Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Biography

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The Under-12 Rule Lung Transplant Controversy began in late May of 2013, when the parents of a 10-year-old Philadelphia area girl withcystic fibrosis, Sarah Murnaghan, launched a campaign to change the "under-12" policy of the United Network for Organ Sharing(UNOS), which they asserted was "age discrimination." Her plight received considerable media attention, particularly because Kathleen Sebelius refused to grant an exception to the rule. The system organizing lung transplants in the United States was overhauled in 2004 and again in 2008. The system gives those over the age of 12 a lung allocation score, which is used to prioritize patients for transplant based partially on the urgency of their need. However, children under 12 are granted lungs on a first-come, first-served basis. In addition, there are far fewer donor lungs available for children under the age of 12 than there are for adults—between 10 and 20 as opposed to 1,700 in a given year. Sarah Murnaghan's parents argued that she needed a lung transplant or else she would die in a matter of weeks, but that this was not possible because existing rules give higher priority for adult donor lungs to children who are at least 12 years old. Specifically, her parents argued that she only had a few weeks to live but under current UNOS transplant policy did not qualify for adult donor lungs even though it is now possible to downsize adult lungs for transplantation into children.
Kathleen Sebelius refused to grant an exception to the rule. In response to Sebelius' argument that a review of the policies would need to take place before the rule can be changed, Tom Price argued that such a process would take an entire year to complete and that the girl would be dead by that time. At the time of her transplant in June 2013 Murnaghan had been waiting on the transplant list for about 18 months. Because of the side effects of antibiotics she had to take to treat her cystic fibrosis, Murnaghan developed permanent hearing loss. She also has osteoporosis and Cystic fibrosis-related diabetes. While the family portrayed their daughter's case as one of bureaucracy getting in the way of lung transplantation that should have been (and later, was) awarded based on her extreme necessity and limited time left to live should she not obtain the transplant, some bioethicists questioned this depiction. For example, Arthur Caplan said, "In general, the road to a transplant is still to let the system decide who will do best with scarce, lifesaving organs". In addition, he explained the reason children do not get put on the adult lung transplant list: "The reason kids get lower priority for lungs is that adult lungs rarely fit so you have to use only a part of one. Using only a lobe from an adult cadaver donor negatively impacts the chance of survival." Similarly, Stuart Sweet of the lung transplant program at St. Louis Children's Hospital contended, "the issue here is really about how we designed this system to try to make it fair for everyone waiting for lungs. There are ways of working through this that don't involve breaking the rules." This controversy came to a head on July 24, 2013, when a perspective piece was published in the The New England Journal of Medicineregarding the debate over under-12 allocation rules. The piece, written by Karen Ladin and Douglas Hanto, noted that "...as a treatment for cystic fibrosis (the most common diagnosis among pediatric candidates for lung transplants), transplantation has been shown in several retrospective studies to have only marginal benefit (although some data suggest otherwise). However, they also pointed out that a valid argument exists for those who wish to change the rules, specifically: "Younger patients who meet the size requirements and could benefit from adult lungs should be considered eligible."

A study published in the Chest, noted that high lung allocation score (above 75) is associated with increased morbidity and mortality following transplantation. Murnaghan had an LAS score of 91 out of 100 upon her first transplant. Her second LAS score was 87 out of 100. An article posted in the American Journal of Transplantation authored by Dr. Sweet and Dr. Barr in December 2013 discussed points brought up by the Murnaghan family. First they stated, "Indeed, the pool of adult transplant candidates is more than 50 times larger than the number of pediatric candidates. So the actual number of lungs recovered from donors under 12 reflects both donor availability and candidate demand. In fact, roughly 5% of the 400+ donors each year under 12 provide lungs compared to more than 35% of the 400+ adolescent donors (Figure 1). It is unlikely that donor characteristics are solely responsible for the lower percentage. Thus one area of focus for the pediatric lung transplant community should be to explore tapping into this apparent opportunity." They also stated, "The second concept propagated by this story is that lobar transplant from adult donors is the best solution to the (perceived) lack of lung donors for children under 12. Although this option may be appropriate for children in circumstances where experienced transplant surgeons and physicians counsel the family that waiting for suitably sized donor organs from a pediatric donor is not feasible, the reality is that there are limited data supporting this approach for young children (in the most widely referenced series, the youngest recipient of an adult deceased donor lobar transplant was 9 years old) . Moreover, the authors' experience with living donor lobar transplant suggests that size matching is critical to successful outcome. Thus, a change to the allocation system that encourages increased use of lobar transplant for young children would be premature."
On June 5, 2013, Michael Baylson directed Kathleen Sebelius to temporarily suspend the under 12 rule following an emergency hearing. Judge Baylson stated in a memo regarding the issue of the temporary restraining order: "the Court concluded that issuance of the TRO was very much in the interest of the public as well as the Plaintiffs and Sarah." He also stated "Finally, this Court did not in any way, shape, or form dictate when or whether Murnaghan should receive a lung transplant." Organ Procurement and Transplantation Network (OPTN) responded by making a temporary one year appeals process for children under the age of 12 whose doctors feel may benefit from adult lungs. This temporary appeals process expires on June 30, 2014.

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

  

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker

Lungs For Kids Lungs Diagram of a Smoker after Smoking Cancer Anatomy And Heart Drawing Images AFter Smoking Wee of a Weed Smoker