KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Debate Over A Dying Child And A Lack Of Transplant Organs

Several columnists explore the difficult questions raised by the case of Sarah Murnaghan, a 10-year-old with cystic fibrosis who needs a lung transplant to survive.

Los Angeles Times: The Rules Of Organ Transplant Vs. A Dying Little Girl
Was U.S. Health and Human Services Secretary Kathleen Sebelius being rigid and cruel when she refused an exception to the rules so a 10-year-old girl could receive a lung transplant from an adult? The girl, Sarah Murnaghan, was placed on the adult transplant list — she also remains a priority patient on the pediatric transplant list — after a judge ordered the change to be made. As much as transplants save lives that half a decade ago couldn’t be saved, the world of transplants is also a heartbreaking one, and one that often seems heartless to outsiders. There are never enough organs for all the need, so doctors and medical ethicists lay down rules intended to do the most good with what’s available (Karin Klein, 6/6).

USA Today: Letting A Child Die For A Voluntary Ideal
And this brings us to the most wrenching question of all: what about the people who will die to save Sarah? Think about it: If adult lungs become available within the next ten days – the extent of Judge Baylson's suspension – and Sarah's doctors surgically reduce them so that they fit, will another person, say a young woman whose 21 year-old life is also hanging by a thread, now die instead? That's an agonizing question to pose. ... The answer, of course, is to increase the organ supply. But with annual voluntary donations falling far behind demand, we need to give people an incentive to donate. Sarah's ordeal should force a re-examination of the 1984 National Organ Transplant Act (NOTA), the law that makes it illegal for anyone to give or acquire an organ for material gain (Sally Satel, 6/6).

Bloomberg: Sick Girl May Get A Lung But It's Not A Happy Ending
The case points up the tragic and, despite efforts to the contrary, inherently arbitrary nature of organ allocation. As long as there is an absolute shortage of organs, giving one person a transplant means denying it to someone else. Contrary to what many people assume, merely signing an organ donor card doesn't mean your organs will be transplanted when you die. You have to die in exactly the right way, and very few people do. The shortages are especially acute for pediatric organs since, fortunately, relatively few children die from massive brain trauma. The separate pediatric and adult lists reflect the need to make sure those rare organs go to children who can't tolerate transplants from adults (Virginia Postrel, 6/6).

National Review: A Lung For Sarah Murnaghan
Talk radio and TV have been ringing with strident and even hysterical accusations that HHS Secretary Kathleen Sebelius is "letting this little girl die," or "choosing who will live and who will die." Some are linking Sebelius's supposed callousness to the terrible, politicized rationing of health care that Obamacare will inaugurate. This is all backwards. The people calling upon Sebelius to intervene and grant a waiver from the usual rules regarding children and transplants are the ones urging the politicization of medical care — at least in this case. They would be the ones responsible for setting a terrible precedent. The lesson would be this: If you can muster public pressure through social media, the press, and politicians, your loved one can get an advantage over others waiting for a lung or kidney or liver. Photogenic patients or those with media-savvy or even politically well-connected relatives would go to the head of the line. That is exactly what conservatives ought to fear (Mona Charen, 6/7). Needed: A Conversation On Organ Donation
A national debate on organ transplant waiting list rules would draw attention to what is really at issue here—that the demand for organs in the United States far outpaces the supply. ... even though polls show that the vast majority of Americans are willing to donate organs, in practice, fewer than half are willing to donate a family member's organs upon request by a doctor. Possible solutions include shifting to an opt-out system, whereby individuals would be presumed to be donors unless they, at the time of applying for or renewing a driver's license or state ID card specifically opted out of being a donor (Michael Yudell, 6/6).

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