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(CBS News)   It took a court order, but a 10-year old girl with only weeks to live is now allowed to receive adult lungs   (cbsnews.com) divider line 153
    More: Strange, lung transplant, court orders, adult lungs, suspend the rules, Robert Bales, lungs, Lou Barletta, Kathleen Sebelius  
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4564 clicks; posted to Main » on 06 Jun 2013 at 1:00 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-06-06 11:46:55 AM  
And the person who is going to die because they aren't getting those lungs? What's that person's name?
 
2013-06-06 12:05:13 PM  

DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?


Joey.  But nobody likes Joey, so it's okay.
 
2013-06-06 12:10:00 PM  

DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?


Ted.
F*ck Ted.
 
2013-06-06 12:13:56 PM  
There is no guarantee yet she'll get lungs before she dies.

But honestly, shoehorning too-big adult lungs into a child that may not even be able to use them to leave an adult or even possibly an OLDER child to die is so much more humane, right?

/not

I grieve for the child and parents, but truly, medicine is not perfect, and life sometimes sucks. A line has to be drawn somewhere, and kicking others down to claw your way over them is not really in the spirit of life.
 
2013-06-06 12:14:41 PM  

DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?


She didn't get bumped to the top of the list, only put on it based on the severity of her illness. Prior to this ruling, she was deemed ineligible because of her age. I doubt she'll end up being saved and then we'll have to deal with those people biatching that she should have been first in line.
 
2013-06-06 12:16:34 PM  

Popcorn Johnny: DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?

She didn't get bumped to the top of the list, only put on it based on the severity of her illness. Prior to this ruling, she was deemed ineligible because of her age. I doubt she'll end up being saved and then we'll have to deal with those people biatching that she should have been first in line.


I understand that, but by being put on the list at all, she's displacing everyone who would go below her. I feel very badly for this girl and her family, but I also feel badly for everyone else on the list. I'm not sure why this person is getting precedence.
 
2013-06-06 12:21:41 PM  

DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?


She didn't get bumped up the transplant list, you know. There's no guarantee they will even find a donor in time to save her.

On the other hand, it was pointed out that the rule existed because there was no guarantee the 10 year old's chest would be large enough to be able to accommodate an adult's lungs.

Asking the DHHS to intervene though was stupid. They don't make the rules, IIRC. The transplant foundations do.

DamnYankees: I understand that, but by being put on the list at all, she's displacing everyone who would go below her. I feel very badly for this girl and her family, but I also feel badly for everyone else on the list. I'm not sure why this person is getting precedence.


Probably because her condition is all but curable with a transplant, and she's a 10 year old child, which means she's much more likely to survive the surgery than the 70 year old guy who smoked for 40 years.
 
2013-06-06 12:26:01 PM  

hardinparamedic: Probably because her condition is all but curable with a transplant, and she's a 10 year old child, which means she's much more likely to survive the surgery than the 70 year old guy who smoked for 40 years.


This is why we let doctors and transplant boards make these decisions. Not judges, not you and not me. There's a reason about age cutoffs, and it shouldn't be overturned by a judge.
 
2013-06-06 12:30:09 PM  

DamnYankees: This is why we let doctors and transplant boards make these decisions. Not judges, not you and not me. There's a reason about age cutoffs, and it shouldn't be overturned by a judge.


The problem is that, as pointed out in TFA, the rule was made a long time ago, and may no longer be valid thanks to advances in organ procurement and selection. The arbitrary age range may also be flawed as well.

I do agree with you, though, that the courts intervening create a dangerous president for anyone who has enough money to take transplant boards to court.
 
2013-06-06 12:31:41 PM  

hardinparamedic: The problem is that, as pointed out in TFA, the rule was made a long time ago, and may no longer be valid thanks to advances in organ procurement and selection. The arbitrary age range may also be flawed as well.


Ok, but once again, this is an appeal to make to the transplant board. Not a judge.
 
2013-06-06 12:34:18 PM  

DamnYankees: Ok, but once again, this is an appeal to make to the transplant board.


And when that transplant board refuses to re-examine it's policies in light of peer-reviewed, and available evidence on the advancement of organ procurement and typing based on patient body size and cavity capabilities?
 
2013-06-06 12:35:50 PM  

hardinparamedic: DamnYankees: Ok, but once again, this is an appeal to make to the transplant board.

