As of Wednesday, June 12, and after a six-hour operation, 10-year-old Sarah Murnaghan has a new pair of lungs. Sarah has cystic fibrosis and had been in such serious condition — she has been in the intensive care unit at Children’s Hospital of Philadelphia since last month and her lung capacity had diminished to 30 percent — that doctors said that, had she been an adult, her condition would have placed her at the top of the organ donation list for adult lungs.
However, because U.S. transplant rules specify that children under 12 must receive pediatric lungs and can only be offered adult lungs after adolescents and adults on the waiting list have been considered, Sarah did not qualify for the transplant she absolutely needed.
Sarah’s family and that of 11-year-old Javier Acosta (who is also at the hospital awaiting a transplant) decided to challenge the transplant policy. Their efforts have more than been rewarded: last week, District Judge Michael Baylson ordered the Organ Procurement and Transplantation Network to put Sarah on the list for adult lungs on the grounds that the U.S. transplant policy “amounts to improper age discrimination.”
A statement from Sarah’s family notes that, after the surgery, ”her doctors are very pleased with both her progress during the procedure and her prognosis for recovery.” Doctors used an adult lung cut down to fit her body and are said to have had “had no challenges resizing and transplanting the donor lungs. The surgery went smoothly and Sarah did extremely well. ”
Ashish Shah, the surgical director of lung transplants at The Johns Hopkins Hospital in Baltimore, tells USA Today that, after a lung transplant, patients spend one to two days in intensive care and another two weeks in the hospital, if everything goes well; afterwards, they must have physical therapy and rehabilitation. About half of patients live about five years after receiving a lung transplant and a third for ten years.
Sarah is now in intensive care and likely faces a long recovery due to how sick she was prior to the surgery; since Saturday, she has been unconscious and breathing through a tube; her body could still reject the new lungs.
Needless to say, her family is, according to a spokeswoman, “beyond excited” and very much aware that someone else “had to lose a family member.”
Questions of Medical Ethics and Organ Transplants
Sarah’s case has drawn national attention with some medical experts saying that the judge’s ruling could set a “dangerous precedent.” In light of her case, and with a view to future ones, the U.S. organization that oversees organ transplant policy has created a special appeal and review system for young patients.
Emphasizing that doctors and scientists, not the government, should set policy about transplants, the Obama administration declined to intervene in Sarah’s case.
Art Caplan, a bioethicist at New York University Langone Medical Center, points out that “adult lungs don’t fit well in children’s bodies, and that makes it hard to transplant them.” Lung transplants are particularly difficult, says Caplan, because of the increased chances for infection as “lungs are constantly exposed to viruses and bacteria.”
Joshua Sonett, chief of General Thoracic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, indeed says that Sarah faces some huge challenges. He emphasizes that the main issue is the need to “improve organ donation.” As he points out, a system in which everyone is presumed to be an organ donor — such “presumed consent” exists in various forms in France, Spain, Australia, Belgium and Portugal — would mean there would be plenty of organs and therefore no need for families to get on a waiting list, or to seek legal recourse, for their loves ones.
A deep thank you to all Care2 members who signed the petition to get Sarah a life-saving, life-changing transplant.
Photo from Thinkstock