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Old Jun 5, 2013, 10:35 PM   #1
citizenzen
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Should 10 Year-Old Girl Get New Lungs?

I can sympathize with any parent who wants to see their child spared from suffering.

However, I'm troubled by the special treatment being afforded to this girl.

It seems to me as if publicity trumped medical considerations.

Thoughts?

Quote:
PHILADELPHIA — A dying 10-year-old girl has become eligible to seek donor lungs from an adult transplant list, after a federal judge Wednesday granted her family’s emergency petition.

The Newtown Square family is challenging organ transplant rules that say children under age 12 must wait for pediatric lungs to become available. The Murnaghans say that rarely happens, and they want the rule changed for all children in Sarah’s situation.

However, Baylson’s ruling lifting the age requirement applies only to Sarah, at least until the hearing on the request for a broader injunction. Sarah’s aunt, Sharon Ruddock, believes the 10-day window is long enough for her niece to reach the top of the list and be matched for a transplant.

On Tuesday, Health and Human Services Secretary Kathleen Sebelius declined to intervene in the case, despite urgent pleas from several members of Congress from Pennsylvania. Sebelius said that such decisions should be made by medical experts and noted that there were three other children at Children’s Hospital alone in the same condition.

Bayles ordered Sebelius to instruct the Organ Procurement and Transplantation Network to add Sarah to the adult list “so that she can be considered ... based on the medical severity of her condition as compared to the medical severity of persons over 12.”

http://www.washingtonpost.com/nation...647_story.html
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Old Jun 5, 2013, 11:43 PM   #2
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Is there a medical reason for not allowing children adult organs? Unless it is harmful I don't see why there is a problem here.
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Old Jun 5, 2013, 11:44 PM   #3
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I agree. This is only going to make other people who need transplants try and involve the court system. This judge made a huge mistake in my opinion.
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Old Jun 5, 2013, 11:47 PM   #4
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Nice way to sour the donation process.
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Old Jun 5, 2013, 11:48 PM   #5
citizenzen
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Nice way to sour the donation process.
I don't follow.

How will this sour the donation process?

I'll donate regardless the outcome of this matter.
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Old Jun 6, 2013, 01:41 AM   #6
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Originally Posted by MacNut View Post
Is there a medical reason for not allowing children adult organs? Unless it is harmful I don't see why there is a problem here.
According to the articles, using suitable adult organs can work. That isn't the issue. The issue is that there is a shortage of donated organs, and, a lot of people worked hard to create fair rules, and the rules have been circumvented.
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Old Jun 6, 2013, 09:01 AM   #7
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As a parent, my heart breaks at just the thought of having one of my children in this position.

However, the rules are in place - for whatever reason... and to be honest, i'm not sure why adult lungs can't be given to children under age 12 - but those are the rules that are in place that we have to go by.

I don't want the government deciding who lives and who dies (more than they already do). What do you say to the person who was #1 on the recipient list, but now gets bumped to #2 and then they are two ill by the time another lung is available?
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Old Jun 6, 2013, 09:09 AM   #8
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This is why doctors should be making these decisions not bureaucrats in Washington.
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Old Jun 6, 2013, 09:20 AM   #9
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This is why doctors should be making these decisions not bureaucrats in Washington.
What I find odd, is that it is the Republicans in Washington who have taken this cause to heart. They are the party that always makes the argument you just made. However, it is important to note that it wasn't a decision being made by bureaucrats in Washington, but by a single Judge. That judge decided to circumvent the legislation/regulations/medical opinions of experts for some reason that couldn't have been based on law, rules, regulations, or the Constitution. This was purely a political/emotional decision.

It's good to know that when the circumstances warrant, the GOP thinks it's perfectly ok for bureaucrats in Washington to get involved in decisions that have nothing to do with running our country.

(Before anyone attacks me for partisanship, which I am, but keep in mind who was in an uproar over the cuban kid stuck in a closet or the girl who was on life support, but gets their panties in a wad anytime a Democrat does anything similar).