And when that transplant board refuses to re-examine it's policies in light of peer-reviewed, and available evidence on the advancement of organ procurement and typing based on patient body size and cavity capabilities?


I'm not sure what the claim would be that (i) they are doing this, since what possible reason would they have for doing so and (ii) you have any sort of enforcement right against them in court. You're basically arguing its bad policy, and you can do that, but I don't know what basis a court has to intervene. Appeal to Congress to change the law.
 
2013-06-06 12:38:19 PM  

DamnYankees: You're basically arguing its bad policy, and you can do that, but I don't know what basis a court has to intervene. Appeal to Congress to change the law.


I would assume the jurisdiction of the courts, in that event, would fall under the Fifth Amendment Due Process clause, especially if federal or state funds were being used to pay for the girl's treatment.
 
2013-06-06 12:39:09 PM  

DamnYankees: Appeal to Congress to change the law.


It's not a law. It's a transplant foundation policy. Congressional law delegates the delegation of organs to needing patients to the regional transplant authorities. The only thing the law addresses is for-profit buying and selling of organs.
 
2013-06-06 12:39:39 PM  

hardinparamedic: DamnYankees: You're basically arguing its bad policy, and you can do that, but I don't know what basis a court has to intervene. Appeal to Congress to change the law.

I would assume the jurisdiction of the courts, in that event, would fall under the Fifth Amendment Due Process clause, especially if federal or state funds were being used to pay for the girl's treatment.


Ok, but my understanding is not that the court struck down the entire system on a due process claim, but that they just made a special exception for this girl. Is that not right?
 
2013-06-06 12:40:35 PM  

DamnYankees: Ok, but my understanding is not that the court struck down the entire system on a due process claim, but that they just made a special exception for this girl. Is that not right?


Not really sure. I'll do some research on the matter. I would assume if they made a "Special Exception" for the girl, it was as an emergency order because the court felt that it would not be able to wait for them to re-examine the policy.
 
2013-06-06 01:04:04 PM  

hardinparamedic: DamnYankees: I understand that, but by being put on the list at all, she's displacing everyone who would go below her. I feel very badly for this girl and her family, but I also feel badly for everyone else on the list. I'm not sure why this person is getting precedence.

Probably because her condition is all but curable with a transplant, and she's a 10 year old child, which means she's much more likely to survive the surgery than the 70 year old guy who smoked for 40 years.


The person below her may not be a 70-year-old guy who smoked for 40 years. It may be a 14-year-old girl who has similar health problems to her.
 
2013-06-06 01:04:59 PM  

DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?


why does that matter? Did she skip to the head of the line or is this ruling just a matter of her not being forced to the back of it?
 
2013-06-06 01:05:38 PM  
So then the doctor who thought it would be safe to say, "dammit, I could fix this right NOW if only the law allowed this type of procuedure!  <sigh> I'm sorry.", might have to admit that it can't be done.
 
2013-06-06 01:06:16 PM  

DamnYankees: hardinparamedic: The problem is that, as pointed out in TFA, the rule was made a long time ago, and may no longer be valid thanks to advances in organ procurement and selection. The arbitrary age range may also be flawed as well.

Ok, but once again, this is an appeal to make to the transplant board. Not a judge.


So..... Death panels
 
2013-06-06 01:06:20 PM  

DamnYankees: I understand that, but by being put on the list at all, she's displacing everyone who would go below her. I feel very badly for this girl and her family, but I also feel badly for everyone else on the list. I'm not sure why this person is getting precedence.


She's not, only being allowed to be placed on the list. You seem to think that when a new person is added to the list, they automatically go to the end of the line, that's not true. A person who is going to die in a matter of weeks isn't placed behind somebody that has a few years to live.
 
2013-06-06 01:06:28 PM  
I was afraid this would be Schiavo'd.

I'm glad it's not.
 
2013-06-06 01:06:39 PM  

hardinparamedic: it was as an emergency order because the court felt that it would not be able to wait for them to re-examine the policy.

they were tired of listening to the media ask them to make an exception for this girl.

//if we're honest.. There were almost certainly better candidates with a longer-term recovery prognosis, but the kid got the media attention.
 
