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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
    More: Strange, lung transplant, court orders, adult lungs, suspend the rules, Robert Bales, lungs, Lou Barletta, Kathleen Sebelius  
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4576 clicks; posted to Main » on 06 Jun 2013 at 1:00 PM (3 years ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-06-06 01:39:12 PM  

hardinparamedic: 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.


Doh, thought it was ms.  Didn't read the current article, just past ones / on other services.

Will a transplant actually cure CF?  I know CF destroys your lungs, wasn't aware that a lung transplant was a perm. fix.
 
2013-06-06 01:42:46 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.


Actually, that is precisely the spirit of life.  Maybe not our general definition of civilized life, but in a battle for your own survival it definitely is the way it happens.  Survival instincts are very powerful.  But, yeah, no guarantee.

If the person who gets booted down the list files suit, that'll really eff things up in this case.  Hmmm, who to choose, who to choose?
 
2013-06-06 01:43:06 PM  

Satanic_Hamster: Will a transplant actually cure CF?  I know CF destroys your lungs, wasn't aware that a lung transplant was a perm. fix.


It will fix the pulmonary complications, but not the GI and Pancreatic issues.

If someone is on death's door, it's pretty much the only way to ensure they survive at that point.
 
2013-06-06 01:45:22 PM  

skullkrusher: 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.


KiltedBastich: 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.


She wasn't stamped as not being eligible for a transplant. She was simply placed on a waiting list for pediatric lungs. Part of the reason there is a separate list for adult and pediatric lungs is that there is little research on how a child will handle adult lungs. Will the child turn out just fine? Will they not be able to breathe as a result of potentially jamming the lungs into a cavity too small for them? We simply do not know.

Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

Needing an organ donation is inherently a tragic situation. We argue that this girl deserves lungs because she has a name and a face to us now. The rest of the people on the list don't have those to us. That doesn't mean they aren't any less deserving. Their deaths will be tragic.
 
2013-06-06 01:47:13 PM  

hardinparamedic: Venous-Venous ECMO


Everything I've read about venousvenous ECMO shows "sub optimal" results to the point of being considered unproven . Has there been improvements?
 
2013-06-06 01:49:20 PM  

studs up: hardinparamedic: Venous-Venous ECMO

Everything I've read about venousvenous ECMO shows "sub optimal" results to the point of being considered unproven . Has there been improvements?


venovenous, der.
 
2013-06-06 01:53:23 PM  

Serious Black: She wasn't stamped as not being eligible for a transplant. She was simply placed on a waiting list for pediatric lungs. Part of the reason there is a separate list for adult and pediatric lungs is that there is little research on how a child will handle adult lungs. Will the child turn out just fine? Will they not be able to breathe as a result of potentially jamming the lungs into a cavity too small for them? We simply do not know.


"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."

No medical reason why it can't be done if the size and type are right. Saying we don't know if there is a medical reason when there is no indication that there is one is not a very convincing argument.

Serious Black: Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

Needing an organ donation is inherently a tragic situation. We argue that this girl deserves lungs because she has a name and a face to us now. The rest of the people on the list don't have those to us. That doesn't mean they aren't any less deserving. Their deaths will be tragic.


that IS the tragedy of organ donation. However, this girl also will die without the transplant. The only thing preventing her from getting a transplant is an archaic rule that has no medical basis. She isn't cutting the line, she isn't being given priority over other people for her age. She must contend with the same rules they do now that she is no longer subject to a rule that has no basis in science. Ignoring the pros and cons of saving a child's life vs an adult's, what is the ethical dilemma?
 
2013-06-06 01:58:43 PM  
Serious Black:

Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

But, there is no guarantee now that if a set of lungs that matches her would matching anyone sitting on that list.  Previously, she had no shot at those lungs even if she were the only one to match.  Now, she has a shot.  But, if someone else is a match, then your question stands.  I think it was an ethical issue just saying "no, you're under 12, therefore we won't even consider you."  That issue of a blanket No in this case is resolved.  I support that resolution.  I hope they come to that conclusion in the review of the policy for all future cases.
 
2013-06-06 02:00:37 PM  
Are there the same abstention rules for smokers awaiting lung transplants as there are for alcoholics awaiting liver transplants?  Substance free for X amt of time.
 
2013-06-06 02:02:02 PM  

skullkrusher: Serious Black: She wasn't stamped as not being eligible for a transplant. She was simply placed on a waiting list for pediatric lungs. Part of the reason there is a separate list for adult and pediatric lungs is that there is little research on how a child will handle adult lungs. Will the child turn out just fine? Will they not be able to breathe as a result of potentially jamming the lungs into a cavity too small for them? We simply do not know.

