[This is the final part of “Wholly Pro-Life”, a 6-part series on what a consistent pro-life ethic requires across the full span of human life and condition.]

Sixteen Weeks Old

Zion Sarmiento was sixteen weeks old when he died. He had Down syndrome and a heart defect that a transplant could likely have repaired. He never received one. His case became part of the reason a U.S. senator introduced federal legislation this year aimed at a problem most Americans assume the law already solved decades ago.^[1] It did not: the Americans with Disabilities Act has banned disability-based discrimination in healthcare since 1990. Zion died in 2021, thirty-one years into a law written specifically to prevent what happened to him. Nobody involved in his case had to announce that his life mattered less because of his diagnosis. The decision simply got made, the way this kind of decision usually gets made, without anyone having to say the quiet part out loud.

This series has spent five installments testing one claim against five different places it gets costly to hold: that every human being carries God’s image without qualification, at every stage and in every condition. This final installment tests it against a case that offers nothing to argue with, no complicating medical detail to hide behind. A baby with a treatable heart defect either counts, or the whole claim was never really unqualified to begin with.

What This Article Is Not Arguing

Genuine medical contraindications to transplant are real, and this article is not arguing against them. A body that cannot survive the surgery, or that lacks the physiology to benefit from a donor organ, presents a real clinical judgment that has nothing to do with discrimination. Doctors have to make hard calls about who a transplant will actually help, and organs are scarce enough that those calls carry real weight. Nothing here argues that every patient who wants an organ should receive one regardless of medical suitability, or that transplant medicine should stop weighing genuine risk factors.

What this article is examining is narrower and different: criteria that assess a patient’s perceived capacity for independence rather than their medical suitability for the procedure itself. A committee asking whether a patient can “independently comply” with a strict post-transplant medication schedule is not asking a medical question about whether the organ will function in that body. It is asking a social one, about how much support a life is allowed to need before it stops being worth extending. A patient with a devoted family able to manage medication and appointments on his behalf can fail this test anyway, simply because the test was never really measuring what it claimed to measure.

Collapsing that distinction either direction gets the article wrong: read as opposing medical judgment altogether, it argues something it does not mean to argue, and read as accepting every rejection labeled clinical as therefore legitimate, it misses exactly the pattern the rest of this piece documents.

Organ Transplant Discrimination, Three Decades Old

Sandra Jensen was the first widely documented case. In 1995, two hospitals denied her a heart-lung transplant for a single stated reason: she had Down syndrome. She had no other disqualifying condition. Public advocacy eventually reversed the decision, and she received the transplant, living for two more years before dying of unrelated causes. At the time, this looked like it might be an isolated failure, corrected once enough attention was paid to it. However, twenty-six years later, Zion Sarmiento’s case shows the same failure surviving three decades of federal law explicitly written to prevent it. Between those two dates sits a third documented instance: in 2019, HHS’s Office for Civil Rights resolved a complaint against a hospital system where a doctor had allegedly determined a patient was not a good heart transplant candidate specifically because of an intellectual disability and the fact that she did not live independently – the same “independence” standard this article keeps returning to, applied plainly enough that federal civil rights investigators intervened.

And the pattern is not limited to dramatic individual cases that happen to draw public attention. A 2023 nationwide study of Medicare records found that adults with intellectual and developmental disabilities were 54 percent less likely to even be evaluated for a kidney transplant, and 62 percent less likely to actually receive one, than patients without those disabilities, despite achieving equivalent outcomes on the occasions they were transplanted.^[2] The gap was not explained by anything about how their bodies would respond to a donor organ, since the outcomes were the same once the transplant occurred. It was explained entirely by how these patients were assessed before anyone got that far – filtered out earlier in the process, on grounds that had nothing to do with whether the surgery would work.