2013-06-06 01:06:45 PM  
Another reason that it doesn't pay to be an ugly malcontent: all the charismatic stories and characters get everything while they'll let you die.

Seriously though, I feel bad for the kid but worse for the person they edged out
 
2013-06-06 01:06:57 PM  
I sense a burgeoning practice for myself in the field of "organ donation procurement law." If done right, it could mesh well with the criminal defense practice I already have going.
 
2013-06-06 01:08:16 PM  

skullkrusher: DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?

why does that matter? Did she skip to the head of the line or is this ruling just a matter of her not being forced to the back of it?


From what I've read, the ruling places her on the list as if she were 12 years old and eligible to receive an adult pair of lungs. That means if she gets a pair of adult lungs, somebody else necessarily will not get those lungs, and that someone else will almost certainly die from not getting a transplant.
 
2013-06-06 01:09:13 PM  
Does it average out to where we can consider her legal, or how does that work?
 
2013-06-06 01:12:04 PM  

SecretAgentWoman: There is no guarantee yet she'll get lungs before she dies.

But honestly, shoehorning too-big adult lungs into a child that may not even be able to use them to leave an adult or even possibly an OLDER child to die is so much more humane, right?

/not

I grieve for the child and parents, but truly, medicine is not perfect, and life sometimes sucks. A line has to be drawn somewhere, and kicking others down to claw your way over them is not really in the spirit of life.


Um....what?
www.biography.com
 
2013-06-06 01:12:24 PM  
If it saves just one life, amirite?
 
2013-06-06 01:12:54 PM  

Somaticasual: There were almost certainly better candidates with a longer-term recovery prognosis, but the kid got the media attention.


You do realize this only places her on the list, right? The same list that everybody else goes on when they need a lung transplant.
 
2013-06-06 01:13:38 PM  
"This is an incredibly agonizing situation where someone lives and someone dies," said Sebelius.

"Based on their age," responded Barletta. "Based on their age."


Or, you know, based on the fact that someone that young that's already in end-stage CF failure is going to get maybe another 6 months of life out of the lung (CF... kind of keeps going even after transplants iirc) whereas the older patient that would otherwise get it would potentially live until they died of old age (well, lungs are a dodgy one, so about 5 years on average... but still).

Or based on the fact that transplant rejection in general is frequently higher in very young patients like this.

Basically, you're outright murdering someone that would be near-guaranteed survival with this transplant so that you can give the kid a long-shot chance of prolonging her sickness a few months before dying anyhow.

So... good job.

CBS News spoke to a leading specialist who said these rules may be out of date and that there is no medical reason why a child cannot receive an adult lung if it is the right blood type and size.

Must be legit if they won't even name their source on that.  Not like decades of expertise went into current policy, I'm sure if one anonymous source claiming unverified credentials says it it must be true.  This is how I know that 9/11 was an inside job, the moon landings were faked, and JFK was actually killed by the Martian Manhunter using mind bullets from the grassy knoll.
 
2013-06-06 01:14:25 PM  
What odds are they giving in Vegas that she croaks before suitable donor lungs are found?
 
2013-06-06 01:15:34 PM  

Serious Black: skullkrusher: DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?

why does that matter? Did she skip to the head of the line or is this ruling just a matter of her not being forced to the back of it?

From what I've read, the ruling places her on the list as if she were 12 years old and eligible to receive an adult pair of lungs. That means if she gets a pair of adult lungs, somebody else necessarily will not get those lungs, and that someone else will almost certainly die from not getting a transplant.


right but my understanding is that she is not being pushed to the head of the line, she is merely not forced to wait until there are no adult recipients waiting for lungs. I haven't seen any indication that she is being given priority - she is just not being held back from receiving them until all others have had a shot.

So, of course she is taking lungs that might go to someone else but that's the case for anyone of any age on the recipient list.
 
2013-06-06 01:15:55 PM  

Jim_Callahan: Or, you know, based on the fact that someone that young that's already in end-stage CF failure is going to get maybe another 6 months of life out of the lung (CF... kind of keeps going even after transplants iirc) whereas the older patient that would otherwise get it would potentially live until they died of old age (well, lungs are a dodgy one, so about 5 years on average... but still).


You do realize 5 years is longer than 6 months, especially for a child, right?

And the lung transplant DOES eliminate the Pulmonary problems that come from CF, which are the "most likely to kill me" problems.
 