"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."

No medical reason why it can't be done if the size and type are right. Saying we don't know if there is a medical reason when there is no indication that there is one is not a very convincing argument.

Serious Black: Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

Needing an organ donation is inherently a tragic situation. We argue that this girl deserves lungs because she has a name and a face to us now. The rest of the people on the list don't have those to us. That doesn't mean they aren't any less deserving. Their deaths will be tragic.

that IS the tragedy of organ donation. However, this girl also will die without the transplant. The only thing preventing her from getting a transplant is an archaic rule that has no medical basis. She isn't cutting the line, she isn't being given priority over other people for her age. She must contend ...


UNOS, the United Network for Organ Sharing, last revised the rule in 2010. What's changed since then that pediatric cases can handle adult lungs? What's change that makes having two separate lists for organs irrelevant?
 
2013-06-06 02:03:15 PM  

studs up: hardinparamedic: Venous-Venous ECMO

Everything I've read about venousvenous ECMO shows "sub optimal" results to the point of being considered unproven . Has there been improvements?


Seems to work great in neonates. Our facility used it during the 2009 H1N1 outbreak in a few patients who had severe ARDS.

The outcomes seem to be much better in Pediatrics than they are in Adults, though. ECMO is one of the second-line treatments for severe oxygenation disorders in kids, while it's not even recommended in adults with ARDS.
 
2013-06-06 02:03:24 PM  

Magnus: Serious Black:

Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

But, there is no guarantee now that if a set of lungs that matches her would matching anyone sitting on that list.  Previously, she had no shot at those lungs even if she were the only one to match.  Now, she has a shot.  But, if someone else is a match, then your question stands.  I think it was an ethical issue just saying "no, you're under 12, therefore we won't even consider you."  That issue of a blanket No in this case is resolved.  I support that resolution.  I hope they come to that conclusion in the review of the policy for all future cases.


She was never not on the priority list. She was at the bottom of the list as she is a pediatric case and is cross-listed on the pediatric donor list. This ruling moves her ahead of people who are not on the pediatric donor list.
 
2013-06-06 02:03:31 PM  

hardinparamedic: Satanic_Hamster: Will a transplant actually cure CF?  I know CF destroys your lungs, wasn't aware that a lung transplant was a perm. fix.

It will fix the pulmonary complications, but not the GI and Pancreatic issues.

If someone is on death's door, it's pretty much the only way to ensure they survive at that point.


I didn't know there were GI and pancreatic issues. I thought it was only a lung thing.

Learned me something new.
 
2013-06-06 02:06:42 PM  

give me doughnuts: I didn't know there were GI and pancreatic issues. I thought it was only a lung thing.

Learned me something new.


Yeah, the breathing problems are pretty evident, but CF tends to mess up a lot of organs.  Had a buddy from high school die from it, a few months after graduation.
 
2013-06-06 02:10:19 PM  
Yuri could hook her up. Maybe she would prefer a nice set of gills. Perhaps some Z-ray eyes?
theinfosphere.org
 
2013-06-06 02:15:10 PM  

Serious Black: She was never not on the priority list. She was at the bottom of the list as she is a pediatric case and is cross-listed on the pediatric donor list. This ruling moves her ahead of people who are not on the pediatric donor list.


The ruling places her in triage with people not on the pediatric donor list. She still has to meet the right criteria, like blood type, size and need. Why is it inappropriate to consider these things? Arbitrarily placing her at the bottom of the normal list because she is also on the pediatric list is just stupid. Why is a bureaucratic rule a consideration in a medical triage?
 
2013-06-06 02:15:59 PM  

skullkrusher: The only thing preventing her from getting a transplant is an archaic rule that has no medical basis


I'm not sure what you mean with this statement. Archaic rule? Surgeons have been doing lung transplants long enough that the rules are archaic? There are a variety of things preventing her from getting a transplant. Age, serotype, current medical status etc.

We have just let emotions guide the decision on who goes on a transplant list. This is exactly the wrong reason in determining eligibilty.  Far from being archaic, this is a cutting edge situation that continues to be refined by bioethicists. Humans should understand that we are going to die. Some of us may have the ability to utilize technology to extend life but when that technology is a limited resource, rational decisions need to be made to benefit the greatest number of people possible. I see no tragedy at all. Thank FSM that we now have the ability to correct problems/diseases. And not all of us will get to take advantage of this technology and will die.

