Turning Wrong Into Right: The 2013 Lung Allocation Controversy
Annals of Internal Medicine
Scott D. Halpern, MD, PhD
Ann Intern Med. Published online 25 June 2013 doi:10.7326/0003-4819-159-5-201309030-00684
Insufficient supply prevents many Americans from receiving health care services they might benefit from. Sometimes, as in the case of transplantable organs, both the processes and outcomes of allocating limited resources are highly visible. In other contexts, allocation proceeds more opaquely, as when physicians discharge patients from intensive care units to open beds for other patients (1). The ethics of both rule-based and “bedside†rationing hinge on how well each process promotes fairness, maximizes benefit, and gives priority to patients who are the worst off. Unfortunately, inevitable tensions arise when trying to balance equity, efficiency, and priority. Consequently, some people will feel mistreated.
Such perceived mistreatment fueled recent controversy surrounding Sarah Murnaghan, a 10-year-old girl dying of cystic fibrosis at the Children's Hospital of Philadelphia. As her condition deteriorated, Murnaghan's family and friends organized an impressive media campaign claiming that a policy preventing Murnaghan from receiving priority for lungs from adult donors discriminated against children.
This policy, enacted in 2010 by the Department of Health and Human Services (DHHS) Organ Procurement and Transplantation Network (OPTN), states that children younger than 12 years receive highest priority for lungs from donors younger than 12, secondary priority (behind adolescents aged 12 to 17 years) for donors aged 12 to 17, and lowest priority for donors 18 years or older.
Spurred by the Murnaghans' public relations blitz, U.S. Senator Patrick Toomey (R-Pa) (2) and media outlets echoed the claim that this policy discriminated against children, and District Court Judge Michael Baylson imposed a 10-day restraining order against the DHHS. With Murnaghan (and ultimately, another child at the same hospital) thus given equal priority as adults for receiving lungs from adult donors, Murnaghan received a double lung transplant from an adult donor before a full hearing could ensue.
This intervention sets a troubling precedent. The court did not seek evidence to assess the merit of the age-discrimination claim. Measuring this policy's impact on different age groups requires careful consideration of the numbers of adults, adolescents, and children awaiting transplantation; the availability of donors in each group; and the expected benefit when patients receive donor lungs outside of their age range. Preliminary analyses presented by the United Network for Organ Sharing 5 days after the court decision showed no evidence that existing policy reduced lung access for children (3). Had expert testimony been allowed, it may have also become clear that absent the policy, far more adults would become recipients of children's lungs than vice versa.
Continue reading
______________________________________________________
"You have the power to SAVE lives."
To register as a donor in California:
www.donateLIFEcalifornia.org | www.doneVIDAcalifornia.org
Outside California:
www.organdonor.gov | www.donatelife.
Scott D. Halpern, MD, PhD
Ann Intern Med. Published online 25 June 2013 doi:10.7326/0003-4819-159-5-201309030-00684
Insufficient supply prevents many Americans from receiving health care services they might benefit from. Sometimes, as in the case of transplantable organs, both the processes and outcomes of allocating limited resources are highly visible. In other contexts, allocation proceeds more opaquely, as when physicians discharge patients from intensive care units to open beds for other patients (1). The ethics of both rule-based and “bedside†rationing hinge on how well each process promotes fairness, maximizes benefit, and gives priority to patients who are the worst off. Unfortunately, inevitable tensions arise when trying to balance equity, efficiency, and priority. Consequently, some people will feel mistreated.
Such perceived mistreatment fueled recent controversy surrounding Sarah Murnaghan, a 10-year-old girl dying of cystic fibrosis at the Children's Hospital of Philadelphia. As her condition deteriorated, Murnaghan's family and friends organized an impressive media campaign claiming that a policy preventing Murnaghan from receiving priority for lungs from adult donors discriminated against children.
This policy, enacted in 2010 by the Department of Health and Human Services (DHHS) Organ Procurement and Transplantation Network (OPTN), states that children younger than 12 years receive highest priority for lungs from donors younger than 12, secondary priority (behind adolescents aged 12 to 17 years) for donors aged 12 to 17, and lowest priority for donors 18 years or older.
Spurred by the Murnaghans' public relations blitz, U.S. Senator Patrick Toomey (R-Pa) (2) and media outlets echoed the claim that this policy discriminated against children, and District Court Judge Michael Baylson imposed a 10-day restraining order against the DHHS. With Murnaghan (and ultimately, another child at the same hospital) thus given equal priority as adults for receiving lungs from adult donors, Murnaghan received a double lung transplant from an adult donor before a full hearing could ensue.
This intervention sets a troubling precedent. The court did not seek evidence to assess the merit of the age-discrimination claim. Measuring this policy's impact on different age groups requires careful consideration of the numbers of adults, adolescents, and children awaiting transplantation; the availability of donors in each group; and the expected benefit when patients receive donor lungs outside of their age range. Preliminary analyses presented by the United Network for Organ Sharing 5 days after the court decision showed no evidence that existing policy reduced lung access for children (3). Had expert testimony been allowed, it may have also become clear that absent the policy, far more adults would become recipients of children's lungs than vice versa.
Continue reading
______________________________________________________
"You have the power to SAVE lives."
To register as a donor in California:
www.donateLIFEcalifornia.org | www.doneVIDAcalifornia.org
Outside California:
www.organdonor.gov | www.donatelife.
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