Turning Wrong Into Right: The 2013 Lung Allocation Controversy

Insufficient supply prevents many Americans from receiv-ing health care services they might benefit from. Some-times, as in the case of transplantable organs, both the processes and outcomes of allocating limited resources are highly visible. In other contexts, allocation proceeds more opaquely, as when physicians discharge patients from in-tensive care units to open beds for other patients (1). The ethics of both rule-based and “bedside ” rationing hinge on how well each process promotes fairness, maximizes bene-fit, and gives priority to patients who are the worst off. Unfortunately, inevitable tensions arise when trying to bal-ance equity, efficiency, and priority. Consequently, some people will feel mistreated. Such perceived mistreatment fueled recent controversy surrounding Sarah Murnaghan, a 10-year-old girl dying of cystic fibrosis at the Children’s Hospital of Philadelphia. As her condition deteriorated, Murnaghan’s family and friends organized an impressive media campaign claiming that a policy preventing Murnaghan from receiving prior-ity for lungs from adult donors discriminated against children. This policy, enacted in 2010 by the Department of Health and Human Services (DHHS) Organ Procurement and Transplantation Network (OPTN), states that chil-dren younger than 12 years receive highest priority for lungs from donors younger than 12, secondary priority (behind adolescents aged 12 to 17 years) for donors aged 12 to 17, and lowest priority for donors 18 years or older. Spurred by the Murnaghans ’ public relations blitz, U.S. Senator Patrick Toomey (R-Pa) (2) and media outlets echoed the claim that this policy discriminated against