Michael Baylson: Judge Sets Medical Precendent By Allowing 10-Year-Old Lung Transplant

A federal judge on Wednesday temporarily allowed 10-year old Sarah Murnaghan, who is fighting end-stage cystic fibrosis, to move up the adult waiting list for a lung transplant. U.S. District Judge Michael Baylson suspended an age factor in the nation’s transplant rules for ten days for Sarah due to the severity of her condition.  

The current organ allocation system, implement in 2005 by the Organ Procurement and Transplantation Network (OPTN) determines list position based on a “lung allocation score” (LAS), which puts patients at the highest mortality risk, rather than those who’ve waited longest, at the top of the donor recipient list. This new system has reduced the number of deaths among patients awaiting transplants by ensuring that organs are distributed to patients with less stable diagnoses; however, the new method of allocation only applies to recipients of 12 years or older. 

Consequently, without Baylson’s ruling, Sarah, who has an LAS score that would place her as the highest priority for her blood type in region, all adults in region, with the corresponding blood type, would have been offered the lungs first, even those with more stable diagnoses and lower LAS scores. Sarah would have been offered adult lungs only if no adult candidates accepted the organ.

The allocation system was established with an age restriction because the biological needs and circumstances of candidates under the age of twelve are considerably different from either adolescent or adult candidates. Younger recipients have greater physiologic reserve to aid in the arduous recovery, while older ones face higher risk of stroke, diabetes and other diseases, and, of course, their lifespans are shorter to begin with. However, one key disparity is the size and lung capacity of donors and patients among these age ranges. Candidates 12 years and older are prioritized as recipients over children ages 0-11 primarily because of such size considerations.

Sarah is a top priority on the pediatric donor list; however, according to data compiled by OPTN, pediatric donors are consistently far fewer than the adult donors. Moreover, while many more adult lungs are donated, the ruling does not guarantee Sarah a transplant. Matches are based on blood type, lung size, and other medical factors.

The current allocation policy allows for special review of exceptional cases. Thus, the OPTN Lung Review Board, a national group of transplant physicians and surgeons, can make an exceptional ruling for Sarah. However, the OPTN released a statement on May 27, saying that it could not create a policy exemption on behalf of an individual patient because “giving an advantage to one patient may unduly disadvantage others.”

Baylson’s decision, which came a day after Health and Human Services Secretary Kathleen Sebelius declined to become involved in the case, is highly controversial. The ruling opens up a host of questions about organ allocation, including the possibility of a wholesale policy change that would add approximately twenty children from ages 8 to 11 annually to the adult waiting list.  

Politics aside, Sarah’s situation calls into sharp focus the scarcity of organ donors across the United States. Last year, surgeons performed 16,055 kidney transplants, 5,805 liver transplants, 1,949 heart transplants, and 1,830 patients received lung transplants. Altering the current organ allocation policy may result in an optimal outcome for patients such as Sarah, but ultimately, the best way to aid all patients waiting to receive an organ, is to consider becoming a donor.