(edit) Has anyone ever looked into the success rates of adult transplants into children this age? I'm guessing someone has, and they probably aren't as good as giving this incredibly rare commodity to an older, equally needy patient. In other words, this rugrat's case is going to kill someone else, but she's getting special treatment because she's younger. If her success probability is lower, then isn't that a giant waste?
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Old Jun 6, 2013, 09:45 AM   #10
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The Republicans are contradicting themselves while not wanting the politicians making these decisions and then turning around and calling for Sebelius to sign a waiver.
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Old Jun 6, 2013, 09:50 AM   #11
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Originally Posted by mcrain View Post
What I find odd, is that it is the Republicans in Washington who have taken this cause to heart. They are the party that always makes the argument you just made. However, it is important to note that it wasn't a decision being made by bureaucrats in Washington, but by a single Judge. That judge decided to circumvent the legislation/regulations/medical opinions of experts for some reason that couldn't have been based on law, rules, regulations, or the Constitution. This was purely a political/emotional decision.

It's good to know that when the circumstances warrant, the GOP thinks it's perfectly ok for bureaucrats in Washington to get involved in decisions that have nothing to do with running our country.
And, to some extent, I'm actually OK with that in a case like this. Judges are supposed to do that "justice tempered with mercy" thing. It this does work out for the girl, it may result in an older person such as myself dying. Age discrimination I suppose, but, I'm getting quite used to it. It seems quite arbitrary, as you say, which cases become a cause celebre on Fox News:

Quote:
(Before anyone attacks me for partisanship, which I am, but keep in mind who was in an uproar over the cuban kid stuck in a closet or the girl who was on life support, but gets their panties in a wad anytime a Democrat does anything similar).
Even quite recently, some politician (I forget who) was boasting about how proud they were of the Terri Schiavo brouhaha. Even from a Republican point of view, I never quite got that one.

Last edited by jnpy!$4g3cwk; Jun 6, 2013 at 09:51 AM. Reason: edit
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Old Jun 6, 2013, 10:07 AM   #12
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Originally Posted by mcrain View Post
(edit) Has anyone ever looked into the success rates of adult transplants into children this age? I'm guessing someone has, and they probably aren't as good as giving this incredibly rare commodity to an older, equally needy patient. In other words, this rugrat's case is going to kill someone else, but she's getting special treatment because she's younger. If her success probability is lower, then isn't that a giant waste?
I've been trying to find that information. What I've found just compares pediatric to adult lung transplant. Basically it seems like children are more likely to die than adults in the first year after transplant, but more likely to live 8 or more years after the transplant than adults. The median survival times are similar (about 5 years). However, the differences aren't conclusive (statistically significant) because the sample size of pediatric cases is so small. Another however, because I don't want to pay $30+ per article so I've just been reading abstracts, I don't know if these studies controlled for differences between the adults and children in the studies (such as disease type, severity, etc.).

http://www.sciencedirect.com/science...41134505001193
http://www.jsht.jp/uploads/%E5%B0%8F...6%E6%96%87.pdf


(this study found no difference between adults and kids)
http://www.sciencedirect.com/science...22522398702855

Wait, here we go. This is the article we're looking for:

http://onlinelibrary.wiley.com/doi/1...nticated=false

Quote:
Size reduction of donor organs in pediatric lung transplantation

Abstract:  Lobar transplantation and peripheral segmental resection allow downsizing of larger lungs for use in smaller recipients, particularly with regard to pediatric patients on the high urgency waiting list. We studied the safety and outcome of these techniques in children. All pediatric patients who underwent reduced size LTx between January 2000 and March 2009 were retrospectively reviewed and compared with pediatric patients who underwent full size LTx during the same period. Patient characteristics, intra-operative variables, and post-operative morbidity and mortality were compared. Among 28 primary LTxs, 16 (57%) were performed in reduced size technique. Preoperatively, there was a trend toward a higher rate of mechanical ventilation and a higher capillary pCO2 in the reduced size group. Surgical procedures tended to be longer in that group. Post-operative complications, survival and functional parameters were comparable between both groups. Our study demonstrates that reduced size LTx in children is a reliable therapeutic option that provides results comparable to full size LTx. This technique might help to reduce waiting list mortality by expanding the donor pool in pediatric LTx.
Edit: so based on my understanding of these data, it looks like allowing kids access to (but not necessarily preference on) the adult registry makes sense. But I'd also say I've spent a total of 20 minutes thinking about this. The people who made the transplantation rules have probably spent decades thinking about these issues. So I would not be surprised if I'm misinterpreting what I've found and even less surprised if there's tons more information that complicates the issue.
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Old Jun 6, 2013, 10:14 AM   #13
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I hope they can start making cloned organs in test tubes soon so this is no longer an issue....

