Legal Analysis: Murnaghan v. U.S. Department of Health & Human Services

Business Disputes: It’s What We Do

Overview of the Case

Case Citation: Murnaghan v. U.S. Department of Health & Human Services
Key Issue: 10-year-old Sarah Murnaghan, suffering from cystic fibrosis, required a lung transplant. Existing policy prioritized adults and adolescents over children under 12 for adult lung transplants.
Highlights: A landmark case involving organ transplant allocation for children under 12, specifically challenging the “Under 12 Rule.”
Result: The court granted a temporary restraining order, allowing Sarah to be considered for adult lung transplants based on medical severity rather than age.

Sarah Murnaghan was diagnosed with cystic fibrosis at 18 months old. In May 2013, her condition had severely deteriorated, and she was in urgent need of a lung transplant. The existing policy from the Organ Procurement and Transplantation Network (OPTN), overseen by the U.S. Department of Health & Human Services (HHS), prevented her from being eligible for adult lungs due to her age.

Discrimination based on age: The “Under 12 Rule” was seen as discriminatory against children under the age of 12.
Equity in organ allocation: The National Organ Transplant Act (NOTA) mandates equitable organ allocation, which the plaintiffs argued was not being upheld.
Constitutional rights: The plaintiffs claimed that the “Under 12 Rule” violated Sarah’s constitutional rights to due process and equal protection.

Plaintiffs: Argued that the policy was arbitrary, capricious, and an abuse of discretion. They sought an emergency temporary restraining order (TRO) to prevent the application of the “Under 12 Rule” to Sarah.
Defendant: The government’s approach was more procedural, focusing on the established rules and guidelines of the OPTN. HHS Secretary Kathleen Sebelius declined to intervene directly but asked for the policy to be reviewed.

The court granted the emergency TRO, requiring the OPTN to immediately cease the application of the “Under 12 Rule” as to Sarah Murnaghan, allowing her to be considered on equal medical severity grounds as persons over 12. Subsequently, a similar order was granted for another child, Javier Acosta.

The court found the application of the “Under 12 Rule” to Sarah to be an abuse of discretion, discriminatory against children, and not serving any purpose due to the small number of children nationally affected by it. The court also likely considered the urgency of Sarah’s situation and the likelihood of her death without a transplant.

The case prompted a national debate on organ allocation policies and the ethical considerations involved. It led to an emergency meeting of the OPTN to review the policy and the creation of an appeals board to handle similar cases. The case highlighted the complexities of organ donation systems and the need to balance policy with individual medical emergencies.