A dying 10-year-old girl can move up the adult waiting list for a lung transplant after a federal judge intervened in her case Wednesday, a move questioned by a prominent medical ethicist.
U.S. District Judge Michael Baylson suspended an age factor in the nation's transplant rules for 10 days for Sarah Murnaghan because of the severity of her condition.
The girl's family believes that is enough time to find a match. Sarah has been hospitalized at Children's Hospital of Philadelphia for three months with end-stage cystic fibrosis.
"We are beyond thrilled," Janet Murnaghan, the girl's mother, said in an interview, while adding, "Obviously, we still need a match."
The Newtown Square family filed suit Wednesday to challenge organ transplant rules that say children under age 12 must wait for pediatric lungs to become available, or wait at the end of the adult list, which includes adults who aren't as critically ill. The Murnaghans say pediatric lungs are rarely donated, so they believe that older children should have equal access to the adult donations.
The judge's ruling lifting the age requirement applies only to Sarah, at least until a June 14 hearing on the request for a broader injunction. Nationwide, about 1,700 people are on the waiting list for a lung transplant, including 31 children under age 11, according to the Organ Procurement and Transplantation Network.
Experts, though, questioned Judge Baylson's decision on both medical and ethical grounds.
Lung transplants are the most difficult of organ transplants, and children fare worse than adults, which is one reason for the existing policy, said Arthur Caplan, a bioethicist at New York University's Langone Medical Center. He called it troubling -- and perhaps precedent-setting -- for a judge to overrule that medical judgment, and predicted a run to the courthouse by patients who don't like their place on the waiting list. "I'm not sure I want judges or congressmen or bureaucrats trying to decide what to do with organs at the bedside," Dr. Caplan said.
Health and Human Services Secretary Kathleen Sebelius declined Tuesday to intervene in the case, despite urgent pleas from several Pennsylvania congressmen. She said there were three other children at Children's Hospital alone in the same condition. Ms. Sebelius has called for a review of pediatric transplant policies amid the higher death rates for pediatric patients, but the Murnaghans say Sarah doesn't have time for that.
"I have pushed HHS to promptly answer questions about existing policy, and I am grateful that a neutral arbiter will have the opportunity to review the facts," Sen. Bob Casey, D-Pa., said in a statement. "We need to be doing everything we can to ensure that Sarah, and others like her awaiting transplants, are given the best chance to live. This includes encouraging individuals and families to consider organ donation, so that more people waiting for organs are given the gift of life."
Sarah's doctors, one of whom testified Wednesday at an emergency hearing before Judge Baylson, believe that they can perform a successful transplant on her with adult lungs.
"She definitely understands things have improved quite a bit," the girl's aunt, Sharon Ruddock, said after the ruling.
Joel Newman, spokesman for the United Network for Organ Sharing that operates the nation's transplant network, said he was unaware of any previous court order that overruled a transplant policy.
While many more adult lungs than children's lungs wind up being donated, the ruling doesn't guarantee Sarah a new set of lungs. The matches are based on blood type, the risk of dying, the chance of surviving a transplant and other medical factors. The donor lungs would also have to be an appropriate size for her chest.
Mr. Newman said some lungs donated from deceased adults have been offered for children's transplants over the past two years, although he couldn't give a number. But he said all were turned down by the children's surgeons.
The UNOS system was established to avoid bias in determining who gets organs, thus ensuring that the rich or celebrities, for example, don't have a better chance, Dr. Caplan noted. He said it is transparent, with policies open to public comment and scrutiny before they are enacted. "When a judge steps in and says, 'I don't like these rules, I think they're arbitrary,' they better be very arbitrary, or he's undermining the authority of the whole system. Why wouldn't anybody sue?"