2013 and we're still talking about organ donations? We're so behind.
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Old Jun 6, 2013, 11:31 AM   #14
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This kind of special treatment is vastly unfair, IMO, especially to the other three children in the same hospital suffering from the same condition.

From what I understand, these rules are formulated through years of endeavour by medical professionals. I think that breaking those rules based on the emotions of the public is very wrong.
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Old Jun 6, 2013, 11:36 AM   #15
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How does the transplant list work. Is it next on the list or do they look for the worst cases and those in the worst shape.
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Old Jun 6, 2013, 12:36 PM   #16
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Originally Posted by zin View Post
This kind of special treatment is vastly unfair, IMO, especially to the other three children in the same hospital suffering from the same condition.

From what I understand, these rules are formulated through years of endeavour by medical professionals. I think that breaking those rules based on the emotions of the public is very wrong.
Agreed. I think more people will turn to the courts in the future for this kind of thing based on this ruling.
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Old Jun 6, 2013, 12:38 PM   #17
citizenzen
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Originally Posted by ucfgrad93 View Post
Agreed. I think more people will turn to the courts in the future for this kind of thing based on this ruling.
The first step is getting the media to pay attention to your case.

The second step is to get a judge to pay attention to the hype.
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Old Jun 6, 2013, 01:02 PM   #18
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How does the transplant list work. Is it next on the list or do they look for the worst cases and those in the worst shape.
The United Network for Organ Sharing is the organisation that handles matching donors to patients. Essentially, it isn't a "list" in the conventional sense because that implies it is like a queue as you describe. From what I gather it is essentially just a huge pool of patients from which best matches can be obtained:

Quote:
Originally Posted by United Network for Organ Sharing
When a deceased organ donor is identified, a transplant coordinator from an organ procurement organization accesses the UNet system and enters necessary medical information about the donor. The system uses this information to match the medical characteristics of the candidates waiting against those of the donor. The system then generates a ranked list of patients who are suitable to receive each organ. This list is called a "match run." Factors affecting ranking may include:
  • tissue match
  • blood type
  • length of time on the waiting list
  • immune status
  • distance between the potential recipient and the donor
  • degree of medical urgency (for heart, liver, lung and intestines)
More information
It's clear that the waiting time is relatively unimportant compared to the other factors.
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Old Jun 6, 2013, 02:55 PM   #19
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It might be worth pointing out at this time that everyone here needs to let their loved ones know that they do want to have their organs used for transplants; they need to sign their drivers licenses; and, they should probably be donating blood regularly. As an aside, it would be nice if you got tested for bone marrow transplants.
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Old Jun 7, 2013, 07:38 AM   #20
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Originally Posted by mcrain View Post
What I find odd, is that it is the Republicans in Washington who have taken this cause to heart. They are the party that always makes the argument you just made. However, it is important to note that it wasn't a decision being made by bureaucrats in Washington, but by a single Judge. That judge decided to circumvent the legislation/regulations/medical opinions of experts for some reason that couldn't have been based on law, rules, regulations, or the Constitution. This was purely a political/emotional decision.

It's good to know that when the circumstances warrant, the GOP thinks it's perfectly ok for bureaucrats in Washington to get involved in decisions that have nothing to do with running our country.

(Before anyone attacks me for partisanship, which I am, but keep in mind who was in an uproar over the cuban kid stuck in a closet or the girl who was on life support, but gets their panties in a wad anytime a Democrat does anything similar).

