On June 12 a young cystic fibrosis patient named Sarah Murnaghan finally received a much-needed transplant of an adult lung. What makes this news is that Sarah is only 10 years old.

Adult lungs are not readily available for transplant, and children’s lungs are just plain rare. Because children are smaller than adults, adult lungs have to be resized to fit them, adding an additional level of risk of failure. Therefore the organization that oversees transplants, the Organ Procurement and Transplantation Network (OPTN), had developed a policy of not considering adult lung transplants for children under the age of 12. But following an urgent request by her parents, last week, a federal judge ruled that younger children should be eligible for adult lungs, opening the way for Sarah to receive her lungs and for other children to be considered as well.

Not everyone is happy about the new development. For years, the OPTN has done its best to allocate scarce organs equitably and fairly. The recent ruling disturbs some people because it implies that seeking help from the courts (as Sarah’s parents did) is a legitimate way to deal with what are clearly complex medical and ethical decisions. I’m as glad as anyone that little Sarah was saved by a lung transplant. But given that there are too few transplantable organs available, do we want medical professionals and ethicists to make such decisions based on certain principles of fairness and medical effectiveness, or do we want the decisions made by judges and lawyers based on who shouts the loudest?

You decide.

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