Sarah Murnaghan

Sarah Murnaghan is a 10-year old girl from Newtown Square, Pennsylvania whose doctors would like her to receive a lung transplant. She has been waiting for one for a year and a half. as treatment for cystic fibrosis. Her plight received national attention in June 2013.
Case and backround
Current organ allocation rules created because adult lungs do not fit well into pediatric recipients bar her from receiving an organ from an adult donor. Because of the small number of pediatric donors, her family has staged a publicity and legal campaign to get lungs for her, either by having the families of deceased donors direct lungs be given to her or by altering the rule that adult organs not be allocated to pediatric recipients. Either of these changes would likely lead to the death of another person on the transplant waiting list so that Murnaghan can be transplanted. A medical, ethical, and legal debate has ensued around these extremely difficult life-and-death choices.
The family appealed to United States Secretary of Health and Human Services Kathleen Sebelius, asking her to direct the Organ Procurement and Transplantation Network (OPTN), a member organization of US transplant centers and organ procurement organizations which holds the exclusive federal contract to allocate deceased-donor organs to alter policy. She refused, but directed the OPTN to review their allocation policy.
End-stage cystic fibrosis is one of the most common indications for pediatric lung transplantation; however, the medical benefit of the therapy has been questioned. One study published in the New England Journal of Medicine suggested that transplant for pediatric cystic fibrosis patients was far more likely to shorten their lives than lengthen them . The public debate around this case differs significantly from the policy debate in that it focuses on the emotion of a sick child and ignores the reality that prioritizing any one person necessarily deprives another candidate a transplant. It will probably not be publicly known which other patient dies if Murnaghan is transplanted instead, and so it will not be possible to compare the likely survival benefit between the two people.
The case highlights the desperation of transplant candidates whose situation makes transplant extremely unlikely, and raises ethical issues regarding maximizing the utility of transplantable organs while leaving other patients with little to no hope. Medical ethicists and transplant professionals debate these trade-offs, and there is no generally accepted conclusion as to how to balance the competing ethical principles of maximizing beneficence, minimizing maleficence, and achieving justice. Given the shortage of organs, any allocation policy will result in the death of many patients: how that determination gets made is a subject of constant debate. The family's decision to cast the allocation decision as arbitrary and bureaucratic has frustrated transplant professionals and medical ethicists who appreciate the larger question of the complexity of organ allocation and the reality of trying to maximize the benefit of the limited pool of organs.
Federal Court Case
According to KDKA-FM, Murnaghan was added to the adult transplant list. This was the result of U.S. District Court Judge Michael Baylson's judicial temporary restraining order which directs Sebelius to order the Organ Procurement and Transplantation Network (OPTN) to temporarily suspend its "Under-12" rule (barring access to adult and teen transplants for pediatric patients) for at least 10 days, until a hearing on June 14. The ruling is specific, applying only (at least, for now) to the Sarah Murnaghan case- though Judge Baylson indicated he might consider similar requests and his subsequently added a second recipient. His ruling does not specify which other waiting recipient should die instead of Murnaghan; he leaves that to the existing allocation system to determine. Many biomedical ethicists (Arthur Caplan among them) contend that it does raise questions: about equity when deciding what other young persons should be considered (and how urgently), how this will impact the need to carefully proceed in the rule formation process (and how it impacts existing rules), the impact this move will have on encouraging other younger (and older) patients and advocates to seek judicial intervention, and the impact this and other pediatric cases would have on the adults and teens (and future patients') need for a transplant. The ethical concerns go beyond just pediatric/adult lung transplantation- they pertain to other organs, though some organs in adults and children are needed in different areas and at certain times more than others, and the specific patient and their illness and/or injury prognosis will impact just how long they can wait, even in end-stage conditions.
Operation
On June 12, 2013, Murnaghan successfully underwent a double lung transplant, and doctors were pleased with her progress and prognosis. She received new lungs from an adult donor in an operation lasting over six hour at Children's Hospital of Philadelphia.

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