Lead researcher Brittany Hand put the finding plainly: intellectual and developmental disability should not categorically disqualify adults from transplants, and despite existing protections like the ADA, people with these disabilities continue to face discrimination in the transplant process. HHS issued regulations as recently as last year stating explicitly that disability bias has no place in transplant decisions – a federal agency having to restate, in 2025, a principle a 1990 law was already supposed to have settled. Congress is moving bipartisan legislation right now, the Charlotte Woodward Organ Transplant Discrimination Prevention Act, named for a woman with Down syndrome who did receive a transplant, specifically because the law already on the books has not been enough to stop this pattern of organ transplant discrimination. A second law would not be necessary if the first one had actually worked.

The Logic Inverted

The mechanism behind this pattern rarely takes the form of a stated policy. Nobody writes a rule declaring a disabled life worth less. Instead, transplant committees rely on “psychosocial criteria,” individualized-sounding standards that one legal scholar has described as functioning as a facially neutral disguise for social worth determinations.^[3] The label sounds clinical enough to pass without objection: an assessment of support systems, of a patient’s ability to manage a complex post-transplant regimen, of whether they can advocate for their own care. No committee member has to hold a conscious belief that a disabled patient matters less. The criterion does that work on its own, filtering for self-sufficiency under the cover of clinical neutrality, and everyone involved can walk away having applied a standard rather than made a judgment.

Consider what this actually inverts. A patient, by definition, is someone whose body cannot fully sustain or heal itself. Needing support is not a disqualifying trait in medicine; instead, it is the entire premise of being a patient at all. No one is denied treatment for a broken leg because they will need a cast changed by someone else, or denied chemotherapy because they will need help getting to appointments. Yet in this one judgment, needing support becomes the disqualifier rather than the reason for care, and the more a person’s daily life requires the involvement of others, the less their continued life is treated as having a claim on scarce medical resources. The logic runs backward from how medicine treats need everywhere else it appears.

This series has found the same mechanism in different clothing at every turn: a legal process gave one party’s interest a courtroom while leaving another’s voice structurally unrepresented, a sorting system let a category decide who counted as trying hard enough to deserve help so no caseworker ever had to make that judgment out loud, a safeguard built to prove a choice was genuinely free excluded people whose bodies could not perform the proof it demanded, and a belief operated quietly enough that the people who held it never felt like they had done anything resembling hatred. Here the false measure is independence itself, dressed in language borrowed from clinical judgment rather than law, economics, or biology, but doing exactly the same work: deciding in advance whose claim on a shared good gets heard, without anyone having to say so out loud, and without anyone administering the criterion having to feel like they decided anything at all.

Weakness Honored, Not Excluded

Instead of softening this logic, Scripture reverses it outright. Paul asked God three times to remove a weakness he found humiliating, a thorn in the flesh he never names precisely enough for later readers to identify, and the answer he received was not comfort for having to live with it. It was a direct inversion of the premise behind every psychosocial criterion transplant medicine has ever written: “My grace is sufficient for you, for my power is made perfect in weakness” (2 Cor. 12:9). This does not just mean God’s power can work even when someone is weak. It means weakness itself is where that power becomes most visible.

Paul makes the same claim even more pointedly when he turns to the body as a metaphor for the church, because here the claim is not about spiritual weakness in the abstract but about literal, physical bodies and which of their parts matter most. “The parts of the body that seem to be weaker are indispensable, and on those parts of the body that we think less honorable we bestow the greater honor” (1 Cor. 12:22-23). Paul is not instructing the church to tolerate its weaker members out of duty, the way an institution might accommodate a liability it cannot avoid. He is telling them the weaker parts get the greater honor, a direct reversal of the logic that would sort them out first when resources run short, and an even sharper reversal of the logic that would filter them out of consideration before resources are even allocated.

A transplant system that quietly measures a life’s worth by its capacity for self-sufficiency has this logic exactly backward. Scripture does not say the weaker parts get included despite being weaker, as a grudging exception carved out of an otherwise merit-based system; it says they get honored because of it, more than the parts that need nothing from anyone else. Applied to an actual transplant list, that is not a vague sentiment about compassion. It is a specific claim about where honor belongs when a scarce good has to be allocated: not automatically toward the patient who needs the least help to benefit from it, but without any built-in discount against the patient who needs the most.

