the oversight agency to lift temporarily the age restriction. On Wednesday, Sarah received lung portions from an adult.
As of last week, there were 30 children on the pediatric waiting list. A review of data indicates there are fewer child-size lungs for transplantation, and pediatric patients are offered or receive lung transplants at lower rates than others.
There are not enough lungs for all in desperate need. It is essential, then, that the rules efficiently and equitably route available organs to those certain to benefit the most. The age grouping is one factor in a policy process fraught with emotion. What should not be part of the decision is the pressure of online campaigns and judicial orders. The hope is that with advances in surgical and care techniques reducing complications, age and size will recede as determining factors.