Well, it didn’t have to happen, but it did; Sarah Murnaghan’s first lung transplant on June 12 failed almost immediately. She was put back on the organ transplant list, and three days later she was given a second set of adult lungs.  Her condition is improving now.  But here’s the irony; in all the talk in the past several weeks over the landmark case that she represented (adult lungs given to a 10-year-old child), the pubic was unaware that it was her second pair of lungs that have helped her to get better. That fact only became widely known on June 28, nearly two weeks after the second transplant.

The basic problem with transplanting adult lungs into children is that the lungs need to be “resized” to fit the child.  It adds another level of risk to what is already a fairly risky procedure. That’s one of the reasons that the organization that oversees transplants, the Organ Transplant and Procurement Network (OTPN), had a policy of not approving adult lungs for transplant into children under 12 years old.  But Sarah’s parents sued, and so the OTPN decided to keep its “Under 12 rule” but create a special review option for one year to consider exceptions on a case by case basis.  So now we have a precedent that may embolden the parents of other needy children to sue for what they want.  We should all be happy that young Sarah survived the surgeries and is doing well, but make no mistake; that means that the two sets of lungs didn’t go to someone else.

When it comes to such rare and precious resources as human organs, the decisions regarding who gets them are likely to remain contentious. This is worth talking about; who should decide, and how should they decide? The OPTN’s special review option is set to expire in one year unless the full board of directors votes to keep it.  I’ll be interested to see what they do.  

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