The Same Image, Tested to the End

This series began by asking what it actually means to be pro-life, once the phrase stops being a label for one procedure and starts naming a claim about every human life, at every stage and in every condition. Every human being carries God’s image without further qualification, the pillar argued, and the five articles since have tested that one claim against five different places it gets expensive to hold: a courtroom built for one party and not another, a sorting mechanism that quietly decides who deserves help, a safeguard that excludes the very freedom it was built to protect, a belief that discounts a person’s own report of their suffering, and now, in this final installment, a body whose life gets measured by how much it can do without help from anyone else.

Zion’s case carried none of the complicating factors the previous articles in this series identified: no contested medical judgment, no question of anyone’s own wishes (since an infant cannot express a preference either way), and no ambiguity about intent for a careful reader to exploit. Zion Sarmiento could offer nothing in exchange for the transplant that might have saved him: no independence, no self-sufficiency, no capacity to comply with anything on his own, no future economic contribution anyone could point to as a reason to invest in his survival. If the image of God in a person depended even slightly on what that person could offer back, his case is exactly where that claim would finally break, but it doesn’t, and his claim does not.

Zion’s case does not carve out an exception from anything this series has already said. A process that failed to hear a mother’s voice, a system that measured worth by productivity, a safeguard that excluded a genuine choice, a belief that discounted a person’s own testimony – each of these failures assumed, in its own way, that dignity has to be earned, argued for, or demonstrated before it counts. Zion could do none of that. He could not advocate, produce, choose, or report anything on his own behalf, and the claim holds anyway: he was made in the image of God as fully as anyone this series has discussed, without having done a single thing to deserve it. Worth was given, at every stage, including the one that can offer nothing back, and it remains given regardless of who notices.

Questions for Reflection

• Where in your own life or church have you assumed independence is a prerequisite for full belonging?
• How does “power made perfect in weakness” (2 Cor. 12:9) challenge the way you measure your own worth?
• What would it look like, practically, to honor the weakest members of a community rather than merely tolerate them?
• Which of this series’ five earlier installments has been hardest for you to hold alongside the others, and why?
• If a person’s worth does not depend on what they can offer back, what does that change about how you treat someone who can offer nothing at all?

Prayer Points

• Ask God to reveal any place where you have quietly measured someone’s worth by their capacity for self-sufficiency.
• Pray for families navigating a disabled child’s medical care, that they would encounter honor rather than a hidden cost-benefit calculation.
• Ask the Lord to teach your own church community what it means to give greater honor to its weakest members, not merely inclusion.
• Pray for The Gospel Lens as this series closes, that readers would carry its central claim into every place they are tempted to make an exception.

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[1]Senator Ashley Moody, press release introducing the Charlotte Woodward Organ Transplant Discrimination Prevention Act, https://www.moody.senate.gov/press-releases/senator-ashley-moody-introduces-legislation-to-prevent-discrimination-against-people-with-disabilities-in-organ-transplant-system. Background on Sandra Jensen’s 1995 case from bioethics literature, including “The continuing need to combat disability discrimination in organ transplantation,” ScienceDirect. Accessed August 26, 2026.

[2]Brittany Hand et al., published in JAMA Surgery, https://jamanetwork.com/journals/jamasurgery/fullarticle/2801511. Studied Medicare records for 21,384 adults nationwide with end-stage renal disease (10,692 with intellectual/developmental disabilities) and 1,258 kidney transplant recipients (629 with IDD). Traced via Michelle Diament, Disability Scoop, June 25, 2025, and Shaun Heasley, Disability Scoop, May 16, 2023. Accessed August 26, 2026.

[3]“Recalibrating Transplant Eligibility Criteria: Ensuring Equitable Access to Organ Transplantation for Intellectually Disabled Persons,” American Journal of Law & Medicine, Cambridge Core. Accessed August 26, 2026.