I might add that I find it problematic that the judicial system has chosen to get involved. It sets a very bad precedent. As some have pointed out earlier, this girls placement  on the list potentially could end with  somebody else not getting a transplant and dieing. In effect, the court has chosen to determine who lives and dies, in a non criminal situation, by poking its nose into a medical situation. Bad precedent.
 
2013-06-06 02:24:57 PM  
The parents could always:
img.zidbits.com

and then their daughter may be able to live a normal life sometime in the future.
 
2013-06-06 02:27:16 PM  

Magnus: Serious Black:

Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

But, there is no guarantee now that if a set of lungs that matches her would matching anyone sitting on that list.  Previously, she had no shot at those lungs even if she were the only one to match.  Now, she has a shot.  But, if someone else is a match, then your question stands.  I think it was an ethical issue just saying "no, you're under 12, therefore we won't even consider you."  That issue of a blanket No in this case is resolved.  I support that resolution.  I hope they come to that conclusion in the review of the policy for all future cases.


I think you misunderstood the situation. If she were the only match, she would get the lungs even before the court ruling.  The problem is that unless you have a rare blood type, and the donor also has that rare blood type, you're very unlikely to be the only match. The previous rules stated that adult lungs could go to a child under 12 only if everyone else on the list did not match or declined the lungs. Basically she was automatically last priority.  Now the judge's order removes the rule that made her last in priority which puts her the priority list by her triage status which moves her to the top (or very near the top) of the list.
 
2013-06-06 02:29:31 PM  
I listened to the parents talk about how they were fighting this fight for all kids with the same issue.  If that were the case, then why didn't they get a court order allowing all kids who were in their daughter's position to have the same exception?

If I was the parent of another child in the same predicament, you'd better believe I'd be asking for the same exception.

Now that this giel is on the adult list, what happens if children's lungs become available?  Does she keep her place in that line as well?

On top of all of this, how does a federal judge have the right to grant exceptions like this?  This is an extraordinary precedent.
 
2013-06-06 02:32:45 PM  
From the NPR article:

"lung transplants are the most difficult of organ transplants, and children fare worse than adults, which is one reason for the existing [age] policy, said Dr. Arthur Caplan, a bioethicist at New York University..."

"some lungs donated from deceased adults have been offered for children's transplants over the past two years, although he couldn't give a number. But he said all were turned down by the children's surgeons."

It sucks royally, but the problem is shortage of organs. This isn't the judge's call.
 
2013-06-06 02:33:11 PM  

1000Airplanes: I'm not sure what you mean with this statement. Archaic rule? Surgeons have been doing lung transplants long enough that the rules are archaic? There are a variety of things preventing her from getting a transplant. Age, serotype, current medical status etc.


"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."

Yes, there are several things standing in her way of getting a transplant. One of them, "age", has no medical basis.

1000Airplanes: We have just let emotions guide the decision on who goes on a transplant list. This is exactly the wrong reason in determining eligibilty. Far from being archaic, this is a cutting edge situation that continues to be refined by bioethicists. Humans should understand that we are going to die. Some of us may have the ability to utilize technology to extend life but when that technology is a limited resource, rational decisions need to be made to benefit the greatest number of people possible. I see no tragedy at all. Thank FSM that we now have the ability to correct problems/diseases. And not all of us will get to take advantage of this technology and will die.


it's not an emotional stance at all for me. Sure it's sad to see a little kid suffer like this and all that but if age of the potential recipient is not important (whereas, organ size and blood type are), why do we consider age? It's a logical stance, not an emotional one. Perhaps it turns out that no lungs that fit can be had and she does, God forbid, die anyway. At least she wouldn't have died because of a rule that has no medical basis but rather died because a match was not found.
 
2013-06-06 02:35:09 PM  

hardinparamedic: 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.


It's - Precedent.   Back to the worker camps for you!

Heil!
 
2013-06-06 02:35:55 PM  

Truther: 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?


You must be a Republican. You make all your decisions based on emotion. No amount of scientific evidence is necessary. Medical decision must be made purely on whether or not the sick white person is like you. "Teri Schiavo was fully functioning when those judges killed her."
 
2013-06-06 02:36:31 PM  

Serious Black: UNOS, the United Network for Organ Sharing, last revised the rule in 2010. What's changed since then that pediatric cases can handle adult lungs? What's change that makes having two separate lists for organs irrelevant?


