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As of this writing, 10-year-old Sarah Murnaghan continues her battle for life amidst a controversy over whether she should have received the double-lung transplant in the first place.
The child has end-stage cystic fibrosis which placed her at the top of the lung transplant list for children. However, the complex guidelines for transplant recipients meant she was placed at the bottom of the adult transplant list. Her parents were victorious in a legal battle that won Sarah her transplanted lungs only to see them fail and require re-transplantation. In both cases, the transplanted lungs were in poor condition.
Even successful lung transplants last only five years on average. That’s the primary reason why the medical guidelines favor adults receiving lung transplants ahead of children under 12. With re-transplantation, the odds of success lessen. Adults stand a better chance of success, not only because of the relatively short-term success of transplanted lungs, but also because they are better able to withstand the effects of the surgery and the consequent need thereafter to take anti-rejection drugs.
Making the choice to attempt to save a dying child or helping an adult in dire need is akin to the situation in “Sophie’s Choice,” where a mother was forced by the Nazis to choose which of her children to save and which would die in a gas chamber. If there were more lungs available for transplantation, these horrific choices would not have to be made. Sarah’s parents did what any parents would have done; they fought for their child’s life and made extraordinary emotional appeals to the nation’s conscience, finally winning their battle through the legal system. The question is whether it is in the best long-term interests of everyone that a court step-in and overrule the nuanced medical guidelines in effect. As a kidney transplant recipient, I think the court made a mistake.
The court’s decision appears to have been based on emotional rather than sound medical facts. Lungs for transplants are in very short supply. It seems obvious to me the medical guidelines were not based on discriminating against dying children, but on how best to successfully save the most lives in a procedure that is problematic at best. I would rather have the medical experts making those life-and-death decisions, not the legal system. In the end, the court’s decision to try and save Sarah, understandable though it may be, could hurt the future success of lung transplantation in America. It sets a precedent where decisions may be made on emotional appeals rather than sound medical judgment.
I mentioned the issues surrounding kidney transplants are different, primarily because of the disparate nature of the organs. With increased public awareness, the problems facing people needing a kidney transplant can more easily be resolved. The success rate for kidneys is much higher than for lungs. Transplanted kidneys last longer. How long they last is largely dependent on whether they are from a cadaver or a live donor. Live donor kidneys last longer, and those from a blood relative last longer than a non-blood relative. Despite the almost routine nature of transplanting kidneys, people die every year waiting for the availability of an organ. We can save a lot of lives with a few simple steps.
As the public has become aware of the need for donor organs, many (particularly young adults) have agreed to donate their organs upon their death. What is largely unknown is that a survivor’s family can overrule the wishes of the deceased. In other words, though you may have “organ donor” on your driver’s license, your family can frustrate your wishes. Unfortunately that is exactly what happens all too often today.
There are complicated reasons why a family may decide your wishes will not be honored, but my feeling is their feelings should not trump the intentions of the deceased. Why should the family be allowed to overturn a decision an adult of sound mind made? I don’t get it, but the folks involved in transplant programs tell me it happens all of the time. The law needs to be changed so people’s lives can be saved and the donors’ wishes carried out.
Another problem involves human nature and cannot be resolved by a change in any law. Even folks in desperate need of a transplant are often reluctant to ask a family member or friend to donate a kidney. In my case, my wife stepped forward as my donor. I could never have asked her or any other family member or friend to make that sacrifice. She made it easy by making the decision herself and adamantly standing by it. She is a hero among many heroes who have donated an organ to save another. What you should know is that though the procedure is not without some risk and involves more pain and a bit longer recovery than the recipient, most donors recover successfully and go about normal lives. Donors and recipients are not allowed to go through the transplant procedure without thorough testing to ensure a high degree of success.
As more donors come forward, more people can be saved. They are waiting. The decision is yours. ■
Contact the South Philly Review at editor@southphillyreview.com.
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