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Friday, June 7, 2013

Bioethicist Warns Courts Could Undermine Organ Transplant System

Sarah Murnaghan, center, celebrates the 100th day of her stay in Children's Hospital of Philadelphia with her father, Fran, left, and mother, Janet. (Courtesy of Murnaghan Family, via AP)

Sarah Murnaghan, center, celebrates the 100th day of her stay in Children’s Hospital of Philadelphia with her father, Fran, left, and mother, Janet. (Courtesy of Murnaghan Family, via AP)

In what’s thought to be an unprecedented move, a federal judge has now allowed two dying children to jump ahead in the list of people waiting for lung transplants.

This week, a judge ordered that both 10-year-old Sarah Murnaghan and 11-year-old Javier Acosta be given preference on the adult transplant list. Both children have cystic fibrosis and are expected to die without the transplants.

The current lung transplant policy matches children under 12 with pediatric donors, who are rare, or offers them adult lungs only after adolescents and adults on the waiting list have a chance at them.

The rulings effectively bump Murnaghan and Acosta to the top of the adult transplant list.

Art Caplan, director of medical ethics at New York University’s Langone Medical Center, said the rulings are troubling because they could undermine a system that has been working effectively for decades.

“Lawsuits will begin to fly from people who, for whatever reason, are at the bottom of the list,” Caplan told Here & Now.

Caplan says while the intentions are good, a series of lawsuits could cause grave consequences for the 1,700 people on the waiting list for a lung transplant, including 31 children under age 11.

“It’s a fundamental, morally good thing to protect your child, try to help your child. But there are too many children who need organs,” Caplan said. “Parents want to help their kids, but you have to put a set of rules in place because not everybody’s life is going to be saved.”

Dr. Stuart Sweet, a pediatric pulmonologist at St. Louis Children’s Hospital, helped draft the rules for the United Network for Organ Sharing (UNOS).

He said the bottom line is, there is a lack of organs for children and adults.

“Children die waiting for lungs every year. Adults die waiting or lungs every year. The only way to prevent children from dying on the waiting list is for there to be enough donors to give each one of them an organ,” Sweet told Here & Now.

Caplan said there are three things people can do to increase the supply of organs:

  1. Sign up to be an organ donor when you get your driver’s license
  2. Tell your loved ones that you want to be an organ donor
  3. Lobby to change the way people are registered to be organ donors

Caplan says the U.S. should move from an opt-in to an opt-out system, similar to Europe.

“We should change the default and say, most people do want to be organ donors, let’s presume they are,” Caplan said. “And then ask people who don’t want to do it … to say, no I don’t want to do that.”

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Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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