I don't know. IANAD. I am going by the information I have and discussing the ethical issues about her bumping someone off the list. Why are there 2 separate lists? Why is age 12 important? Is it based on body size?
 
2013-06-06 02:45:29 PM  

bgilmore5: Truther: 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?

You must be a Republican. You make all your decisions based on emotion. No amount of scientific evidence is necessary. Medical decision must be made purely on whether or not the sick white person is like you. "Teri Schiavo was fully functioning when those judges killed her."


Generally, champ, liberals condemn Republicans for being unfeeling gestapo property rights Nazis more interested in money than the sanctity of life.  You need to get your talking points straight if you're going to fall into lockstep with your progressive overlords.
 
2013-06-06 02:45:33 PM  

Rising_Zan_Samurai_Gunman: Magnus: Serious Black:

Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

But, there is no guarantee now that if a set of lungs that matches her would matching anyone sitting on that list.  Previously, she had no shot at those lungs even if she were the only one to match.  Now, she has a shot.  But, if someone else is a match, then your question stands.  I think it was an ethical issue just saying "no, you're under 12, therefore we won't even consider you."  That issue of a blanket No in this case is resolved.  I support that resolution.  I hope they come to that conclusion in the review of the policy for all future cases.

I think you misunderstood the situation. If she were the only match, she would get the lungs even before the court ruling.  The problem is that unless you have a rare blood type, and the donor also has that rare blood type, you're very unlikely to be the only match. The previous rules stated that adult lungs could go to a child under 12 only if everyone else on the list did not match or declined the lungs. Basically she was automatically last priority.  Now the judge's order removes the rule that made her last in priority which puts her the priority list by her triage status which moves her to the top (or very near the top) of the list.


Quite possibly.  I understood it that she was not allowed adult lungs, period, because she is under 12.  Is that not what the ruling was?  Relief from the 12 yr old rule?
 
2013-06-06 02:47:06 PM  

hardinparamedic: 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.


It is a "Special Exception."

"Baylson suspended the age limit in the nation's transplant rules for 10 days for Sarah, who has been at the Philadelphia hospital for three months. A June 14 hearing on the request has been scheduled for a broader injunction.

Nationwide, about 1,700 people are on the waiting list for a lung transplant, including 31 children under age 11, according to the Organ Procurement and Transplantation Network."

So the ruling applies only to this girl, not other children in the same situation who didn't go to court, and will only be in effect for 10 days.
 
2013-06-06 02:47:08 PM  

skullkrusher: Serious Black: UNOS, the United Network for Organ Sharing, last revised the rule in 2010. What's changed since then that pediatric cases can handle adult lungs? What's change that makes having two separate lists for organs irrelevant?

I don't know. IANAD. I am going by the information I have and discussing the ethical issues about her bumping someone off the list. Why are there 2 separate lists? Why is age 12 important? Is it based on body size?


Agreed. Furthermore, If it's body size, then why not just say body size instead of setting an arbitrary age limit? Appropriate size of the organs is already a triage consideration. You're never going to get the lungs from a deceased 7 foot basketball player transplated into a sick 3 foot midget, for example.
 
2013-06-06 02:49:31 PM  

Magnus: Rising_Zan_Samurai_Gunman: Magnus: Serious Black:

Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

But, there is no guarantee now that if a set of lungs that matches her would matching anyone sitting on that list.  Previously, she had no shot at those lungs even if she were the only one to match.  Now, she has a shot.  But, if someone else is a match, then your question stands.  I think it was an ethical issue just saying "no, you're under 12, therefore we won't even consider you."  That issue of a blanket No in this case is resolved.  I support that resolution.  I hope they come to that conclusion in the review of the policy for all future cases.

I think you misunderstood the situation. If she were the only match, she would get the lungs even before the court ruling.  The problem is that unless you have a rare blood type, and the donor also has that rare blood type, you're very unlikely to be the only match. The previous rules stated that adult lungs could go to a child under 12 only if everyone else on the list did not match or declined the lungs. Basically she was automatically last priority.  Now the judge's order removes the rule that made her last in priority which puts her the priority list by her triage status which moves her to the top (or very near the top) of the list.

Quite possibly.  I understood it that she was not allowed adult lungs, period, because she is under 12.  Is that not what the ruling was?  Relief from the 12 yr old rule?


It is indeed relief from the rule, but from what I've seen (and what other health professionals have said), the rule merely placed her at the bottom of the list instead of where she would be without considering her age.
 
