Organ scarcity’s the real transplant dilemma

The News TribuneJune 19, 2013 

A Pennsylvania family’s legal fight to get a lung transplant for Sarah Murnaghan, a 10-year-old with cystic fibrosis, ultimately proved successful. She is now recuperating after receiving adult lungs that under federal rules wouldn’t have been available to her because of her age.

Sarah’s story has a happy ending. But medical ethicists are rightly concerned about health decisions being made by a judge rather than by transplant experts.

In Sarah’s case, a federal judge ordered that she have access to lungs from adult donors — essentially circumventing rules set up by the national transplant system overseen for the federal government by the nonprofit United Network for Organ Sharing (UNOS).

Those rules give children under 12 top priority for lungs from other children and second priority for lungs from donors 12 to 17 years old. They don’t get adult lungs unless there are no adult transplant candidates in the area — something that rarely occurs.

Those rules were made based on medical data regarding organ size, the severity of patients’ condition and their survival prospects should they receive a transplant. Implementing those rules has significantly increased survival chances for patients of all ages.

That said, UNOS is right to start allowing appeals of transplant decisions — a good way to keep future cases out of court. And it will re-examine its rules over the next year to see if changes should be made in how lung transplant decisions are made regarding children.

Setting aside medical considerations, most Americans likely would prefer to see children be given top priority whenever feasible. It’s heart-wrenching to see a young person suffering and facing the grim prospect of a shortened life.

Sadly, it happens all too often. Many children die each year waiting for a transplant of lungs or other vital organs. But that number could be greatly reduced if every American agreed to be an organ donor.

While 90 percent of Americans say being an organ donor is the right thing to do, only about 45 percent of adults have actually signed up to donate, usually as part of being licensed to drive. That’s about 109 million potential donors, but it’s not enough.

Most people die of old age or conditions that leave their organs too diseased or damaged for transplant. Donors can’t have cancer or an infectious disease and must be under 90 years old. The typical donor is someone who dies of a head injury, kept alive on a ventilator — only about 1 percent of deaths.

Someday we’ll probably be able to “grow” organs for transplant. Until then, millions more donors are needed. If you’re not already signed up to be an organ donor, register at donatelife.net or via Facebook’s timeline (under Life Event/Health & Wellness).

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