2013-06-06 01:18:04 PM  
As the weather warms the potential for organ donors increases.

t1.gstatic.com
 
2013-06-06 01:20:56 PM  

SecretAgentWoman: There is no guarantee yet she'll get lungs before she dies.

But honestly, shoehorning too-big adult lungs into a child that may not even be able to use them to leave an adult or even possibly an OLDER child to die is so much more humane, right?

/not

I grieve for the child and parents, but truly, medicine is not perfect, and life sometimes sucks. A line has to be drawn somewhere, and kicking others down to claw your way over them is not really in the spirit of life.


Lemme guess - you are a liberal Democrat...

/What do I win?
 
2013-06-06 01:21:12 PM  

skullkrusher: Serious Black: skullkrusher: DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?

why does that matter? Did she skip to the head of the line or is this ruling just a matter of her not being forced to the back of it?

From what I've read, the ruling places her on the list as if she were 12 years old and eligible to receive an adult pair of lungs. That means if she gets a pair of adult lungs, somebody else necessarily will not get those lungs, and that someone else will almost certainly die from not getting a transplant.

right but my understanding is that she is not being pushed to the head of the line, she is merely not forced to wait until there are no adult recipients waiting for lungs. I haven't seen any indication that she is being given priority - she is just not being held back from receiving them until all others have had a shot.

So, of course she is taking lungs that might go to someone else but that's the case for anyone of any age on the recipient list.


What do you think the organ donation list is? It's a priority queue. By being considered as if she is 12 years old instead of 10, she jumped ahead of a lot of other people on the list. Just because she may not be (almost certainly isn't) priority #1 doesn't mean she isn't being prioritized ahead of a lot of other people now because of the change. And if she does get a set of lungs because of this reprioritization, somebody else inevitably will not get them.
 
2013-06-06 01:21:21 PM  

Walker: DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?

Ted.
F*ck Ted.


He still owes me money!
 
2013-06-06 01:23:31 PM  
The age cutoff is based on the fact the we don't know as much about pre-adolescent risk/survival as we do about adult risk/survival, because pre-adolescent transplant cases are rare.  "Don't know enough" would have been a good reason not to try the first transplant, I guess.
 
2013-06-06 01:23:36 PM  

Serious Black: What do you think the organ donation list is? It's a priority queue. By being considered as if she is 12 years old instead of 10, she jumped ahead of a lot of other people on the list. Just because she may not be (almost certainly isn't) priority #1 doesn't mean she isn't being prioritized ahead of a lot of other people now because of the change. And if she does get a set of lungs because of this reprioritization, somebody else inevitably will not get them.


but the reason she was in the back of the list was an arbitrary rule about adult lungs in younger patients. It'd be like saying the red-heads have to wait until all others have been given a shot at an available organ and then changing that policy (even if only in one instance at the moment) and then saying that that ginger is jumping ahead of people. Technically, yes, but not unfairly so.
 
2013-06-06 01:24:29 PM  

skullkrusher: Serious Black: skullkrusher: DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?

why does that matter? Did she skip to the head of the line or is this ruling just a matter of her not being forced to the back of it?

From what I've read, the ruling places her on the list as if she were 12 years old and eligible to receive an adult pair of lungs. That means if she gets a pair of adult lungs, somebody else necessarily will not get those lungs, and that someone else will almost certainly die from not getting a transplant.

right but my understanding is that she is not being pushed to the head of the line, she is merely not forced to wait until there are no adult recipients waiting for lungs. I haven't seen any indication that she is being given priority - she is just not being held back from receiving them until all others have had a shot.

So, of course she is taking lungs that might go to someone else but that's the case for anyone of any age on the recipient list.


Gotta agree with skullkrusher here. The point is that there should not be an arbitrary limit. Triage still applies. The lung she needs would still have to be small enough and the right blood type, and it would still be allocated based on severity of need. All this ruling really does is allow those standards to be applied to her, rather than a rubber-stamp "Not Eligible For Transplant" ruling.
 
2013-06-06 01:26:07 PM  
There are machines that can be used to keep a child alive with no heart (http://www.cbsnews.com/8301-18563_162-57489521/experimental-pump-kee ps -children-alive-to-receive-heart-transplant/ ) and machines to clean blood for kidney patients....but no machine that can add oxygen to the blood stream....enabling some to live without lungs for a while?
 