2013-06-06 02:50:02 PM  

avratt: Are there the same abstention rules for smokers awaiting lung transplants as there are for alcoholics awaiting liver transplants?  Substance free for X amt of time.


Yes there are.  If they find any trace of tobacco in your blood, you are not eligible.  I had a freind whose SO was on the list and she could not smoke around him for fear that he would not be eliegible.  Eventually he did get the transplant, but she told me that transplant recipients don't make it more than 7 years after the transplant.  I don't know if this applies to CF though.
 
2013-06-06 02:52:35 PM  

KiltedBastich: skullkrusher: Serious Black: UNOS, the United Network for Organ Sharing, last revised the rule in 2010. What's changed since then that pediatric cases can handle adult lungs? What's change that makes having two separate lists for organs irrelevant?

I don't know. IANAD. I am going by the information I have and discussing the ethical issues about her bumping someone off the list. Why are there 2 separate lists? Why is age 12 important? Is it based on body size?

Agreed. Furthermore, If it's body size, then why not just say body size instead of setting an arbitrary age limit? Appropriate size of the organs is already a triage consideration. You're never going to get the lungs from a deceased 7 foot basketball player transplated into a sick 3 foot midget, for example.


right. If it is a sizing issue, having an arbitrary age seems rather stupid. Based on the brief details in TFA, however, that seems to be the only medical reason for the different lists
 
2013-06-06 02:53:44 PM  

Serious Black: Magnus: Rising_Zan_Samurai_Gunman: Magnus: Serious Black:

Let's not gloss over the ethics here. Regardless of this ruling placing the girl on the adult transplant list, there are far too few sets of lungs available to ensure everybody on that list will get a transplant. By ordering that this 10-year-old girl be considered an adult for transplant purposes, she now qualifies for a set of lungs that, if she gets them, somebody else will not get. That somebody else will die. What makes that person's life worth less than the girl's life? Because they didn't get media attention drawn to their case?

But, there is no guarantee now that if a set of lungs that matches her would matching anyone sitting on that list.  Previously, she had no shot at those lungs even if she were the only one to match.  Now, she has a shot.  But, if someone else is a match, then your question stands.  I think it was an ethical issue just saying "no, you're under 12, therefore we won't even consider you."  That issue of a blanket No in this case is resolved.  I support that resolution.  I hope they come to that conclusion in the review of the policy for all future cases.

I think you misunderstood the situation. If she were the only match, she would get the lungs even before the court ruling.  The problem is that unless you have a rare blood type, and the donor also has that rare blood type, you're very unlikely to be the only match. The previous rules stated that adult lungs could go to a child under 12 only if everyone else on the list did not match or declined the lungs. Basically she was automatically last priority.  Now the judge's order removes the rule that made her last in priority which puts her the priority list by her triage status which moves her to the top (or very near the top) of the list.

Quite possibly.  I understood it that she was not allowed adult lungs, period, because she is under 12.  Is that not what the ruling was?  Relief from the 12 yr old rule?

It is indeed relief fr ...


gotcha.  thanks.
 
2013-06-06 02:59:12 PM  
this is sick. there were three other children who were just as ill in that hospital.
 
2013-06-06 03:01:06 PM  

Trey Le Parc: bgilmore5: Truther: 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?

You must be a Republican. You make all your decisions based on emotion. No amount of scientific evidence is necessary. Medical decision must be made purely on whether or not the sick white person is like you. "Teri Schiavo was fully functioning when those judges killed her."

Generally, champ, liberals condemn Republicans for being unfeeling gestapo property rights Nazis more interested in money than the sanctity of life.  You need to get your talking points straight if you're going to fall into lockstep with your progressive overlords.


Everyone is a liberal or conservative. I forgot. Are you saying Republicans embrace logic and science? There's plenty to be said for your argument. If her brain had not liquified while Republicans paraded her corps around on TV, Teri Schiavo probably would agree Republicans are "unfeeling gestapo property rights Nazis more interested in money than the sanctity of life." BTW, the Repubs don't give a damn about the sanctity of life.
 
2013-06-06 03:02:15 PM  

KiltedBastich: skullkrusher: Serious Black: UNOS, the United Network for Organ Sharing, last revised the rule in 2010. What's changed since then that pediatric cases can handle adult lungs? What's change that makes having two separate lists for organs irrelevant?

I don't know. IANAD. I am going by the information I have and discussing the ethical issues about her bumping someone off the list. Why are there 2 separate lists? Why is age 12 important? Is it based on body size?

