Adult lungs transplanted into 10-year-old girl raises ethical questions

The world has been closely following the plight of 10-year-old Sarah Murnaghan, a girl with end stage cystic fibrosis whose parents sued to have her removed from a child's waiting list for a lung transplant in order to receive lungs from an adult donor in a timely fashion. Sarah is now on her second set of lungs, after her initial transplant was rejected. The incident is provoking questions about ethical behavior in the medical community.

LOS ANGELES, CA (Catholic Online) - The second lung transplant given to the Pennsylvania girl raises new questions about how to make the best use of a precious resource, ethicists say.

Sarah's case is controversial as her parents sued to get her onto the transplant list for an adult set of lungs. Typically, children are considered only for child-size lungs.

"Sadly, she faces very long odds of surviving. Even with good donor lungs, survival rates are only 50 percent at six years," Arthur Caplan, a physician and head of the division of bioethics at NYU Langone Medical Center in New York City says.

"She apparently got low quality organs to try and keep her alive to 'bridge' her to another transplant," Caplan says.

"Did it make sense to give her a second set of lungs in a pretty close-to-experimental procedure? She surely needed them, but given her medical situation, should she have been on the adult list in the first place?"

A second organ transplant is inherently controversial. "If the goal is to save lives with scarce lungs, should re-transplants ever be done following an initial acute failure of a first set?" Caplan asks. "I would say no, if others could have used organs who had not had a first shot. That is a tough position, but lung transplants are rare, and not yet on a par with kidney or liver transplants."

Sarah is now taking some breaths on her own, although she continues to breathe mostly with the help of a ventilator. Murnaghan posted pictures on Facebook of her daughter smiling wanly. She's due for additional surgery to repair her diaphragm, which was damaged during the operation, her mother says.

"Sarah is doing well, alert, improving inch by inch," Murnaghan posted on her Facebook page this weekend. Sarah's "surgery will bring us closer to successful extubation," in which doctors remove her breathing tube.

A previous attempt to remove Sarah from her breathing tube was unsuccessful. "Ever since the unsuccessful extubation she has struggled with fears that she will suffocate and stop breathing."

It's always difficult to decide how to allocate organs, because it means denying someone a chance at life, Pediatrician G. Kevin Donovan, director of the Edmund D. Pellegrino Center for Clinical Bioethics says.

The best way to make those decisions "is probably not to involve the courts," Donovan says. "The courts will have the same sympathy that we all would, but not the same medical information" as doctors at the bedside.

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"It really is a very difficult case," he says. "And difficult cases make good publicity, but bad precedents."

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