(edit) Has anyone ever looked into the success rates of adult transplants into children this age? I'm guessing someone has, and they probably aren't as good as giving this incredibly rare commodity to an older, equally needy patient. In other words, this rugrat's case is going to kill someone else, but she's getting special treatment because she's younger. If her success probability is lower, then isn't that a giant waste?
Actually, the judges decision came AFTER the decision by the HHS secretary Sebilius or whatever that dolt's name is. She said at first the decision needed to be made by the doctors and the scientists, who already agreed that the girl should get a lung transplant. That decision came first, not the judge's decision.

Get used to this, it's only the beginning of the new medical system where the doctor's are not involved, but a judge and an unelected public official.

Also, in the words of our "president" is that if we can just save the life of one child then it's worth it. This is of course relating to gun control and not health care.
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Old Jun 7, 2013, 08:37 AM   #21
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Actually, the judges decision came AFTER the decision by the HHS secretary Sebilius or whatever that dolt's name is. She said at first the decision needed to be made by the doctors and the scientists, who already agreed that the girl should get a lung transplant. That decision came first, not the judge's decision.

Get used to this, it's only the beginning of the new medical system where the doctor's are not involved, but a judge and an unelected public official.

Also, in the words of our "president" is that if we can just save the life of one child then it's worth it. This is of course relating to gun control and not health care.
You're confused. At any given time, there are far fewer lungs available than there are people eligible for transplants. "Doctors and scientists" may have agreed she should get a lung transplant, but that can only mean that she should have been eligible for transplant. The fact of the matter is if she gets a transplant, that means someone else doesn't. I don't know whether or not the current allocation system is well designed and that other person should get the transplant more than she should--and I assure you, neither do you.
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Old Jun 7, 2013, 11:58 AM   #22
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Actually, the judges decision came AFTER the decision by the HHS secretary Sebilius or whatever that dolt's name is. She said at first the decision needed to be made by the doctors and the scientists, who already agreed that the girl should get a lung transplant. That decision came first, not the judge's decision.
Your version of events doesn't line up with other versions I have read. What is the source for your version?

Quote:
Get used to this, it's only the beginning of the new medical system where the doctor's are not involved, but a judge and an unelected public official.

Also, in the words of our "president" is that if we can just save the life of one child then it's worth it. This is of course relating to gun control and not health care.
Get used to what? The first person I ever personally knew who had a heart transplant was, what, 23 years ago or so? He had to get in line and hope that he didn't die before a match became available. How do you think this should have worked? Should the heart go to the highest bidder?
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Old Jun 7, 2013, 12:06 PM   #23
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How is this any of our business, much less the Federal Government's?

It's between the girl, her doctors, and the transplant community.

The Constitution grants certain very limited powers to the Federal government. Its strictures on Federal power have been blown away in recent decades, in particular by insanely overarching interpretations of the Commerce Clause. Lungs for transplant are in no way "commerce" under even the grimmest, most ghoulish interpretation.

The fact that life-and-death decisions of this sort are delegated to a single unelected Federal bureaucrat (Sebelius) is as vivid an example of how off-track our government has gotten as any. Truly chilling.
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Old Jun 7, 2013, 12:19 PM   #24
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The fact that life-and-death decisions of this sort are delegated to a single unelected Federal bureaucrat (Sebelius)
It isn't. In fact, the situation is quite different. People were demanding that Sebelius intervene and she said she couldn't do it.

Last edited by jnpy!$4g3cwk; Jun 7, 2013 at 12:21 PM. Reason: typo
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Old Jun 7, 2013, 02:15 PM   #25
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How is this any of our business, much less the Federal Government's?

It's between the girl, her doctors, and the transplant community.

The Constitution grants certain very limited powers to the Federal government. Its strictures on Federal power have been blown away in recent decades, in particular by insanely overarching interpretations of the Commerce Clause. Lungs for transplant are in no way "commerce" under even the grimmest, most ghoulish interpretation.

The fact that life-and-death decisions of this sort are delegated to a single unelected Federal bureaucrat (Sebelius) is as vivid an example of how off-track our government has gotten as any. Truly chilling.
What j said. Didn't you read? It's a federal judge who made the decision, not Sebelius.

I think that this is very scary. Actually, I think anyone who public ally complains about transplants in the US should mandatorily be signed up for the organ donor list, along their parents, sibs, children and grandchildren. The problem isn't really the courts or the judges but the lack of donors.
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