Agreed. Furthermore, If it's body size, then why not just say body size instead of setting an arbitrary age limit? Appropriate size of the organs is already a triage consideration. You're never going to get the lungs from a deceased 7 foot basketball player transplated into a sick 3 foot midget, for example.


Body size is imperfect. For that matter, age is as well. But none of us sitting here typing away at our computers knows nearly as much as the people who actually developed the criteria used by UNOS to prioritize those in need of donations. They have a brutal job. They have a thankless job. The doctors at UNOS aren't just siting in a room munching on popcorn and laughing maniacally while watching a live feed of this girl dying. I'm sure it eats at them that their rules will inherently result in one person dying while another lives. That is the very nature of organ transplantation in an environment where we have far too few organs and far too many people who need them.

Everyone sitting here yelling about how this 10-year-old girl deserved to be on the list as if she were an adult has an incomplete set on information about this case and what will happen if, because she has been moved up on the list, somebody else gets denied the lungs she gets. UNOS surely had justification for the age rule when they implemented it. Maybe it doesn't need to be there anymore. Armchair quarterbacking will not solve the problem though.
 
2013-06-06 03:03:41 PM  
In this thread I've learned that many farkers think the organ transplant list is like waiting in line at Subway.
 
2013-06-06 03:05:05 PM  

bgilmore5: BTW, the Repubs don't give a damn about the sanctity of life


I was informed that this is a major problem. Pro-Lifers run that party. Has someone changed the definition of "sanctity of life" while my lappy re-booted?
 
2013-06-06 03:07:02 PM  

Serious Black: Everyone sitting here yelling about how this 10-year-old girl deserved to be on the list as if she were an adult has an incomplete set on information about this case and what will happen if, because she has been moved up on the list, somebody else gets denied the lungs she gets.


and that's the heart of the discussion (NPI). It is undeniable that someone gets denied the lungs if she gets them. However, if 12 is just used as an age to break up the two lists because of body size, it is not unfair that she gets the lungs ahead of someone else. She should have been ahead of them in the first place if all else is considered.
 
2013-06-06 03:07:25 PM  

skullkrusher: KiltedBastich: skullkrusher: Serious Black: UNOS, the United Network for Organ Sharing, last revised the rule in 2010. What's changed since then that pediatric cases can handle adult lungs? What's change that makes having two separate lists for organs irrelevant?

I don't know. IANAD. I am going by the information I have and discussing the ethical issues about her bumping someone off the list. Why are there 2 separate lists? Why is age 12 important? Is it based on body size?

Agreed. Furthermore, If it's body size, then why not just say body size instead of setting an arbitrary age limit? Appropriate size of the organs is already a triage consideration. You're never going to get the lungs from a deceased 7 foot basketball player transplated into a sick 3 foot midget, for example.

right. If it is a sizing issue, having an arbitrary age seems rather stupid. Based on the brief details in TFA, however, that seems to be the only medical reason for the different lists


It is very likely more than just size:

One of those facts, he says, involves statistics showing children receiving adult lungs or even pieces of the organ have a poor survival rate after surgery.

The real point is that there is medical basis for current policies. If people think those should be changed, that's fine. But leave it up to experts to figure that out, not some judge who knows nothing about it.
 
2013-06-06 03:14:43 PM  

pseudoscience: skullkrusher: KiltedBastich: skullkrusher: Serious Black: UNOS, the United Network for Organ Sharing, last revised the rule in 2010. What's changed since then that pediatric cases can handle adult lungs? What's change that makes having two separate lists for organs irrelevant?

I don't know. IANAD. I am going by the information I have and discussing the ethical issues about her bumping someone off the list. Why are there 2 separate lists? Why is age 12 important? Is it based on body size?

Agreed. Furthermore, If it's body size, then why not just say body size instead of setting an arbitrary age limit? Appropriate size of the organs is already a triage consideration. You're never going to get the lungs from a deceased 7 foot basketball player transplated into a sick 3 foot midget, for example.

right. If it is a sizing issue, having an arbitrary age seems rather stupid. Based on the brief details in TFA, however, that seems to be the only medical reason for the different lists

It is very likely more than just size:

One of those facts, he says, involves statistics showing children receiving adult lungs or even pieces of the organ have a poor survival rate after surgery.

The real point is that there is medical basis for current policies. If people think those should be changed, that's fine. But leave it up to experts to figure that out, not some judge who knows nothing about it.



