Organ transplantation: Special consideration for kids
By Dorothy L. Tengler

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Nearly 120,000 men, women and children currently need life-saving organ transplants. Every 10 minutes another name is added to the national organ transplant waiting list. As of March, 1,760 of these patients were pediatric. But just how long do children have to wait, and how is the process different for them than for adults?

INDUSTRY PULSE

Do you think the current lung transplant system amounts to age discrimination?
  • 1. Yes
  • 2. No

It all depends. For example, few children die and donate organs each year, so few pediatric lungs become available. Only 20 lungs were donated from children under age 12 years in 2012 compared to 1,500 from adults.

The Organ Procurement and Transplantation Network (OPTN) treats children under age 12 years as a separate pool from adolescents and adults because it is hard to fit a larger lung in the chest of a child. But there are very few pediatric lungs available for transplantation. Not only that, the rules for children to gain access to adult lungs are tight, and the grounds for doctors and patients to seek an exception are limited.

In 2008, Dr. Joe Brierley, a consultant pediatric intensivist at Great Ormond Street Hospital in the United Kingdom teamed up with Dr. Vic Larcher, consultant in general pediatrics and ethics, to review the discrepancies between and within European countries. Their review drew on the United States, Australia and Canada and evaluated the legal, ethical and cultural barriers surrounding organ transplants for children. They found that incompatible organ size and relatively low donation rates meant that children often die before organs become available.

Here in the U.S., new ethical questions have been raised, surrounding the recent lung transplantation case of a 10-year old girl from Pennsylvania. Although Sarah Murnaghan worked her way up the donor list for children, the lungs she need were still not available 18 months later. Under OPTN's Policy 3.7.6, a child in need of organs is given a priority code of 1 or 2, depending on age and illness severity, and although those under age 12 are given a priority code for pediatric lungs, they are ineligible for adult lungs.

Once Murnaghan's parents challenged the under-12 policy, a district court judge ruled in favor of the family, temporarily suspending the age factor in transplant rules for 10 days. Murnaghan underwent double lung transplants in June and was finally discharged from the hospital Aug. 27.

Murnaghan's case may affect other children near death as the judge also ordered U.S. Health Secretary Kathleen Sebelius to review the issue of how organs were allocated. The executive committee of OPTN then met to consider whether children under 12 were being treated unfairly — whether these children should be considered for adult lungs ahead of adults who were in less dire need.

The panel voted to allow transplant centers to request priority status for children under 12 on a case-by-case basis, enabling the children to vie for lungs from older donors based on need.

"This does not grant any patient access to the adult allocation tier," said Dr. Stuart Sweet, secretary of the executive committee and director of the pediatric lung transplant program at St. Louis Children's hospital. "It simply allows the transplant team treating the patient to petition the OPTN's review board."

It's a start.

Dorothy L. Tengler, MA, is a freelance medical writer/communication specialist with nearly 20 years of experience in the pharmaceutical and medical communication industries. She has developed educational and medical marketing materials, including monographs, slide kits, health articles, primary and review manuscripts, and pharmaceutical sales training materials.