2013-06-06 01:26:19 PM  

Walker: DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?

Ted.
F*ck Ted.


tvseriesfinale.com
What the hell dude? Everyone likes Ted.
 
2013-06-06 01:26:53 PM  

SecretAgentWoman: There is no guarantee yet she'll get lungs before she dies.

But honestly, shoehorning too-big adult lungs into a child that may not even be able to use them to leave an adult or even possibly an OLDER child to die is so much more humane, right?

/not

I grieve for the child and parents, but truly, medicine is not perfect, and life sometimes sucks. A line has to be drawn somewhere, and kicking others down to claw your way over them is not really in the spirit of life.


No. A line does not have to be drawn. There need to be some rules guiding the precedence of patients in the transplant list - there does not need to be a line over riding medical judgement and the other rules based solely on an arbitrary age threshold.

RTFA.
 
2013-06-06 01:27:15 PM  

KiltedBastich: skullkrusher: Serious Black: skullkrusher: DamnYankees: And the person who is going to die because they aren't getting those lungs? What's that person's name?

why does that matter? Did she skip to the head of the line or is this ruling just a matter of her not being forced to the back of it?

From what I've read, the ruling places her on the list as if she were 12 years old and eligible to receive an adult pair of lungs. That means if she gets a pair of adult lungs, somebody else necessarily will not get those lungs, and that someone else will almost certainly die from not getting a transplant.

right but my understanding is that she is not being pushed to the head of the line, she is merely not forced to wait until there are no adult recipients waiting for lungs. I haven't seen any indication that she is being given priority - she is just not being held back from receiving them until all others have had a shot.

So, of course she is taking lungs that might go to someone else but that's the case for anyone of any age on the recipient list.

Gotta agree with skullkrusher here. The point is that there should not be an arbitrary limit. Triage still applies. The lung she needs would still have to be small enough and the right blood type, and it would still be allocated based on severity of need. All this ruling really does is allow those standards to be applied to her, rather than a rubber-stamp "Not Eligible For Transplant" ruling.


exactly
 
2013-06-06 01:27:24 PM  

DamnYankees: hardinparamedic: Probably because her condition is all but curable with a transplant, and she's a 10 year old child, which means she's much more likely to survive the surgery than the 70 year old guy who smoked for 40 years.

This is why we let doctors and transplant boards death panels make these decisions. Not judges, not you and not me. There's a reason about age cutoffs, and it shouldn't be overturned by a judge.

 
2013-06-06 01:29:52 PM  

hardinparamedic: Probably because her condition is all but curable with a transplant, and she's a 10 year old child, which means she's much more likely to survive the surgery than the 70 year old guy who smoked for 40 years.


Wait, I thought she had MS?  Didn't think a transplant would "cure" that.
 
2013-06-06 01:30:09 PM  
She should receive the lungs, but only if she, her siblings, and her parents all agree to be sterilised.

Cystic Fibrosis has a simple cure.
 
2013-06-06 01:30:19 PM  

ferretman: There are machines that can be used to keep a child alive with no heart (http://www.cbsnews.com/8301-18563_162-57489521/experimental-pump-kee ps -children-alive-to-receive-heart-transplant/ ) and machines to clean blood for kidney patients....but no machine that can add oxygen to the blood stream....enabling some to live without lungs for a while?


There is something called ECMO, Extracorporeal Membrane Oxygenation, which functions as artificial lungs with a heart bypass machine. If the heart is functioning properly and pumping adequately, they'll do what's known as Venous-Venous ECMO, which just infuses oxygenated blood.

The problem is it's a temporary solution, as in two weeks is the most you'll usually see someone on it, requires massive amounts of transfused blood that is heparinized, leaving the patient unable to clot, and requires invasive, large bore catheters placed in the femoral veins or subclavian veins.
 
2013-06-06 01:30:55 PM  

Satanic_Hamster: hardinparamedic: Probably because her condition is all but curable with a transplant, and she's a 10 year old child, which means she's much more likely to survive the surgery than the 70 year old guy who smoked for 40 years.

Wait, I thought she had MS?  Didn't think a transplant would "cure" that.


Cystic Fibrosis.
 
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