Correct answer most of the time.

That being said, the boards are also fallible and the criteria weird sometimes.  Worked with a lot of Lung/Heart transplants over the years, peds and adults.  And sometimes the decisions seemed rather capricious.  However keep in mind, it is a *lot* more complicated than a simple sorting list.  Organ implantation criteria is an incredibly complex matrix of physiological and social issues.  It is so complex in fact that one cannot always say that because person A received and organ, person B did not.  Sometimes you can have a perfectly viable organ that is not a good match for anyone.

/and despite what people say, money and status buys organs in the US
/but that's another story
 
2013-06-06 03:15:50 PM  

skullkrusher: Serious Black: Everyone sitting here yelling about how this 10-year-old girl deserved to be on the list as if she were an adult has an incomplete set on information about this case and what will happen if, because she has been moved up on the list, somebody else gets denied the lungs she gets.

and that's the heart of the discussion (NPI). It is undeniable that someone gets denied the lungs if she gets them. However, if 12 is just used as an age to break up the two lists because of body size, it is not unfair that she gets the lungs ahead of someone else. She should have been ahead of them in the first place if all else is considered.


And what pseudoscience just posted is exactly what I had said before: that there is an unproven track record behind giving adult lungs to a child. I mean, why else would UNOS create a rule that looks arbitrary to you and me? I highly doubt they are either incompetent or malicious. They did it for a good reason, and they know far more about the actual statistics behind organ transplantation than anybody here or anywhere else biatching that they're sentencing this girl to death. Nobody knows better than them that they are sentencing people to death.
 
2013-06-06 03:20:54 PM  

Serious Black: skullkrusher: Serious Black: Everyone sitting here yelling about how this 10-year-old girl deserved to be on the list as if she were an adult has an incomplete set on information about this case and what will happen if, because she has been moved up on the list, somebody else gets denied the lungs she gets.

and that's the heart of the discussion (NPI). It is undeniable that someone gets denied the lungs if she gets them. However, if 12 is just used as an age to break up the two lists because of body size, it is not unfair that she gets the lungs ahead of someone else. She should have been ahead of them in the first place if all else is considered.

And what pseudoscience just posted is exactly what I had said before: that there is an unproven track record behind giving adult lungs to a child. I mean, why else would UNOS create a rule that looks arbitrary to you and me? I highly doubt they are either incompetent or malicious. They did it for a good reason, and they know far more about the actual statistics behind organ transplantation than anybody here or anywhere else biatching that they're sentencing this girl to death. Nobody knows better than them that they are sentencing people to death.


sorry, I missed psuedo's post. That is a different story but apparently there is some difference of opinion on the matter between the unnamed expert in TFA and the guy in psuedo's post
 
2013-06-06 03:21:20 PM  

Serious Black: skullkrusher: Serious Black: Everyone sitting here yelling about how this 10-year-old girl deserved to be on the list as if she were an adult has an incomplete set on information about this case and what will happen if, because she has been moved up on the list, somebody else gets denied the lungs she gets.

and that's the heart of the discussion (NPI). It is undeniable that someone gets denied the lungs if she gets them. However, if 12 is just used as an age to break up the two lists because of body size, it is not unfair that she gets the lungs ahead of someone else. She should have been ahead of them in the first place if all else is considered.

And what pseudoscience just posted is exactly what I had said before: that there is an unproven track record behind giving adult lungs to a child. I mean, why else would UNOS create a rule that looks arbitrary to you and me? I highly doubt they are either incompetent or malicious. They did it for a good reason, and they know far more about the actual statistics behind organ transplantation than anybody here or anywhere else biatching that they're sentencing this girl to death. Nobody knows better than them that they are sentencing people to death.


I worked on and collected the data for multiple heart and lung tx patients and studies as a matter of course.  The above is correct.
 
2013-06-06 03:21:51 PM  

pseudoscience: The real point is that there is medical basis for current policies. If people think those should be changed, that's fine. But leave it up to experts to figure that out, not some judge who knows nothing about it.


if the guy in your link is correct, then I agree
 
2013-06-06 03:22:57 PM  

BafflerMeal: pseudoscience: skullkrusher: KiltedBastich: skullkrusher: Serious Black: UNOS, the United Network for Organ Sharing, last revised the rule in 2010. What's changed since then that pediatric cases can handle adult lungs? What's change that makes having two separate lists for organs irrelevant?

I don't know. IANAD. I am going by the information I have and discussing the ethical issues about her bumping someone off the list. Why are there 2 separate lists? Why is age 12 important? Is it based on body size?

