6/06/2013

The Danger of the Cute Factor

Sometimes Michael and I watch "America's Funniest Home Videos." We have a running joke that no matter what videos get chosen as finalists if one has a kid it will win. In fact, it will win even if it's not actually very funny. People just automatically feel predisposed toward cute kids.

That's what's so dangerous about Judge Michael Baylson's decisions in the case of two children awaiting lung transplants. Baylson has decided that the "cute factor" trumps actual medical facts. The two children are desperately in need of lung transplants but there are no pediatric lungs available at the moment. Thus Baylson has ordered that the children be bumped to the top of the adult waiting list.

This is very troubling. Until yesterday afternoon transplant list priority was decided strictly on medical terms. The best match for the patient who needed the organ most. Today we have a new paradigm: The cutest or most sympathetic patient regardless of match or projected outcome.

The 10 year success rates of pediatric lung transplants is about 30% at 15 years that drops off to around 20%. While more children receive lung transplants today the outcomes have not significantly improved. In short, pediatric transplants are not always "life saving" they are more likely to be "life extending."  (source)

Jumping the line based on non-medical criteria such as age or the fact that the recipient is a child may prove to be not only dangerous for the child who may not survive a transplant with a too large lung, but also damaging to the idea of the transplant process being blind to social status.

Over the years speaking about donation I've encountered many people who think that transplant recipients are chosen because of their social status. High profile transplants like Steve Jobs underscore this misconception because of the media coverage involved. When I was told I would need a transplant I also had this mistaken idea. Being a gay man I thought I would be passed over for transplant simply because I would not seem as "socially valuable" as someone with children or because of social prejudice against gay people in general. I was thrilled to learn that none of that goes into the mix. There was no litmus test for who was more valuable to society or who was an insider or outsider. It was strictly based on medical need. This is the way it should be.

With the judiciary now getting involved in the process we are opening a Pandora's box where medical need may take second place to perceptions of value or cuteness. If a lung is available who does it go to? A cute 7 year old who might live another year or two with it or a 50 year old who may be able to live out the rest of her life with it? With Judge Baylson's rulings we now have the answer: whoever can garner the most public sympathy and win the popularity contest.

What people who cheer this ruling do not take into consideration is that there could well be a child who is 12 or 13 (the point at which they move to the adult list) who may be denied a transplant that could give them a better outcome because of a capricious legal ruling. The sad fact of organ transplantation is that for every organ transplanted someone else on the waiting list may well die before another organ is available. It's not just little Sarah who is dying it is thousands of men, women, boys and girls. Being able to jump the line with the help of a judge means that someone else will likely die instead.

That is why those who are petitioning and calling on this child's behalf would do better to be out in the streets talking about donation, signing up donors and making sure that as many people as possible sign up to be organ donors and are aware that allowing their children to be donors if the horrible happens can save the life of someone like Sarah.

If you think this is an isolated "one off" type of ruling, today proved you wrong. Another family of a pediatric patient filed suit and received a court order to go to the head of the class. Let the flood gates open. If you need an organ and can get the right amount of public support you too may file a lawsuit to jump the line - no matter whether the transplant will better your chances of living or not. Dangerous precedents indeed.

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