Agreed. Furthermore, If it's body size, then why not just say body size instead of setting an arbitrary age limit? Appropriate size of the organs is already a triage consideration. You're never going to get the lungs from a deceased 7 foot basketball player transplated into a sick 3 foot midget, for example.

right. If it is a sizing issue, having an arbitrary age seems rather stupid. Based on the brief details in TFA, however, that seems to be the only medical reason for the different lists

It is very likely more than just size:

One of those facts, he says, involves statistics showing children receiving adult lungs or even pieces of the organ have a poor survival rate after surgery.

The real point is that there is medical basis for current policies. If people think those should be changed, that's fine. But leave it up to experts to figure that out, not some judge who knows nothing about it.


Correct answer most of the time.

That being said, the boards are also fallible and the criteria weird sometimes.  Worked with a lot of Lung/Heart transplants over the years, peds and adults.  And sometimes the decisions seemed rather capricious.  However keep in mind, it is a *lot* more complicated than a simple sorting list.  Organ implantation criteria is an incredibly complex matrix of physiological and social issues.  It is so complex in fact that one cannot always say that because person A received and organ, person B did not.  Sometimes you can have a perfectly viabl ...

For anyone interested, here is the policy from UNOS:

One key point:

What if my doctors do not agree with my lung allocation score or pediatric priority?
If your transplant physician or surgeon believes that you have exceptional characteristics, and that your needs are not adequately reflected by your lung allocation score, then your transplant center may ask the Lung Review Board to review your situation. Similarly, if a transplant physician or surgeon feels that a lung candidate younger than 12 has a medical condition comparable to Priority 1, but does not meet one of the criterion listed in policy, they may request the Lung Review Board to review the pediatric candidate's situation. The Lung Review Board is a national group of transplant physicians and surgeons who will consider your special circumstances and determine what steps to take.

So there is a medical board that can review your case. I have no knowledge of what happened here, but I suspect the board already reviewed it and the family didn't like their answer. I admit I would probably do the exact same thing if it was my child, but this stepping over the line.
 
2013-06-06 03:23:14 PM  
live with it, libtards. Some die.
 
2013-06-06 03:25:46 PM  

bgilmore5: Truther: 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?

You must be a Republican. You make all your decisions based on emotion. No amount of scientific evidence is necessary. Medical decision must be made purely on whether or not the sick white person is like you. "Teri Schiavo was fully functioning when those judges killed her."


www.steves-digicams.com
Don't move....
 
2013-06-06 03:28:31 PM  

pseudoscience: One key point:

What if my doctors do not agree with my lung allocation score or pediatric priority?
If your transplant physician or surgeon believes that you have exceptional characteristics, and that your needs are not adequately reflected by your lung allocation score, then your transplant center may ask the Lung Review Board to review your situation. Similarly, if a transplant physician or surgeon feels that a lung candidate younger than 12 has a medical condition comparable to Priority 1, but does not meet one of the criterion listed in policy, they may request the Lung Review Board to review the pediatric candidate's situation. The Lung Review Board is a national group of transplant physicians and surgeons who will consider your special circumstances and determine what steps to take.

So there is a medical board that can review your case. I have no knowledge of what happened here, but I suspect the board already reviewed it and the family didn't like their answer. I admit I would probably do the exact same thing if it was my child, but this stepping over the line.


how does one get a position on this board?


cdn.unrealitymag.com
 
2013-06-06 03:30:18 PM  

skullkrusher: pseudoscience: One key point:

What if my doctors do not agree with my lung allocation score or pediatric priority?
If your transplant physician or surgeon believes that you have exceptional characteristics, and that your needs are not adequately reflected by your lung allocation score, then your transplant center may ask the Lung Review Board to review your situation. Similarly, if a transplant physician or surgeon feels that a lung candidate younger than 12 has a medical condition comparable to Priority 1, but does not meet one of the criterion listed in policy, they may request the Lung Review Board to review the pediatric candidate's situation. The Lung Review Board is a national group of transplant physicians and surgeons who will consider your special circumstances and determine what steps to take.

So there is a medical board that can review your case. I have no knowledge of what happened here, but I suspect the board already reviewed it and the family didn't like their answer. I admit I would probably do the exact same thing if it was my child, but this stepping over the line.

how does one get a position on this board?

[cdn.unrealitymag.com image 540x810]


Are you insinuating she is an expert on lungs?
 
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